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  Access statistics : Table of Contents
   2014| July-September  | Volume 39 | Issue 3  
    Online since December 31, 2014

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Platelet indices: consideration in thrombocytopenia
DA Elsewefy, BA Farweez, RR Ibrahim
July-September 2014, 39(3):134-138
Background There is increasing evidence that platelet indices, such as mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR), have a significant role in the discrimination between hyperdestructive thrombocytopenia and hypoproductive thrombocytopenia, and they can be of great help as they are routinely generated by automated cell counters. Objective In this study, we aimed to assess the sensitivity and specificity of these indices and set cutoff values that aid in the diagnosis of thrombocytopenia cause. Materials and methods We recruited 20 individuals as the control group and 80 thrombocytopenic patients, who were divided into two groups: group I ( n = 40) included newly diagnosed immune thrombocytopenic purpura (ITP) patients (hyperdestructive thrombocytopenia), whereas group II ( n = 40) included hypoproductive thrombocytopenia patients. The MPV and platelet distribution width were derived from automated cell counter results. The P-LCR was calculated. Results In ITP (hyperdestructive thrombocytopenia) patients, the MPV and P-LCR were significantly higher; the best cutoff value for MPV was greater than 9.7 fl and for P-LCR was greater than 33.6%, with a diagnostic accuracy of 70.1 and 99.6%, respectively. Conclusion The MPV and P-LCR provide information about the underlying conditions of thrombocytopenia. These indices should be considered in the diagnosis of thrombocytopenia. The P-LCR can be safely relied upon for a positive diagnosis of ITP.
  26,645 850 -
Blood indices to differentiate between β-thalassemia trait and iron deficiency anemia in adult healthy Egyptian blood donors
AR Soliman, G Kamal, A Elsalakawy Walaa, TH Sallam Mohamed
July-September 2014, 39(3):91-97
Background β-Thalassemia trait (BTT) often shows microcytosis, a normal or an increased red blood cell (RBC) count, and an elevated level of HbA 2 , which provide the basis for laboratory screening. BTT is an important differential diagnosis of iron deficiency anemia (IDA). Donors with BTT have hemoglobin values comparable with normal; hence, they are accepted for donation and they usually escape diagnosis. Aim The aim of this work was to differentiate BTT from IDA through blood indices performed in routine complete blood count. Patients and methods A total of 200 samples were obtained from apparently healthy adult Egyptian blood donors randomly. Complete blood count and mean corpuscular volume (MCV) were performed to all individuals. Hemoglobin electrophoresis and/or serum ferritin was performed to samples with MCV less than 78 fl. Results Prevalence of BTT in this study was 6%, whereas IDA represented 4.5% of total 200 samples investigated. The cutoff value of MCV 73 fl was 91.7% sensitive and 100% specific in differentiating BTT from IDA. Red blood cell distribution width at level 14.5% or below can differentiate BTT from IDA with 83.3% sensitivity and 100% specificity. RBCs count at value above 5.47 million/mm 3 can differentiate BTT from IDA with 100% sensitivity and 100% specificity. Conclusion The cutoff values of MCV 73 fl or less, RBC count above 5 × 10 6 /mm 3 , and red blood cell distribution width 14.5% or less were suggested to be associated with a high probability of BTT.
