الفهرس 
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Abstract
The C-X-C Motif Chemokine 12 (CXCL12) also known as stromal cell-derived factor 1 (SDF1), is a chemokine protein that in humans is encoded by the CXCL12 gene on chromosome 10. It is ubiquitously expressed in many tissues and cell types. Stromal cell- derived factors 1-alpha and 1-beta are small cytokines that belong to the chemokine family, members of which activate leukocytes and are often induced by proinflammatory stimuli such as lipopolysaccharide, tumour necrosis factor (TNF), or interleukin (IL1).
Acute lymphoblastic leukaemia (ALL) is a malignant transformation and proliferation of lymphoid progenitor cells in the bone marrow, blood and extramedullary sites. While 80% of ALL occurs in children, it represents a devastating disease when it occurs in adults. The incidence of ALL follows a bimodal distribution, with the first peak occurring in childhood and a second peak occurring around the age of 50.
While dose-intensification strategies have led to a significant improvement in outcomes for paediatric patients, prognosis for the elderly remains very poor. Despite a high rate of response to induction chemotherapy, only 30–40% of adult patients with ALL will achieve long-term remission.
The main results of the study revealed that:
There is no statistically significant difference between ALL patients and healthy controls as regard the age and sex.
Among our studied population 66.7% have Pre B ALL and 33.3% have T ALL. 46.7% have high risk stratification. Hepatitis C virus was positive in 16.7% of patients. Enlarged LN was detected in 46.7% of patients, HSM was detected in 53.3% and CNS affection was detected in 10% of included patients.
Hemoglobin level of included patients ranged between 4-13 gm/dl with mean value of 8.100 ± 2.660. WBCs ranged between 2 – 560 x103 cell/mm3 with mean value of 94.867 ± 153.264. Platelets count ranged between 13-300 x106/mm3 with mean value of 71.967 ± 61.633. BM aspirate ranged between 45-95 with mean value of 86.200 ± 12.133. Aspirate after induction ranged between 1-90 with mean value of 11.360 ± 24.764.
Among our studied population 73.3% were treated by hypercvad protocol followed by 16.7% were treated by CALGB protocol and 16.7% were treated by dada farber protocol. T (9:20) was positive in 13.3% of included patients.
Among our studied population 13.3% were died during induction. 28% were MRD after induction. Most of our included patients 88% respond to induction.
Among our studied population 17.4% developed relapse. Time in days to relapse ranged between 45-76 days with mean value of 57.250 ± 13.036 days.
Regarding the outcome, mortality rate was 70% among our included patients, the most common cause of death was ARDS in 57.1% followed by sepsis in 26.2% then COVID in 16.7%. The overall survival in days ranged between 5-365 days with mean value of 169.833 ± 146.756 days. Disease free interval ranged between 0-336 days with mean value of 141.932 ± 143.209 days.
Serum CXCL12 level was statistically significant higher in ALL patients than healthy controls and in Type B ALL than T ALL. However, there was no significant association between CXCL12 serum level and the risk stratification or the sex of patients with ALL.
There is no statistically significant difference in serum CXCL12 level in relation to the protocol of ttt, minimal residual disease after induction, response after induction and relapse in patients with ALL.
There is no statistically significant difference in serum CXCL12 level in relation to death during induction, clinical outcome and the cause of death in patients with ALL.
At cutoff value ≥402.5 CXCL12 level has 100% sensitivity and 100% specificity to diagnose ALL.
At cutoff value ≥1435 CXCL12 level has 75% sensitivity and 80% specificity to predict pre B ALL
CXCL12 level has statistically significant negative correlation with hemoglobin level and statistically significant positive correlation with time in days to relapse in patients with ALL.