الفهرس 
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Abstract
Lymphoma is the most common blood cancer. The two main forms of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma (NHL).B-cell lymphomas are much more common than T-cell lymphomas and account for approximately 85% of all NHLs. Among Egyptian patients, NHL is the third common malignancy out of all malignances and it is of high rank among cancers in each sex, where it accounts for 8.4% of estimated incidence.
Diffuse large B-cell lymphoma (DLBCL) is the most common form of NHL, accounting for about 30 % of newly diagnosed cases of NHL in the United States. In Egypt, It represents about 49% of NHL presenting to the National Cancer Institute (NCI), Cairo University.DLBCL occurs in both sexes, although it is slightly more common in men. Although DLBCL can occur in childhood, its incidence generally increases with age, and roughly half of the patients are over the age of 60 years.
DLBCL is an aggressive lymphoma that can arise in lymph nodes or outside of the lymphatic system. Often, the first sign of DLBCL is a painless, rapid swelling that is caused by enlarged lymph nodes. For some patients, the swelling may be painful with appearing of compression symptoms.
There are multiple clinical and laboratory prognostic factors affecting the clinical course of DLBCL.Among the laboratory prognostic factors, MYCprotein expressionwas found to be associated with poor outcome in DLBCL patients.
This study was conducted with an overall aim to determine MYC protein score in relation to secretor status in patients with DLBCL in order to extrapolate their clinical and prognostic impact.Thirty DLBCLpatients were enrolled in this study during the period from Oct.1st, 2014 to Oct.1st, 2016 with 15 age and sex matched normal subjects as control.The median overall survival for the studied patients was 12 months.
A full medical history was taken from the patients with special stress on the start of symptoms, complaint regarding B symptoms, abdominal pain, bone pain and neurological manifestations and history of treatment received. Thorough clinical examination with special emphasis onwhole body examination for enlarged lymph node, spleen and liver.
Patients were subjected to several investigations including routine laboratory investigations (CBC, liver function tests, kidney function tests and ESR), diagnostic and prognostic laboratory investigations (LMR, Lymph node biopsy for histopathological examination, BMB, β2M and LDH).Lymph node biopsy for histopathological examination was the backbone for diagnoses of our cases and Bone marrow trephine biopsies were done for clinical staging and prognosis.Special laboratory investigations included determination of MYC protein expressionby visualizing the IHC stained slides and determination of MYC score by a pathologist and also by using computerized program MRTALAB to determine IOD by image analysis, while secretor status was determined by interpretation of the resultsof the Lewis blood group phenotypewhich was done by using heamagglutination test. In addition to that, determination of the clinical staging and the DLBCL prognostic index were done.
For the control group, they were investigated by CBC, Liver function tests, Kidney function tests, ESR, LMR,, LDH and secretor status.
DLBCL patients were males more than females (56.7% vs. 43.3%) with a mean age of 57.2±9.9 years. from all the studied clinical finding, only splenomegaly which showed statistically significant difference between the percentage of affected males in compared to females (p>0.005).
Hematological parameters of the studied patients showed that, LMR was significantly lower in patients than in the control group and also was associated with all bad prognostic markers likes’ high β2M, high LDH andpositive MYC protein expression with high scores (>50%).
As regards secretor status, we found that, DLBCL patients who were non secretors manifested all bad prognostic markers including high β2M, high LDH and positive MYC protein expression. They had also lower OS (9.76 months) than those who were secretors. There was a statistically significant difference between non secretor status of the studied patients in relation to positive MYC expression, where p value was 0.011. Also a statistically significant difference was found in relation to IOD where p was 0.0001.
Expression of MYC protein by IHC analysis of lymph node biopsies was negative in 46.7% (14/30 cases) and positive in 53.3% of them (16/30 cases). MYC protein expression in the studied patients showed significant positive correlation to β2M, LDH, IPI and IOD.In addition, there was a significant negative correlation to ALC and LMR.Age, Hb concentration, TLC and platelet count did not show any significant correlation to MYC protein expression.
The IOD of MYC protein expression by image analyzerin the studied DLBCL patients showed significant positive correlation to β2M,and LDH.Significant negative correlation to ALC and LMR were also showed.Age, some hematological markers (Hb concentration, TLC, platelet count) and the remaining serum markers (urea, creatinine, ALT and AST) did not show any significant correlation.There was a statistically significant correlation betweenMYC score by manual and the automated analysis using IOD in which that this correlation between the manual scoring and automated analysis was very high and matched.
The ROC curve for MYC score related to IPI showed that AUC was statistically significantly high (AUC= 0.919, p=0.001) which denotes that MYC score is a sensitive variable in predicting prognosis among DLBCL patients.
To the best of our knowledge, the secretor status of patients with DLBCL has not been elucidated. Our study has shed light on the prognostic value of secretor state in deciding the appropriate therapy strategy underscoring the need for individualized approaches for treating patients.