Akut Lenfoblastik Lösemide Flow Sitometri ile İmmünofenotiplemenin Prognoz Üzerine Etkileri

Yıl 2021, Cilt: 11 Sayı: 1, 22 - 28, 30.01.2021

Sultan Aydin Köker , Yesim Oymak , Raziye Vergin Dilek İnce , Fearh Genel

https://doi.org/10.16899/jcm.787016

Cited By: 1

Öz

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.

Anahtar Kelimeler

akım sitometrisi, immünofenotipleme, akut lenfoblastik lösemi, çocuk

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

Öz

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.

Anahtar Kelimeler

flow cytometry, immunophenotyping, acute lymphoblastic leukemia, children

Kaynakça

• 1. Lanskowsky P. Leukemias. In: P. Lanzkowsky (ed). Manual of Peadiatric Hematol and Oncol 4th ed. Elsevier Academic Press. San Diego 2005: 415-53.
• 2. Gurney JG, Severson RK, Davis S et al. Incidence of cancer in children in the United States. Sex-, race-, and 1-year age-specific rates by histologic type. Cancer 1995; 75: 2186-95.
• 3. Rowe J.M. Prognostic factors in adult acute lymphoblastic leukaemia. British Journal of Haematology 2010; 150: 389–405.
• 4. Chessells JM, Harrison CJ, Kempski H et al. Clinical features, cytogenetics and outcome in acute lymphoblastic and myeloid leukemia of infancy: report from MRC Childhood, Leukemia working party. Leukemia 2002; 16: 776-84.
• 5. Silverman, L.B. Childhood Acute Lymphoblastic Leukemia: Currently Applied Prognostic Factors, International society of pediatric oncology 2010; 18-24.
• 6. Coustan-Smith E, Sancho J, Hancock ML et al. Clinical importance of minimal residual disease in childhood acute lymphoblastic leukemia. Blood 2000; 96: 2691-6.
• 7. Bene MC, Castoldi G, Knapp W et al. European Group for the İmmünological Characterization of Leukemia (EGIL): Proposals fort he immünological classification of acute leukemias. Leukemia 1995; 9: 1783-6.
• 8. Owen P. Smith and Ian M. Hann. Clinical features and therapy of lymphoblastic leukemia. Pediatric Hematology, Third Edition Robert J. Arceci, Ian M. Hann, Owen P. (eds). Smith Copyright by Blackwell Publishing Ltd 2006: 450-81.
• 9. Pieters R, Carroll WL. Biology and Treatment of Acute Lymphoblastic Leukemia. Pediatr Clin N Am 2008; 55: 1–20.
• 10. Schrappe M, Reiter A, Zimmermann M et al. Long-term results of four consecutive trials in childhood ALL performed by the ALL-BFM study group from 1981 to 1995: Berlin-Frankfurt-Munster. Leukemia 2000; 14: 2205-22.
• 11. Noronha EP, Marinho HT, Thomaz EB et al. Immünophenotypic characterization of acute leukemia at a public oncology reference center in Maranhão, northeastern Brazil. Sao Paulo Med J 2011; 129: 392-401.
• 12. Schrappe M, Reiter A, Ludwig WD et al. Improved outcome in childhood acute lymphoblastic leukemia despite reduced use of anthracyclines and cranial radiotherapy: results of trial ALL-BFM 90. German-Austrian-Swiss ALL-BFM Study Group. Blood 2000; 95: 3310-22.
• 13. Arceci RJ, Hann IM, Smith OP. Clinical features and therapy of lymphoblastic leukemia. In Arceci RJ, Hann IM, Smith OP (eds). Pediatric Hematology. 3th ed Malden, Massechusetts Blackwell, 2006: 450-81.
• 14. Pui C-H, Evans WE. Treatment of acute lymphoblastic leukemia. N Engl J Med 2006; 354: 166-78.
• 15. Rego EM, Garcia AB, Viana SR et al. Characterization of acute lymphoblastic leukemia subtypes in Brazilian patients. Leuk Res 1996; 20: 349-55.
• 16. Dalia A, Salem Sherin M, Abd El-Aziz. Flow cytometric İmmünophenotypic Profile of Acute Leukemia: Mansoura Experience; Indian J Hematol Blood Transfus 2012; 28: 89–96.
• 17. Uckun FM, Sensel MG, Sun L et al. Biology and treatment of children T lineage acute lymphoblastic leukaemia. Blood 1998; 91: 735–46.
• 18. Aric M, Schrappe M, Harbott J et al. Prednisone good response (PGR) identifies a subset of t(9;22) childhood acute lymphoblastic leukemia (ALL) at lower risk for early leukemia relapse. Blood 1997; 90: 2494–8.
• 19. Lauten M, Möricke A, Beier R et al. Prediction of outcome by early bone marrow response in childhood acute lymphoblastic leukemia treated in the ALL-BFM 95 trial: differential effects in precursor B-cell and T-cell leukemia. Haematologica 2012; 97: 1048–56.
• 20. Möricke A, Reiter A, Zimmermann M et al. German-Austrian-Swiss ALL-BFM Study Group. Risk-adjusted therapy of acute lymphoblastic leukemia can decrease treatment burden and improve survival: treatment results of 2169 unselected pediatric and adolescent patients enrolled in the trial ALL-BFM 95. Blood.2008; 111: 4477-89.
• 21. Uyttebroeck A, Suciu S, Laureys G et al. Treatment of childhood T-cell lymphoblastic lymphoma according to the strategy for acute lymphoblastic leukaemia, without radiotherapy: long term results of the EORTC CLG 58881 trial. Eur J Cancer 2008; 44: 840-6.