الفهرس 
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Abstract
Chronic lymphocytic leukemia is a leukemia of small mature B cells (CLL), is considered traditionally a disease of elderly patients with generally long survival rate and highly variable duration and outcome.
There are multiple clinical and laboratory prognostic factors affecting the clinical course of CLL. Among the laboratory prognostic factors, the ZAP-70 expression which is the surrogate marker of IgVH mutational status was found to be associated with poor outcome in CLL patients.
This study was conducted with an overall aim to evaluate the level of sCD14 and IL-10 in CLL patients and to relate them with the disease characteristics.
Forty newly diagnosed CLL patients were enrolled in this study during the period from Jan.1st, 2014 to Jun. 30th, 2016 with 20 age and sex matched normal volunteers as control.
Patients were physically examined then investigated with CBC, LDH, β2M levels; flow cytometry using chronic panel, where all the included patients had CLL immunophenotypic score of 4 or 5. The ZAP-70 was determined by flow cytometry, while serum sCD14 and IL-10 concentrations were determined by sandwich ELISA method. In addition to determination of the clinical staging and the CLL prognostic index. The control group were investigated by CBC, sCD14 and IL-10.
The percentage of male CLL patients was higher than of female patients (70% vs. 30%) with a mean age of 58.95±7.9 years. About 75.0% of them were diagnosed incidentally during routine blood examination for other reasons. Physical examination showed 97.5% of them with lymphadenopathy, 60% with splenomegaly and 15% with hepatomegaly. Expression of ZAP-70 was negative in 72.5% and positive in 27.5% of them.
ZAP-70 expression showed significant statistical association with Rai staging but not with Binet staging. Positive ZAP-70 expression was associated with significant lower mean Hb concentration and platelets count, but significantly higher mean TLC, ALC, β2-microglobulin, sCD14 and IL-10. About 63.6% of positive ZAP-70 expression was found in high risk patients.
Among CLL patients, the mean serum sCD14 and IL-10 were significantly higher in comparison to the control (7.94 vs. 2.51 µg/ml for sCD14) and (36.09 vs. 6.32 pg/ml for IL-10).
Serum sCD14 and IL-10 showed statistically significant higher levels in relation to advanced Binet and Rai staging of CLL patients as well as high risk CLL prognostic index (p<0.01).
The ROC curve for sCD14 and IL-10 showed a highly significant AUC which denotes that they are sensitive markers in predicting ZAP-70 positivity among CLL patients.
Serum sCD14 level showed statistically significant positive correlation to ZAP-70, IL-10 and significant negative correlation to hemoglobin concentration.
Serum IL-10 level showed statistically significant positive correlation to TLC, ALC and significant negative correlation to hemoglobin concentration and platelets count.
The multiple regression analysis showed serum IL-10 to be more significant predictor for ZAP-70 positivity in patients with CLL.
In this study, serum sCD14 and IL-10 showed high predictive value for ZAP-70 positivity among CLL patients which put them as alternative markers for ZAP-70 expression since their measurement by ELISA is easier.