الفهرس 
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Abstract
Summary and conclusion
Acute myeloid leukemia is a clonal disorder of haemopoietic stem cells characterized by the inhibition of differentiation and the subsequent accumulation of cells at various stages of incomplete maturation, and by reduced production of healthy haemopoietic elements.
The homeobox transcription factor CDX2 plays an important role in embryonic development and regulates the proliferation and differentiation of intestinal epithelial cells in the adult. CDX2 is expressed in leukemic cells of 90% of patients with acute myeloid leukemia (AML) but not in hematopoietic stem and progenitor cells derived from normal individuals.
The aim of this work was to study the expression of CDX2 mRNA gene expression level in acute myeloid leukemia (AML) patients using Real time reverse transcriptase polymerase chain reaction (RT-PCR) technique aiming to study its correlation to clinical features and laboratory findings at diagnosis and disease progression.
The current study was conducted on 66 Acute Myeloid Leukemia (AML) patients. Twenty age and sex matched healthy individuals with normal laboratory findings were included as a control group.
In the current study, the expression level of CDX2 gene was significantly higher in AML patients (19272.9± 75809.3) compared to (3±1.1) in controls. The difference was statistically significant (P- value< 0.001).
We found a positive correlation between CDX2 gene and hepatomegaly. Mean expression level of CDX2 was higher in the 15AML patients (22.7%) with hepatomegaly (55574.6 ± 146607.5) than the 51 (77.3%) patients without hepatomegaly (8595.9 ± 30680.4). The difference was highly statistically significant (p<0.001).
We also found a positive correlation between CDX2 gene and splenomegaly. Mean expression level of CDX2 was higher in the 15 patients (22.7%) with splenomegaly (55574.6 ± 146607.5) than the 51 (77.3%) patients without splenomegaly (8595.9 ± 30680.4). The difference was highly statistically significant (p<0.001).
Another positive correlation was found between CDX2 gene and Lymph nodes enlargement. Mean expression level of CDX2 was higher in the 7 patients (10.6%) with Lymph nodes enlargement (107526.8± 209782.6) than the 59 patients (89.4%) without Lymph nodes enlargement (8802.1± 28921.9). The difference was highly statistically significant (p<0.001).
In our study, we found that CDX2 gene correlates with follow up of patients as we found lower CDX2 gene expression (1120.6 ± 2564.8) in the 46 patients who achieved complete remission (69.6%) compared to higher CDX2 gene expression (61023.2±130433.1) in the 20 AML patient(30.3%) who didn’t achieve CR. The difference was highly statistically significant (p<0.001).
We didn’t find any correlation between CDX2 gene expression and age (p-value 0.484, r= 0.334), TLC (p-value 0.773, r= 0.532), Hemoglobin level (p-value 0.289, r= -0.190), platelets count (p-value 0.213, r= -0.328), BM blast (p-value 0.792, r= -0.109) or FAB classification (p-value 0.057).
In conclusion:
Our study demonstrated that CDX2 gene expression is associated with AML. Higher levels were found in patients with extramedallary infiltration as hepatomegaly, splenomegaly and lymph nodes enlargement. Higher level of CDX2 expression is associated with bad prognosis as it was higher in patients who didn’t achieve CR than patients who achieved CR. So CDX2 can be used in diagnosis and prognosis of AML patients.