  13,646 848 -
Iron overload in transfusion-dependent β-thalassemia patients: defining parameters of comorbidities
Deena S Eissa, Rasha A El-Gamal
July-September 2014, 39(3):164-170
Background Iron overload represents a consistent and almost inevitable complication in patients with transfusion-dependent β-thalassemia. The frequently needed erythrocyte transfusions are known to be the leading source of body iron. Increased iron deposition in tissues was strongly suggested to underlie poor growth and development in transfusion-dependent β-thalassemia. This study aimed to investigate the pattern of increase in iron-overload parameters in relation to the therapeutic measures used and explore its effect on the physical growth of patients with transfusion-dependent β-thalassemia. Patients and methods The study included 60 transfusion-dependent β-thalassemia patients (median age 12.5 years, interquartile range 8-17 years) and 20 age-matched and sex-matched controls; each group was further subcategorized into less than 12-year-old and more than 12-year-old subgroups. The studied clinical parameters comprised weight and height, which were used to calculate the body mass index (BMI). Laboratory assays included complete blood counts for the assessment of pretransfusion hemoglobin, serum iron, total iron-binding capacity, ferritin, and growth differentiation factor 15 (GDF15), and the calculation of the transferrin iron saturation percentage (TISP). Results Less than one-third (30%) of the patients had a low BMI; no patient was overweight or obese. The median pretransfusion hemoglobin was 7.1 g/dl (interquartile range 6.8-7.2 g/dl). Fifty-two (86.7%) patients were inadequately chelated, showing serum ferritin levels more than 1000 ng/ml. In patients older than 12 years of age, the BMI was significantly lower in comparison with controls of the same age subgroup as well as patients less than 12 years old. Patients with a low BMI had significantly higher median values of TISP, ferritin, and GDF15 than those with a normal BMI. GDF15 values of the more than 12-year-old patients showed significant positive correlations with TISP and ferritin levels. Setting optimal cutoffs at 63% for TISP and 1210 ng/ml for serum ferritin (area under the curve 0.965 and 0.957, respectively) had indicated low BMI with higher certainties compared with GDF15 at a level of 10 000 pg/ml (area under the curve 0.783) in the more than 12-year-old patients. Conclusion Avoiding iron overload should be warranted for transfusion-dependent β-thalassemia patients to have normal BMI. Although a high GDF15 level is helpful in pointing toward the development of a low BMI, it added no value to TISP or ferritin as indictors of patients' growth retardation.
  2,511 366 1
The application of eosin maleimide-binding test in the diagnosis of hereditary spherocytosis among undiagnosed cases of chronic hemolytic anemia in children
Wessam M El Gendy, Hoda M Hassab, Amal M Ghanem, Irene M Lewis, Sarah M Nawar
July-September 2014, 39(3):109-113
Background Conventional diagnosis of hereditary red blood cell (RBC) membrane disorders, in particular hereditary spherocytosis (HS), is labor intensive, time consuming and requires at least 2 ml of blood, which might be impractical in the neonatal period. Participants and methods We evaluated the use of eosin-5-maleimide (EMA) as a rapid screening test for patients with HS. RBCs from 74 healthy controls and 66 anemic children (35 HS and 31 other hemolytic anemias; 10 cases diagnosed as thalassemia, eight cases of autoimmune hemolytic anemia, one case of ovalocytosis and 12 cases of undiagnosed hemolytic anemia) were stained with EMA and analyzed for their mean fluorescence intensity using flow cytometry. Results RBCs from patients with HS showed a greater degree of reduction in mean fluorescence intensity of EMA compared with those from normal controls and patients with other hemolytic diseases. These findings showed that the fluorescence flow cytometric-based method is a simple, sensitive and reliable diagnostic test for RBC membrane disorders using a small volume of blood, and results could be obtained within 2 h. Such a method could serve as a first-line screening for the diagnosis of HS in routine hematology.
