الفهرس 
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Abstract
This study was carried out on 30 adult newly diagnosed patients as acute lymphoblastic leukemia. The aim of study is to investigate the serum level of APRIL in patients with acute lymphoblastic leukemia at diagnosis and after one cycle induction chemotherapy and to correlate with response to induction chemotherapy and with other known well established prognostic factors.
Physiology of a proliferation inducing ligand agent is TNF superfamily implicated in PC survival. APRIL binds to 2 receptors, BCMA and TACI. In addition, APRIL uses HSPGs as co-receptors.
Altered activities of ligands belonging to TNF superfamily, namely: APRIL was demonstrated in acute lymphoblastic leukemia. APRIL provides a crucial survival signal to immature, naive and activated B cells .This ligand is capable of activating a broad spectrum of intracellular signaling cascades that can either induce apoptosis or protect from programmed cell death.
There were 30 patients with Age ranged from 23-58 with mean value 42.3310.92. Males were 14(53.3%) and females were 14(46.7%).
All cases are subjected to through history taking and complete clinical examination. Laboratory investigations (as CBC, serum Uric acid, LDH, serum urea, serum creatinen, as partate aminotransferase, alanine aminotransferase, total and direct bilirubin, bone marrow aspirate or Biopsy, immunophenotyping, …etc.
The studied patients regarding the diagnosis are classified into B-ALL and T- ALL patients. B-ALL patients were 19(63.3%) and T-ALL were 11(36.7%).
Regarding our study the serum APRIL level in Patients group before treatment ranged from 5.02-16.7(ng/ml) with mean value 10.873.1887 and after treatment ranged from 4.48-14.37 with mean value 9.502.69, while in control group ranged from 2.05-3.22 with mean value 2.530.736. There was statistical significant difference between the two studied groups regarding APRIL.
The serum APRIL level in T – ALL patients group after treatment was higher than serum APRIL level in B- ALL group. in T- ALL group before treatment was ranged from 8.to 15.9 ng /ml with mean 10.63 and in B-ALL group before treatment was ranged from 6.15 to 16.7 ng / ml with