الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 151 |  |  |
| | | from | 151 | | |
Abstract
C
hronic lymphocytic leukemia (CLL) is one of the most common lymphoid malignancies and is characterized by a variable clinical course. Given the toxicities associated with currently available therapies, being able to predict which patients will need treatment could play a significant role in preserving bone marrow function and reducing morbidity and mortality.
IGVH mutational status, interphase FISH abnormalities, CD38, and ZAP-70 are the four novel prognostic markers that are currently used in clinical practice.
CD49d recently emerged as a negative prognosticator in CLL. It has a role in CLL cell migration and retention in LN and BM microenvironment, where they receive growth -and survival-supporting signals. Additionally, low percentage of smudge cells has been appeared to be related to poor outcome.
In this study, we aimed to evaluate CD49d expression and smudge cells percentage in CLL patients to explore their prognostic impact and potential association with clinical status and other standard prognostic indicators.
To fulfill this aim, the present study was conducted on 30 newly diagnosed B-CLL patients. All patients participating in this study were subjected to full history taking, thorough clinical examination, laboratory investigations (complete blood count (CBC), bone marrow aspiration, flowcytometric Immunophenotyping of BM or PB, flowcytometric assessment of CD49d and FISH analysis).
We reported the expression of CD49d in 40% of our CLL patients and a significant association of CD49d expression with lymphadenopathy, splenomegaly and advanced staging.As regards laboratory parameters an association between CD49d expression and high total leucocytic count was observed
On studying the relationship of CD49d expression on other prognostic indicators, our results confirmed the association between this marker and CD38 expression and short LDT, lower percentage of Smear cell, and the presence of p53 deletions.
In the present study, Low percentage of Smear cell (<30%) showed a significantly higher incidence of lymphadenopathy and organomegaly. Additionally, it was associated with a high total leucocytic count, low platelet count, high atypical lymphocytic count and typical IPT scoring.
When the studied prognostic indicators were related to smear cell percentage, we found that patients with low percentage (<30%) had a significant shorter LDT, positive CD38 expression and CD49d expression and ATM and P53 deletions.
In conclusion, increase CD49d+ expression with low smudge cell percentage were consistently associated with poor prognostic indicators, suggesting that they could be considered as adverse predictors and they should be merged together to improve the power of the prognostic panels of CLL in the clinical setting.