الفهرس 
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Abstract
Multiple myeloma is characterized by the proliferation of malignant plasma cells within the bone marrow, which produce an abnormal monoclonal paraprotein and evidence of end organ damage. Multiple myeloma is one of the widespread cancer diseases, as it is the second most common blood cancer, and it is also one of the diseases that is difficult to follow up accurately, especially when trying to know the possibilities of relapse after treatment proactively, and for this reason, the need for ways to follow up patients with multiple myeloma after treatment emerged proactively. Accurate evaluation of the depth of response to treatment, especially post-treatment with an autologous bone marrow transplant.
CRBN, a 442-amino acid protein with multifunction, locates in the cytoplasm, nucleus, and peripheral membrane of the human brain and other tissues. The diverse roles of CRBN on cell metabolism and disease genesis have been extensively studied.
CRBN has an important role in the regulation of ion transport, modulation of AMP activated protein kinase (AMPK) signaling pathway, and metabolism in cell and whole tissues or organs CRBN is closely related to the proliferation and metabolism of normal cells as well as tumor cells and is responsible for antiproliferative activities of immunomodulatory drugs (IMiDs)
CRBN expression affects cellular metabolism and can lead to several diseases including cardiovascular disease, fatty liver, and neurodegenerative diseases (e.g. Alzheimer’s disease) in the absence of IMiD treatment.
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Aim and methods:
The aim of work of the current study was to measure CRBN in MM patients post autologous stem cell transplantation to determine its prognostic impact, to do correlation with other prognostic factors & to detect its influence on maintenance treatment response
To elucidate this aim twenty Newly diagnosed transplant eligible MM patients (NDMMET) were included in the study. All patients received the same treatment; induction by VCD for 6 cycles (28 days-cycle) until CR/VGPR. All patients underwent assessment of Serum CRBN post ASCT to assess the response and to check for any sign of relapse
MM workup was done to all patients involving bone marrow aspiration and bone marrow biopsy plus serum and urine protein immunofixation with free light chain assay in addition to routine methods for diagnosis. Diagnosis and response evaluation were applied according to the International Multiple Myeloma Working group (IMWG) guidelines.
Results of the study:
This study was carried on 20 patients, the age of the studied patients ranged from 42 to 69, and most of them were males.
CRBN ranged from 2.4 to 3.9 with mean of 3.1. All patients were CMV, HIV, HBV negative and 15% of them had HCV positive
In our study when comparing the CBC results between 3 and 6 months after treatment, there is statistically significant increase in Hb, and Platelet; while the other CBC results showed no statistically significant difference.
When comparing the blood chemistry results between 3 and 6 months, there is statistically significant increase in CRP, and Alb; and there
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is statistically significant decrease in BUN, Creatinine, and Alk; while the other blood chemistry results showed no statistically significant difference.
When comparing the Bone marrow aspirate, flowcytometry and cytogenetics results between 3 and 6 months after treatment, there is statistically significant increase in gamma; and there is statistically significant decrease in M Band, minimal residual disease, and B2 Micro globulin.
CRBN is slightly higher in males than females, but it is not statistically significant.
There is statistically not significant correlation between CRBN and all CBC results after 3 months except for WBCs, Segment %, Monocytes %, and L %
There is statistically not significant correlation between CRBN and all blood chemistry results after 3 months except for GGT, Alb, AST, and Ca