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Abstract
bnormalities of immune system, especially in T-cell 10 percent of children with congenital or acquired immunodeficiency develop NHL. Malignancy is the second most common mediated immunodeficiency, pose an increased risk for the development lymphoma. As many as cause of death, and NHL is the most common cancer.
We screened for T cell immune defects 62 infants and children with newly diagnosed lymphoid malignancy including non hodgkins lymphoma (NHL), Hodgkins disease (HD) and acute lymphoblastic leukemia (ALL) in order to consider the possibility of PID as a risk factor of lymphoid malignancy through a cross sectional study.
They were enrolled from the Children’s Hospital of Ain Shams University and National Cancer Institute, Pediatric oncology department, along 9 months (from June 2008 to February 2009) after fulfilling our inclusion criteria. The patients were subjected to history taking, clinical evaluation and an immune deficiency related (IDR) score was used to verify infection rate prior to the diagnosis of their malignacy. An IDR score of 6 or more is considered as the threshold indicating a significant number of illnesses, while an IDR score of 8 or greater is supposed to have positive predictive value of having immunodeficiency. Laboratory evaluation was performed in 32 patients prior to start of chemotherapy. It included a complete blood picture followed by immunological evaluation by counting peripheral lymphocyte subsets (CD3, CD4, CD8, CD4/CD8 ratio) done by flow-cytometry.
The study revealed that HD showed higher number of patients with low CD3 and CD8 levels compared to NHL and ALL where low CD3 level was in 66.7% of HD patients compared to 12.5% of NHL patients and 40% of ALL patients; low CD4 level in 50% of HD patients compared to 18% of NHL patients and 40% of ALL patients and low CD8 level was in 66.7% of HD patients compared to 12.5% of NHL patients and 20% of ALL patients respectively. In addition there was loss of normal correlation between the age of our patients and T-cell subsets representing probable immune dysregulation.
We assessed the patients at two IDR score 6, 8. Group Ι with IDR score ≤ 8: patients with HD, NHL and ALL were (33. 3%), (18. 8%) and (20%) respectively, while at IDR score ≤ 6: patients with HD, NHL and ALL were (33. 3%), (31. 3%) and (20%) respectively with no statistical significant difference . However four studied patients with IDR score ≤ 8 (range 9-18) proved to have T cell subset defect and were diagnosed as congenital immunodeficiency :3 patients with AT and one patient had leucocytes adhesion defect. The AT patients were diagnosed after the diagnosis of their malignancy.