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Abstract
Angiogenesis is the most fundamental step in tumor occurrence and progression and VEGF plays an important role in the pathophysiology of hematological malignancies and progression of NHL. The current study aimed to assess immunocyochemical expression of VEGF in bone marrow biopsies of stage IV NHL and if there is a correlation exist between VEGF score and aggressiveness of NHL, clinical status and laboratory findings. The study was performed on 33 patients of NHL, 28 patients of NHL with bone marrow infiltration categorized as follow: 8 patients with low grade NHL, 11 patients with aggressive NHL and 9 patients with very aggressive NHL and 5 patients of NHL with free bone marrow biopsy from infiltration as a control group. All patients were subjected to: clinical examination and laboratory investigations including complete blood picture, liver function tests, kidney function tests, serum lactate dehydrogenase, B2 microglobulin, bone marrow biopsy for: histological classification according to WHO, staging of NHL and immunocytochemical staining for expression of VEGF. The study revealed that there was lack of expression of VEGF in cases of NHL with free bone marrow biopsies while it was expressed in all cases of NHL with bone marrow infiltration with different degrees of positivity with high score among patients of very aggressive and aggressive NHL and low score among patients with indolent lymphoma. So there was statistically significant relationship between VEGF expression and aggressiveness of NHL, also there was statistically significant relationship between VEGF expression and patients clinical and laboratory findings as LDH, B2M and IPI score. In summary, with our small groups of patients we found prominent expression of VEGF in lymphoma cells associated with higher tumor grading and progression of NHL. These data show that VEGF may have clinical relevance and important role as prognostic predictor for aggressive NHL and the Lymphoma cells in high grade lymphoma that express stranger VEGF staining may be good targets for antiangiogenic therapy. However the effectiveness of this predictor remains to be confirmed by large. Scale prospective studies. To show the prognostic significance of prominent VEGF expression. As immunocytochenical expression of VEGF not detected routinely and not incorporated in to prognostic scoring systems. It is possible that they will be included when antiangiogenic treatment gains a place in the treatment of NHL and then easily measurable markers of angiogenic activity will be necessary.