Akut Lenfoblastik Lösemide İmmunfenotipleme ve Klinik ile İlişkisi

Yıl 2019, Cilt: 19 Sayı: 1, 21 - 26, 01.04.2019

Mesut Garipardıç Zeynep Karakaş Rumeysa Tuna Ayşegül Ünüvar

https://doi.org/10.5222/j.child.2019.80775

Öz

Amaç: Akut lenfoblastik lösemi ALL tanılı çocuk hastalarda immunfenotipleme ve klinik özelliklerle ilişkisini değerlendirmek. Yöntem: Merkezimizde 1989-2007 yılları arasında ALL tanısı almış ve tedavi edilmiş olan 18 yaş altındaki 192 hastada akım sitometri ile incelenen immunfenotipleme sonuçlarının klinik özellikler ile ilişkisi değerlendirildi. Bulgular: Vakaların 79’unu %41,1 kız, 113’ünü %58,9 ise erkek hastalar olusturmaktaydı. Vakalar prekürsör-B hücreli ve T hücreli ALL olarak 2 gruba ayrıldı. T hücreli ALL erkeklerin %27.6’sında görülürken, bu oran kızlarda %14,2 idi p=0,038 . Yaş grupları immunfenotiplendirmeye göre değerlendirildiğinde, 1 yaş altında tüm hastalar prekürsör-B ALL grubunda iken, 1-10 yaş arasındaki vakaların %82,9’u prekürsör B ALL, %17,1’i T-ALL’li grubunda, ≥10 yaş üzerindeki vakaların %58,6’sı prekürsör B ALL’li, %41,4’ü T-ALL grubunda idi p: 0.002 . Hiperlökositoz, ekstramedüller tutulum, lenfadenopati ve mediastinel kitle T hücreli ALL grubunda anlamlı olarak daha sık görüldü. T hücreli ALL sıklığının yıllar içinde azaldığı görüldü. Sonuç: Akut lenfoblastik lösemi erkeklerde kız cinsiyete göre daha fazla görülmektedir. Erkek çocuklarda ve 10 yaş üstünde T hücreli ALL sıklığı artmaktadır. Lenfadenomegali, mediastinel kitle, ekstramedüller tutulum ve hiperlökositoz sıklığı, T hücreli ALL grubunda prekürsör B hücreli ALL grubuna göre anlamlı olarak artmaktadır. T hücreli ALL sıklığının yıllar içinde azaldığı bunun sosyoekonomik düzeyde iyileşme ile ilişkili olabileceği düşünülmüştür.

Anahtar Kelimeler

Akut lenfoblastik lösemi, immunfenotip, klinik özellikler

Immunophenotyping and its Association with Clinical Characteristics in Acute Lymphoblastic Leukemia

Öz

Objective: To evaluate the relationship between immunophenotyping and clinical characteristics of children diagnosed with acute lymphoblastic leukemia ALL . Method: The relationship between immunophenotyping results examined by flowcytometry and clinical features of 192 patients under 18 years who were diagnosed with ALL between 1989 and 2007 in our center were evaluated. Results: Of the patients, 79 41,1 % were girls and 113 58,9 % were boys. The cases were divided into two groups as those with precursor-B cell ALL, and precursor T cell ALL groups. Cases of precursor B, and T-ALL were seen in 27,6 % of male, and 14,2 % of female patients p=0,038 Age groups were also evaluated according to age groups. All patients under 1 year of age were in the precursor-B cell ALL group, while 82,9% of the cases between 1 and 10 years were in precursor-B cell ALL group, and 17,1% of them in T cell ALL group. Still 58 % of the cases above ≥10 years of age were in the precursor-B cell ALL group, and 41,4 % were in the T cell ALL group. Hyperleukocytosis, extramedullary involvement, lymphadenopathy and mediastinal mass were significantly more frequent in the T cell ALL group. The frequency of T cell ALL was found to decrease over time. Conclusion: Acute lymphoblastic leukemia is more frequently seen in males when compared with females. The incidence of T cell ALL increases in male children, and those aged over 10 years of age. The frequency of lymphadenomegaly, mediastinel mass, extramedullary involvement and hyperleukocytosis is significantly increases in the T cell ALL group compared to the precursor B-cell ALL group. It is thought that the decrease in the frequency of T cell ALL over the years may be related to the improvement in socio-economic level.

Anahtar Kelimeler

Acute lymphoblastic leukemia, clinical features, immunophenotype

Kaynakça

• 1. Weir EG, Borowitz MJ. Flow cytometry in the diagnosis of acute leukemia. Seminars in Hematology. 2001;38(2):124-38. https://doi.org/10.1016/S0037-1963(01)90046-0
• 2. Linet MS, Ries LA, Smith MA, Tarone RE, Devesa SS. Cancer surveillance series: recent trends in childhood cancer incidence and mortality in the United States. Journal of the National Cancer Institute. 1999; 91(12):1051-8. https://doi.org/10.1093/jnci/91.12.1051
• 3. Lichtenstein P, Holm NV, Verkasalo PK, Iliadou A, Kaprio J, Koskenvuo M, et al. Environmental and heritable factors in the causation of cancer--analyses of cohorts of twins from Sweden, Denmark, and Finland. The New England Journal of Medicine. 2000;343(2):78-85. https://doi.org/10.1056/NEJM200007133430201
• 4. Belson M, Kingsley B, Holmes A. Risk factors for acute leukemia in children: a review. Environmental Health Perspectives. 2007;115(1):138-45. https://doi.org/10.1289/ehp.9023
• 5. Linet MS, Wacholder S, Zahm SH. Interpreting epidemiologic research: lessons from studies of childhood cancer. Pediatrics. 2003;112(1 Pt 2):218-32.
• 6. Lanzkowsky P, Lipton JM, Fish JD. Lanzkowsky’s manual of pediatric hematology and oncology: Academic Press; 2016.
• 7. Pui CH, Behm FG, Singh B, Schell MJ, Williams DL, Rivera GK, et al. Heterogeneity of presenting features and their relation to treatment outcome in 120 children with T-cell acute lymphoblastic leukemia. Blood. 1990;75(1):174-9.
• 8. Nachman J. Clinical characteristics, biologic features and outcome for young adult patients with acute lymphoblastic leukaemia. British Journal of Haematology. 2005;130(2):166-73. https://doi.org/10.1111/j.1365-2141.2005.05544.x
• 9. Uckun FM, Sensel MG, Sun L, Steinherz PG, Trigg ME, Heerema NA, et al. Biology and treatment of childhood T-lineage acute lymphoblastic leukemia. Blood. 1998;91(3):735-46.
• 10. Taskov H, Dimitrova E, Serbinova M, Mendisova L, Bobev D. Immunological subtypes of childhood acute lymphoblastic leukemia in Bulgaria. Leukemia Research. 1995;19(11):877-81. https://doi.org/10.1016/0145-2126(95)00075-5
• 11. Dakka N, Bellaoui H, Khattab M, Brahimi-Horn MC, Aoued L, Bouzid N, et al. Immunologic profile and outcome of childhood acute lymphoblastic leukemia (ALL) in Morocco. Journal of Pediatric Hematology/Oncology. 2007;29(8):574-80. https://doi.org/10.1097/MPH.0b013e3181256b8f