الفهرس 
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Abstract
High grade Lymphomas are a group of heterogeneous malignant neoplasms of lymphoid tissues derived from clonal expansion of B cells, Natural Killer cells or T cells. This category includes a wide range of subtypes, each with distinct morphological, immunophenotypic, molecular and genetic features. However, they all share a common pattern regarding their rate of growth and proliferative potential.
CD 155 is an onco-immunogenic molecule that is overexpressed on the surface of malignant cells and barely expressed on normal cells. CD 155 is involved in malignant cell proliferation by several mechanisms, including the increased release of VEGF, increased migratory potential of malignant cells and increased proliferation of malignant cells via Cyclin D up-regulation.
Higher levels of sCD 155 in the sera of cancer patients were shown to be directly related to poorer prognosis. This relation is less clear in high grade Non Hodgkin Lymphomas. There is need for new means that serve as prognostic factors that will help improving the treatment decision in each case.
The aim of this study was to assess the prognostic value of high levels of sCD 155 in patients with high grade Non Hodgkin Lymphoma as regards remission rates.
This prospective cohort study included forty patients with newly diagnosed high grade Non Hodgkin Lymphoma, recruited at the Clinical Hematology, Oncology and Bone Marrow Transplantation Department, Internal Medicine Department, Ain Shams University Hospitals, in both inpatient and outpatient settings.
The patients’ group included 20 male patients and 20 female patients, the mean age was 49.28 years. The serum level of soluble CD 155 (sCD 155) was assessed in the patients’ group and was compared to its level in twenty healthy subjects matching the same age and sex as control group. The patients were reevaluated for response after three cycles of chemotherapy.
The types of high grade NHL in the patients’ group were DLBCL (36 patients), leukemic phase of DLBCL (2 patients), cutaneous T cell lymphoma (one patient), and NK cell lymphoma (one patient).
Sixteen patients (40%) presented in stage IV disease, they included 15 patients (37.5%) with bone marrow infiltration upon initial evaluation, whereas one patient had pulmonary infiltration. Eleven patients (27.5%) presented in stage III, 8 patients (20%) in stage II, and 5 patients (12.5%) in stage I.
All patients were subjected to the following at the time of diagnosis after an informed consent:
Full history taking and clinical examination, CBC, kidney function tests, liver function tests, lymph node biopsy and Immunohistochemistry on biopsy, Bone marrow Aspirate and Trephine biopsy with Immunohistochemistry initially for staging, CT scan of neck, chest and pelvi-abdomen with contrast initially for staging, viral markers for HBV, HCV and HIV, assessment of soluble CD 155 (sCD 155) in patients and control group using ELISA (Enzyme-linked immunosorbent assay).
Response was assessed after the patients received 3 cycles of chemotherapy. The patients were reevaluated according to Lugano classification and underwent CT scans and Bone Marrow examination.
We found that the serum level of sCD155 was elevated among patients with high grade NHL at the time of diagnosis, compared to its level in the control group; the difference was statistically significant.
The serum level of sCD155 was high in all the stages of high grade NHL at presentation; sCD155 is incrementally elevated as the stage of the disease is more advanced at presentation.
The mean serum level of sCD155 in patients with bone marrow infiltration at presentation was higher than in patients who presented without bone marrow infiltration.
Among the patients’ group at presentation, 10 patients (25.0%) had HCV infection. The median performance status among the 40 patients was 1.5, with IQR (interquartile range) between 1 and 2.
The median IPI score was 2, with IQR between 2 and 3. There was a significant positive correlation between the levels of sCD155 at presentation with the IPI score.
There was no statistically significant difference between the mean serum levels of sCD155 at presentation and the occurrence of B symptoms, serum LDH level, and associated hepatitis C virus infection.
There was no statistically significant correlation between the mean serum levels of sCD155 at presentation and the performance status, serum LDH level, mean TLC, median ALC or mean hemoglobin at the time of presentation.
The response was assessed after the patients received 3 cycles of chemotherapy, they were reevaluated according to Lugano classification and underwent CT scans and Bone Marrow examination. During therapy, two patients died; they both had high IPI score (>4) and developed sepsis.
The frequency of response showed complete response (CR) in 10 patients (25%) and partial response (PR) in 24 patients (60%). Three patients (7.5%) had stable disease (SD), whereas one patient (2.5%) developed progressive disease (PD). There were two mortality cases, representing 5% of the study population.
There was a statistically significant difference between the mean serum sCD155 levels at presentation and different degrees of response attained after receiving 3 cycles of chemotherapy; the elevation was incrementally in relation to poorer responses.
There was no statistically significant difference between the mean serum sCD155 levels at presentation and the types of high grade NHL, nor the protocols of chemotherapy received.