Paranasal Manifestations of Early Stage Chronic Lymphocytic Leukemia

Year 2015, Volume: 16 Issue: 1, 9 - 12, 01.04.2015

Ceren Günel İrfan Yavaşoğlu İbrahim Meteoğlu Ali Toka Nihan Alkış

Abstract

AMAÇ: Kronik lenfositik lösemi (KLL) en yaygın görülen yetişkin lösemi alt grubudur. Ancak paranazal sinüsler ve KLL arasındaki ilişkiyi araştıran az sayıda çalışma rapor edilmiştir. Bu çalışmada KLL’nin paranazal belirtilerini ve KLL hastalarının nazal mukozalarında Nuclear factor-ĸB (NF-kB) ve Tumor necrosis factor (TNF-α) salınımını saptamayı amaçlandı.GEREÇ VE YÖNTEMLER: Bu çalışma 40 hastayı içeren bir klinik çalışma olarak yapılmıştır. Grup KLL (n=20) herhangi bir tedavi almamış hematoloji kliniği tarafından takip edilen erken evre KLL hastalarından oluşturuldu. Kontrol grubu (n=20) burun tıkanıklığı nedeniyle konka cerrahisi geçirmiş hastalardan oluşturuldu. Tüm hastaların paranazal sinus tomografileri çekilip Lund Mackay sistemine gore skorlandı ve sinüzit bulguları kaydedildi. Tüm hastaların alt konka başından alınan biyopsi materyalleri, NF-kB and TNF-α primer antikorları ile immünohistokimyasal olarak boyandı.BULGULAR: İki grup arasında NF-κB (p=0.716) ve TNF-α (p=1.000) boyama skorlarına göre istatistiksel olarak anlamlı farklılık yoktu. Lund-Mackay skoru (p=0.004) kontrol grubuna göre KLLgrubunda anlamlı olarak daha yüksek bulundu. KLL grubunda en yaygın tanı maksiler sinüzit (n=8) iken, 14 hastada farklı lokalizasyonlarda sinüzit bulguları saptandı.SONUÇ: Bu çalışma erken evre KLL hastalarının akut rinosinüzite eğilimli olduğunu göstermektedir. Bununla birlikte, paranazal sinüsleri kapsayan inflamatuvar süreçte NF-kB ve TNF-α bir role sahip olmadığını düşünmekteyiz

Keywords

Kronik lenfositik lösemi, NF-kB, TNF-α, Lund-Mackay skor, rinosinüzit

Erken Evre Kronik Lenfositik Löseminin Paranazal Belirtileri

Abstract

OBJECTIVE: Chronic lymphocytic leukemia (CLL) is the most common adult leukemia. A few studies have been reported about the relationship between CLL and paranasal sinuses. We aimed to investigate the paranasal manifestations of CLL and to determine the expression of nuclear factor-ĸB (NF-kB) and tumor necrosis factor (TNF-α) in the nasal mucosa in patients with CLL. MATERIALS AND METHODS: This study was a clinical trial that involved 40 patients. Group CLL (n=20) consisted of patients with early-stage CLL who were followed-up at the hematology clinic and who did not receive any treatment. The control group (n=20) consisted of patients who had undergone concha surgery because of nasal obstruction. Paranasal sinus computer tomography scans of all patients were taken, they were scored on the basis of the Lund–Mackay system, and sinusitis findings were recorded. The biopsy material taken from the inferior concha head of all patients was immunohistochemically stained with primary antibodies against NF-kB and TNF-α. RESULTS: There were no statistically significant differences between the two groups with respect to NF-κB (p=0.716) and TNF-α staining scores (p=1.000). The Lund–Mackay scores were significantly higher in the CLL group than in the control group (p=0.004). Fourteen patients had sinusitis at different locations, while the most common diagnosis was maxillary sinusitis (n=8) in the CLL group. CONCLUSION: This study showed that patients with early-stage CLL tend to have rhinosinusitis. However, NF-kB and TNF-α may not have a role in the inflammatory process involving the paranasal sinuses in patients with CLL.

