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Abstract
Acute myelogenous leukemia is a heterogenous group of genetically defined diseases.
It is the most common type of acute leukemia among adults, comprising approximately 80 to 85% of cases of acute leukemia diagnosed in individuals greater than 20 years of age.
So far, the karyotype of the AML blasts is the most important independent prognostic factor.
Fas (CD95) a 45 KD type -1 membrane death receptor protien was found to be expressed by anticancer drugs at the surface of treated cells,thereby increasing tumour cells response to Fas-mediated apoptotic signals
This study aimed to investigate the biological characteristics of AML in eldery by cytogentic analysis, and by studying the Fas gene expression of pretreatment samples and to determine if these characteristics might be useful in providing insight the overall poor therapeutic response of AML in these cases.
Twenty patients with de novo acute myeloid leukemia were included in our study. All patients were subjected to complete medical history, and thorough Physical examination, Routine laboratory investigations, Cytogenetic analysis using G banding technique and estimation of Fas/Apo-1 expression in AML blast cells by flowcytometry.
Patients were classified according to their cytogenetic abnormalities into one of the three groups, the favorable group includes 3 patients(15%) , the Intermediate group include 12 patient (60%) and the unfavorable include 5 patients (25%) .
All patients were treated with (3+7) protocol of induction chemotherapy (Adriamycin 25 mg/m2 intravenous daily from day 1-3, Cytarabine 100mg/m2 continuous intravenous infusion daily from day 1-7).
Follow up for the therapeutic response was done by CBC, BM aspirate study and clinical features of response.
CONCLUSION
Complete response was observed in 9 patients (45%), No response was observed in 11 patients (55%).
2 patients (66.7%) out of 3 patients with favorable cytogenetic abnormalities achieve Complete response.
6 patients (50%) out of 12 patients with intermediate cytogenetic abnormalities achieve Complete response.
1 patient (20%) out of 5 patients with unfavorable cytogenetic abnormalities achieves Complete response.
There was no statistical significant association between gender, BM blasts, cytogenetic abnormalities and response.
There was no statistically significant association between gender, BM blasts, age and cytogenetic findings.
There was a statistically significant association between BM blasts, cytogenetic abnormalities, and response to treatment and Fas expression.
There was no statistical significant association between gender and Fas expression
RECOMMENDATION
Cytogenetic analysis must be done to all patients with AML as it
helps in prediction of the response to standard induction
Further studies of the role of cytogenetic abnormalities in AML in a larger number of patients and how we can get benefit from it in achieving response.
Further studies of the Fas expression and function in a larger number of patients to insight us to its role in drug induced apoptosis and AML.