Akut Lenfoblastik Lösemide Flow Sitometri ile İmmünofenotiplemenin Prognoz Üzerine Etkileri

Abstract

Giriş: Akut lenfoblastik löseminin (ALL) tanı ve prognozu için immünofenotip alt gruplarının tanımlanması çok önemlidir. Gereç ve Yöntem: Çalışmaya TR-ALL 2000 (modifiye) BFM tedavi protokolü uygulanan 105 ALL olgu (65 erkek, 40 kadın; ortalama yaş 5.9 ± 3.8 yıl) çalışmaya dahil edildi. Bulgular: EGIL sınıflaması dağılımları pro-B ALL (n = 1), common B ALL (n = 46), pre-B ALL (n = 40), pre-T ALL (n = 8), kortikal T ALL (n = 6) ve matür T ALL (n = 4). T ALL grubunda lökosit ≥100.000 / mm³, lenfadenopati ≥2 cm, mediastinal tutulum yaygın olarak tespit edildi. T ALL, 8.gün periferik kan yaymasında blast sayısı ve 15. gün kemik iliği aspirasyonu (KİA)’ nundaki blast sayısına göre kemoterapiye kötü yanıt gösterdiği saptandı. Tedavinin indüksiyon döneminde nüks, mortalite ve ölüm oranı T ALL grubunda sık olarak görüldü. Tek değişkenli analizle gösterilen prognostik potansiyele sahip olan değişkenler tanı anında lökosit sayısı, hepatomegali, splenomegali ve lenfadenopati, 8. gün steroid yanıtı, 15. gün KİA yanıtı, risk grubu, nüks ve immünofenotip idi. Çok değişkenli Cox regresyon analizinde ise sadece lökosit sayısının (HR 2.51, p <0.001) prognozu önemli derecede etkilediğini göstermiştir. Sonuç: İmmünofenotipleme ALL'nin tanı ve prognozunda, risk gruplarının tanımlanmasında ve riske baglı tedavi planlamasında etkili olabilir. T ALL tanısı alan hastalarda prognozun kötü olacağı gösterildi.

Keywords

• akım sitometrisi
• immünofenotipleme
• akut lenfoblastik lösemi
• çocuk

The Effects of Immunophenotyping with Flow Cytometry on Prognosis in Acute Lymphoblastic Leukemia

Abstract

Background: The identification of immunophenotype subgroups is very important for the diagnosis and prognosis of acute lymphoblastic leukemia(ALL). Material and Methods: The study included 105 children with ALL(65 males, 40 females; mean age 5.9±3.8 years) who were treated TR-ALL 2000(modified) BFM treatment protocol. Results: The distributions of EGIL classification were pro-B ALL(n=1), common B ALL(n=46), pre-B ALL(n=40), pre-T ALL(n=8), cortical T ALL(n=6), and mature T ALL(n=4). Leukocyte≥100,000/mm³, lymphadenopathy≥2 cm, mediastinal involvement were commonly identified in T ALL group. T ALL had a poor response to chemotherapy according to 8th-day peripheral circulation blast counts and 15th-day bone marrow aspiration(BMA) blast counts. The recurrence, mortality, and death rate in the induction period of treatment were frequently detected in T ALL group. The variables that had prognostic potential, as indicated by univariate analyses, were leukocyte count, hepatomegaly, splenomegaly, and lymphadenopathy at the time of diagnosis, 8th-day steroid response, 15th-day BMA response, risk group, recurrence, and immunophenotyping. Multivariate Cox regression analysis demonstrated that only the leukocyte count(HR 2.51, p < 0.001) was a predictor of prognosis. Conclusion: Immunophenotyping may be effective in the diagnosis and prognosis of ALL, identification of risk groups, and in risk-based treatment planning. T ALL had a poor prognosis.

Keywords

• flow cytometry
• immunophenotyping
• acute lymphoblastic leukemia
• children

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