النمط الظاهري المناعي لحالات سرطان الدم الليمفاوي الحاد لدى الأطفال الفلسطينيين من خلال تجربة مركز سرطان واحد في جنوب الضفة الغربية باستخدام جهاز التدفق الخلوي
Date
2016-11-19
Authors
اسامة نبيل غطاس سلامة
Ussama Nabeel Ghattas Salameh
Journal Title
Journal ISSN
Volume Title
Publisher
AL-Quds University
جامعة القدس
جامعة القدس
Abstract
Background: Acute Lymphoblastic Leukemia (ALL) is the most common cancer in children,
represents approximately 75–80% of acute leukemia. Global incidence is about 3-4 cases per
100,000 population under 15 years old. Researches about pediatric ALL in Palestine are limited.
This study provides the immunophenotyping of pediatric ALL patients at a single cancer center
experience in southern west bank area in Palestine.
Objectives: The main objectives of this study are to characterize the immunophenotypic pattern
of pediatric ALL subtypes among Palestinians, highlight the importance of some clinical features
according to age and immunophenotypic pattern in patients prognosis and response to treatment,
and to determine the response to therapy after induction phase using the minimal residual disease
(MRD) in time point 1 (day 33).
Materials and Methods: This study is an incident study, was conducted from January 2015 to
December 2015 at Huda Al-Masri pediatric cancer department at Beit-Jala hospital, which is
located in the southern area of west bank in Palestine. A total of 15 consecutive children (7
females, 8 males) < than 14 years with newly diagnosed ALL were selected by pediatric
oncologists at Huda Al-Masri pediatric cancer department at Beit-Jala hospital, this hospital is
one of the largest pediatric centers for leukemia patients in Palestine.
Archived data of pediatric ALL patients in their medical files were reviewed with ethical
consideration of patient privacy to obtain some clinical features of the given patient.
All cases either retrospective or incident were tested by College of American Pathologists (CAP)accreditation pathology department at King Hussein Cancer Center (KHCC) in Amman-Jordan
on bone marrow aspirate samples collected in Ethylenediaminetetraacetic acid (EDTA) tubes
according to a two step strategy using panels of monoclonal antibodies based on European Group
for Immunological Characterization of Leukemia (EGIL). For the study purpose, the
immunophenotyping of the incident target cases at 2015 was performed at Huda Al-Masri
pediatric cancer department at Beit-Jala hospital in Bethlehem on bone marrow aspirate samples
collected in EDTA tubes according to a two step strategy using Flow Cytometer, and for
validation purpose, the achieved results were compared with the KHCC results of the same cases
and no significant difference was notedMinimal Residual Disease results were evaluated by examining the most common antigens or CD
markers through reactivity of fluorescent conjugated monoclonal antibodies directed against
lymphoid associated antigens for each ALL type on the surface of bone marrow cells after the
induction point 1 at day 33 of treatment by flow cytometry technique.
Results: Statistical analysis of the results was performed, and the study group comprised 15
newly diagnosed acute lymphoblastic leukemia cases (<14 years). There were 7 females and 8
males with a male/female ratio of 1.14:1. The age distribution of the precursor B-cell ALL
subtype showed that precursor B-cell ALL patients were younger with peak incidence between 2
and 5 years. Geographical distribution of Palestinian pediatric ALL showed that about half of the
cases (46.7%) from Hebron governorate, but with the same percentage of cases diagnosed in
Bethlehem governorate depending on the number of inhabitants.
Immunophenotyping analysis showed that the precursor B-cell phenotype was encountered in 14
(93.3%) cases, mature B-cell in Zero (0%) cases, and T-cell in 1 (6.7%) case. Lineage
Heterogeneity was found only in precursor B-cell ALL cases having one or two myeloid
associated antigens (CD13,CD33) expressed on their blast cells. Lineage Heterogeneity for both
antigens was found in 7.1% of precursor B-cell ALL cases.
By the examining of MRD, we found that 13 of pediatric ALL cases (86.7%) were subjected to
complete remission after the end of induction point 1 at day 33 with the only case of T-cell ALLand 85.7% of precursor B-cell ALL cases, but not statistically significant.
Conclusion: This study is a unique study providing a clear idea about the munophenotyping of
pediatric ALL cases at a single cancer center experience in southern west bank area in Palestine,
and this immunophenotypic distribution was similar to the general immunophenotypic
distribution pattern in developed countries. The age distribution showed a peak incidence
between 2 and 5 years among the precursor B-cell ALL subtype as in developed countries.
Geographical distribution of Palestinian pediatric ALL showed that about half of the cases
(46.7%) from Hebron governorate, but with the same percentage of cases diagnosed in
Bethlehem governorate depending on the number of inhabitants.
The response to treatment for ALL patients was very good as in developed countries, due to the
negative MRD at the end of induction point 1 at day 33 was 86.7% of ALL patients.
Description
Keywords
الكيمياء الحيوية والاحياء الجزيئية , Biochemistry & Molecular Biology