الفهرس 
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Abstract
Understanding the immune biology of AML and designing rational approaches to target the immune environment to improve outcomes is an area of intense research in AML.
Inhibitory checkpoints are part of the normal immune system that function to turn off an immune response. Research on the immune microenvironment of AML has revealed that leukemia cells manipulate the immune system by a dynamic process, through which it takes advantage of the normal inhibitory checkpoints, thus resulting in T-cell exhaustion, a process of gradual loss of T-cell function and down regulation of the immune system. This concept may potentially explain immune escape by hematological malignancies
TIM-3 is a type 1cell surface glycoprotein that belongs to TIMs family. TIM-3 is a negative regulatory receptor that plays a vital role in immune suppression in both innate and adaptive immune systems.
TIM-3 and its ligand, Gal-9, are expressed on AML blast and LSCs. The Tim-3/Gal-9 autocrine loop plays a key role in the self-renewal of LSCs and the maintenance of AML.
Previous studies have investigated the prognostic significance of TIM3 in AML, however the results remained controversial. This prompted us to investigate TIM-3 expression in patients with AML and explore the impact of its expression on the clinico-laboratory characteristics and prognostic behavior of denovo-AML patients.
This study was conducted on 45 newly diagnosed AML patients. All patients were subjected to full history taking, thorough clinical examination, CBC, BM aspiration with examination of Leishman-stained smear, cytochemical analysis, flow-cytometric immunophenotyping of BM blasts using acute leukemia panel and cytogenetic analysis.
A total of 45 patients newly diagnosed AML patients were tested for TIM-3 expression by flowcytometry at diagnosis.
In the present study, TIM-3 was found to be highly expressed in AML patients with mean value 85.48 ± 17.51. According to FAB classification in our patients, a significantly higher Tim3 expression in M4-M5 subtypes compared to other FAB subtypes (P < 0.05)was found
In the current study, no statistically significant association was found between TIM3 expression and demographic data, organomegaly and lymphadenopathy. As regards laboratory parameters, a significant negative correlation was found between Tim3 expression and CD34 expressed on blast cells (P=0.019)
Moreover, this work could not prove any association between Tim3 expression and cytogenetic risk stratification of the studied AML patients.
In the light of the previous findings, the prognostic value of TIM3 in AML is not clear and remains to be explored.