الفهرس 
Chronic Lymphocytic LeukemiaOnly 14 pages are availabe for public view
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Abstract
Chronic lymphocytic leukemia (CLL) is a heterogeneous disease with
a highly variable clinical course. Some patients have a life expectancy
which resembles that of the age-matched general population, while others
progress and need treatment within a few months of diagnosis.
Several clinical and biological variables, some of which validated in
prospective studies, have been reported to predict the outcome of CLL
patients when assessed at presentation of the leukemia.
Among them, the old-fashioned but still widely used clinical staging
systems initially proposed by Rai and/or Binet, or the more demanding
mutational status of IGHV and fluorescent in situ hybridization are the
hallmarks for discriminating patients with an aggressive or indolent clinical
course. Although the latter methods have been standardized, tests are still
expensive and cannot be provided by all laboratories.
For this reason, the search for new cytofluorimetric markers is still of
great interest, especially after CD38 and ZAP-70 have been shown to have
major limitations, the former because of its low prognostic power and the
latter because of well-recognized technical problems. Recently, ROR1,
CD200 and other markers, such as CD25, CD26 and CD69, have been
advocated as being predictive and reliable in identifying patients with
peculiar molecular characteristics of disease and different prognoses.
ROR1 is expressed in several malignancies with low levels of
expression in normal adult tissue. The tumor selective expression has made
ROR1 a potential target for therapy. Targeting ROR1 is attractive as its
expression has been shown to enhance tumor cell growth and survival and
promote epithelial-mesenchymal transition and metastasis.Summary
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CD200 is an immunoglobulin superfamily membrane glycoprotein
expressed on a variety of hematopoietic and non-hematopoietic cells.
CD200 and its ligand CD200R have an important role in the inhibition of
autoimmunity, inflammation, and adaptive immune responses via induction
of regulatory T cells and effects on cytokine production.
The aim of this study was to explore the expression of CD200 and
ROR1 on B-lymphocytes of chronic lymphocytic leukemia and their
correlation with clinical behavior of the disease.
The current study included 25 patients with newly diagnosed chronic
lymphocytic leukemia and 15 age and gender matched apparently healthy
persons as control group. Patients were selected from the outpatient clinics
of the Clinical Oncology Department and the study was carried out in
Clinical Pathology department, Faculty of Medicine, Menoufia University
in the duration between January 2018 and June 2019.
CLL patients were categorized into 2 subgroups according to the
median of ROR1 % expression. group I included patients with low ROR1
% patients (had ROR1 % expression less than the median), while group II
included high ROR1% patients (had ROR1 % expression equal to or more
than the median).
No statistically significant differences were detected between CLL
and control groups regarding age and gender.
The majority of CLL patients had lymphadenopathy (68.0%).
Hepatomegaly and splenomegaly were observed in (48% and 64% of
patients respectively). Most patients were diagnosed at advanced stage
(60% of patients were stage III and IV as regard Rai staging and 56% of
patients were stage C according to Binet staging).Summary
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All CLL cases were CD200 positive with bright expression. Only 3
CLL cases showed ROR1 expression less than 20% and nearly all cases
showed dim expression of ROR1.
There were statistically significant differences between CLL patients
and controls regarding ROR1% and CD 200%.
There was no statistically significant difference between the low and
high ROR1% expression groups regarding all clinical characteristics.
Statistically significant difference between both groups was observed
regarding Hb and B2 microglobulin levels but no statistically significant
differences were found regarding other laboratory parameters.
Negative correlation was demonstrated between ROR1% and Hb levels
while positive correlation was observed between ROR1% and B2
microglobulin levels.
ROR1% expression in CLL patients who had hepatomegaly was
higher than that of patients with no hepatomegaly. Also, ROR1%
expression in CLL patients who had positive Coombs test was higher than
that of patients with negative coombs test.