Evaluation of prognostic variables in chronic lymphocytic leukemia and association with disease stage

Attia,Hanaa R.M.; Ibrahim,Mona Hamed; Abd El‑Aziz,Shereen H.; Abdelrahman,Amany H.; Sobeih,Mohamed Emam; Hagag,Heba A.A.; Yassa,Marianne E.; Osman,Randa A.; Rawi,Rasha; Abd El‑Dayem,Omnia Y.; Elsharkawi,Nahla; Abdelfattah,Raafat; Hassan,Naglaa M.

doi:10.3892/mco.2021.2262

Evaluation of prognostic variables in chronic lymphocytic leukemia and association with disease stage

Authors:
- Hanaa R.M. Attia
- Mona Hamed Ibrahim
- Shereen H. Abd El‑Aziz
- Amany H. Abdelrahman
- Mohamed Emam Sobeih
- Heba A.A. Hagag
- Marianne E. Yassa
- Randa A. Osman
- Rasha Rawi
- Omnia Y. Abd El‑Dayem
- Nahla Elsharkawi
- Raafat Abdelfattah
- Naglaa M. Hassan
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Affiliations: Department of Clinical and Chemical Pathology, Medical Division, National Research Centre, Centre of Excellence, 12622 Cairo, Egypt, Department of Medical Oncology, National Cancer Institute, 11796 Cairo, Egypt, Cytogenetic Unit‑Main Laboratory, Kasr Al‑Ainy School of Medicine, 11562 Cairo, Egypt, Department of Clinical and Chemical Pathology, Kasr Al‑Ainy School of Medicine, 11562 Cairo, Egypt, Department of Clinical Pathology, National Cancer Institute, 11796 Cairo, Egypt, Department of Internal Medicine, Kasr Al‑Ainy School of Medicine, Cairo University, 11562 Cairo, Egypt
Published online on: March 13, 2021 https://doi.org/10.3892/mco.2021.2262
Article Number: 100
Copyright: © Attia et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The aim of the present study was to investigate different biological prognostic markers to identify high‑risk patients with chronic lymphocytic leukemia (CLL) with a higher tumor burden, in order to ensure appropriate management. A total of 81 Egyptian patients with CLL were enrolled in the present study, with 75 healthy subjects serving as the control group. The expression of CD49d, CD38 and ZAP‑70 in CLL cells was assessed using flow cytometry. The fluorescence in situ hybridization technique was employed to evaluate TP53 (del17p), ataxia‑telangiectasia (del11q) and 13q14 (del13q14) genes and the presence of trisomy 12. The serological markers β2 microglobulin (B2M) and sCD23 were measured by ELISA. The CD49d gene was highly expressed in 25.9% and cytogenetic aberrations were observed in 66.6% of all recruited CLL patients. The patients were categorized according to the Binet staging system and a significant increase in the expression of sCD23, CD49d and ZAP‑70 was detected in group C (P=0.008, 0.034 and 0.017, respectively) when compared to groups A and B. CD49d⁺ patients exhibited significantly higher expression of CD38 (P=0.002) and trisomy 12 (P=0.015) and lower expression of del13q14 (P=0.001). Patients who were CD49d⁺ with B2M>3.5 µg/ml exhibited higher total leukocyte count (P=0.048), higher absolute lymphocyte count (P=0.036), higher expression of CD38 (P=0.002) and trisomy 12 (P=0.034) and lower expression of del13q14 (P=0.002). Therefore, sCD23, CD49d and ZAP‑70 may be considered as an optimal prognostic marker combination to be evaluated in the early stages of CLL and throughout disease management. Integrating both serological markers and CD49d expression by flow cytometry may add to the prognostic value of each marker alone and help identify high‑risk patients with a higher tumor burden.

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