Keywords

Chronic lymphocytic leukemia, NF-Κb, TNF-α, Lund–Mackay score, rhinosinusitis

References

• 1. Furman RR, Asgary Z, Mascarenhas JO, Liou HC, Schattner EJ. Modulation of NF-kappa B activity and apoptosis in chronic lymphocytic leukemia B cells. J Immunol 2000; 164: 2200-06. [CrossRef]
• 2. Johnston R, Altman KW, Gartenhaus RB. Chronic lymphocytic leukemia manifesting in the paranasal sinuses. Otolaryngol Head Neck Surg 2002; 127: 582-4. [CrossRef]
• 3. Pagedar NA, Halfdanarson TR, Karnell LH, Hoffman HT, Funk GF. Upper aerodigestive tract cancer in patients with chronic lymphocytic leukemia: incidence, stage, and outcome. Arch Otolaryngol Head Neck Surg 2012; 138: 1171-5. [CrossRef]
• 4. Richmond A. Nf-kappa B, chemokine gene transcription and tumour growth. Nat Rev Immunol 2002; 2: 664-74. [CrossRef]
• 5. Turco MC, Romano MF, Petrella A, Bisogni R, Tassone P, Venuta S. NF-κB/ Rel-mediated regulation of apoptosis in hematologic malignancies and normal hematopoietic progenitors. Leukemia 2004;18:11-7. [CrossRef]
• 6. Gasparini C, Celeghini C, Monasta L, Zauli G. NF-κB pathways in hematological malignancies. Cell Mol Life Sci 2014;71:2083-02. [CrossRef]
• 7. Batikhan H, Gokcan MK, Beder E, Akar N, Ozturk A, Gerceker M. Association of the tumor necrosis factor-alpha -308 G/A polymorphism with nasal polyposis. Eur Arch Otorhinolaryngol 2010;267:903-8. [CrossRef]
• 8. Ohori J, Ushikai M, Sun D, et al. TNF-alpha upregulates VCAM-1 and NF-kappaB in fibroblasts from nasal polyps. Auris Nasus Larynx 2007; 34: 177-83. [CrossRef]
• 9. Wang Z, Zhang Q, Li Y, Li P, Zhang G, Li Y. Involvement of mitogen-activated protein kinases and nuclear factor kappa B pathways in signaling COX-2 expression in chronic rhinosinusitis. Inflamm Res 2009; 58: 649-58. [CrossRef]
• 10. Valencia X, Stephens G, Goldbach-Mansky R, Wilson M, Shevach EM, Lipsky PE. TNF downmodulates the function of human CD4+CD25hi T-regulatory cells. Blood 2006; 108: 253-61. [CrossRef]
• 11. Wang SZ, Ma FM, Zhao JD. Expressions of nuclear factor-kappa B p50 and p65 and their significance in the up-regulation of intercellular cell adhesion molecule-1 mRNA in the nasal mucosa of allergic rhinitis patients. Eur Arch Otorhinolaryngol 2013; 270: 1329-34. [CrossRef]
• 12. Pagedar NA, Halfdanarson TR, Karnell LH, Hoffman HT, Funk GF. Upper aerodigestive tract cancer in patients with chronic lymphocytic leukemia: incidence, stage, and outcome. Arch Otolaryngol Head Neck Surg 2012; 138: 1171-5. [CrossRef]
• 13. Wong RJ, Gliklich RE, Rubin PA, Goodman M. Bilateral nasolacrimal duct obstruction managed with endoscopic techniques. Arch Otolaryng Head Neck Surg 1998; 124: 703-6. [CrossRef]
• 14. Munro S, Brownstein S, Jordan DR, Mcleish W. Nasolacrimal obstruction in two patients with chronic lymphocytic leukemia.Can J Opthalmol 1994; 29: 137-40.
• 15. Lund VJ, Mackay IS. Staging in rhinosinusitis. Rhinology 1993; 31: 183-4.
• 16. Rozman C, Montserrat E. Chronic lymphocytic leukemia. N Engl J Med 1995; 333: 1052-7. [CrossRef]
• 17. Morrison VA. The infectious complications of chronic lymphocytic leukemia. Semin Oncol 1998; 25: 98-106.
• 18. Baldwin AS Jr. The NF-kappa B and I kappa B proteins: new discoveries and insights. Annu Rev Immunol 1996; 14: 649-83. [CrossRef]
• 19. Li Q, Verma IM. NF-kB regulation in the immun system. Nat Rev Immunol 2002; 2: 725-34. [CrossRef]
• 20. Gasparini C, Celeghini C, Monasta L, Zauli G. NF-κB pathways in hematological malignancies. Cell Mol Life Sci 2014; 71: 2083-102. [CrossRef]
• 21. Karosi T, Csomor P, Sziklai I. Tumor necrosis factor-α receptor expression correlates with mucosal changes and biofilm presence in chronic rhinosinusitis with nasal polyposis. Laryngoscope 2012; 122: 504-10. [CrossRef]
• 22. Valera FC, Umezawa K, Brassesco MS, et al. Suppression of inflammatory cytokine secretion by an NF-ĸB inhibitor DHMEQ in nasal polyps fibroblasts. Cell Physiol Biochem 2012; 30: 13-22. [CrossRef]
• 23. Ferrajoli A, Keating MJ, Manshouri T, et al. The clinical significance of tumor necrosis factor-alpha plasma level in patients having chronic lymphocytic leukemia. Blood 2002; 100: 1215-9.