  2,612 261 2
Clinically significant red blood cell antibodies in multitransfused Egyptian thalassemic patients
Dahlia A El Sewefy, Mervat A Al Feky, Mona F Abdel Fatah, Yasmin N El Sakhawy, Iman A Ragab, Heba Tallah N El Sayed
July-September 2014, 39(3):171-176
Background Red blood cell (RBC) alloimmunization is a major challenge to repeated transfusions in β-thalassemia-major patients. The aim of this study was to evaluate the magnitude of RBC alloimmunization and autoimmunization in regularly transfused Egyptian patients with β-thalassemia major and analyze factors that may be responsible for the development of antibodies. Patients and methods This study was conducted on 200 Egyptian β-thalassemia-major patients with age less than 16 years, who routinely visited the Pediatric Hematology Clinic of Ain Shams University Hospital for regular transfusions. All the patients underwent antibody screening. Patients with a positive antibody screen were further tested for antibody identification. The data were analyzed to find out the frequency of alloimmunization, and the patients' records were revised to analyze the factors influencing it. In case of pan-positivity of the antibody-screening cells and the autocontrol, adsorption by autogenic RBCs was performed to uncover the presence of alloantibodies. Results RBC alloantibodies were found in 21 (10.5%) patients. The most frequent alloantibodies encountered were anti-Kell (52.4%) and anti-E (19%). Autoantibodies were encountered in only one patient. They were the warm autoantibody type, and adsorbtion using autogenic RBCs was succesful in eliminating them. The frequency of blood transfusion, the transfusion index, serum ferritin, and the age at first transfusion showed a statistically significant correlation with alloimmunization ( P < 0.05). In contrast, there was no statistically significant association between the patients' sex, age, the ABO, Rh blood groups, and the spleen state and alloimmunization (P > 0.05). Conclusion We conclude that alloimmunization to RBC antigens is a relatively frequent finding among Egyptian transfusion-dependent thalassemic patients. The most frequent antibodies detected were against the Kell and Rh blood groups, mainly anti-Kell and anti-E. The majority of alloantibodies detected in this study were clinically significant.
  1,836 191 2
Evaluation of the procoagulant potential of endothelial microparticles CD144 (VE-Cadherin) positive in coronary syndrome patients
Amany H Mansour, Azaa M Abd Elbaky, Shahir Kamal, M Noura, Abdulrahman Alshaikh
July-September 2014, 39(3):143-148
Background Apoptotic microparticles are responsible for almost all tissue factor activity of the plaque lipid core. We hypothesized that elevated levels of procoagulant microparticles could also circulate in the peripheral blood of patients with recent clinical signs of plaque disruption and thrombosis. The present study included 60 acute coronary syndrome (ACS) adult patients. Group I included 30 patients with diabetes mellitus who presented with ACS. Group II included 30 nondiabetic patients complaining of ACS and 25 healthy individuals as controls. ACS patients were further classified according to laboratory and radiological findings (troponin test and ECG) as follows: group A included 16 ST-segment elevation myocardial infarction (STEMI) patients, group B included 19 non-ST-segment elevation myocardial infarction (NSTEMI) patients, and group C included 25 patients with unstable angina. Traditional laboratory investigations and special laboratory assessments of CD144 fluorescein isothiocyanate by flow cytometry were performed. Results The present study found highly elevated CD144 percentages in diabetic ACS patients compared with healthy controls (P≤0.0001(, and highly elevated creatine kinase-MB (CK-MB), fasting sugar, total cholesterol, triglyceride, HDL, and LDL (P = 0.0001, 0.0001, 0.0002, 0.0002, 0.0001, and 0.0001, respectively). In contrast, nondiabetic ACS patients had significantly elevated CD144, CK-MB, total cholesterol, triglyceride, HDL, and LDL (P = 0.0001, 0.0001, 0.0001, 0.0021, 0.0001, and 0.0021, respectively), whereas fasting sugar and HbA1c did not change significantly. However, the patients in group B (NSTEMI) had significantly elevated CD144% in comparison with patients with unstable angina (group C) ( P = 0.05), but patients with group A (STEMI) had significantly elevated CK-MB compared with patients with unstable angina (group C) (P = 0.02). Conclusion The high levels of circulating microparticles of endothelial origin are increased in diabetic patients with coronary artery disease, suggesting an important role for endothelial injury in the prediction of ACS. Hyperglycemia in ACS is associated with enhanced local thrombin generation and platelet activation, as well as unfavorably altered clot features in patients with and without a previous history of diabetes.
  1,829 127 2
The usefulness of immunoglobulin-like transcript-3 receptor expression in the diagnosis of acute myeloid leukemia with monocytic differentiation
Maha Atfy, Hoda F Ebian, Ashraf M Elhefni, Hebatallah H Atteia
July-September 2014, 39(3):122-127
Background Immunoglobulin like transcript (ILT3) is an immunohibitory transmembrane receptor expressed by plasmacytoid dendritic cells (PDCs), monocytoid dendritic cells (MDCs), and monocytes/macrophages. ILT3 has been previously utilized as a highly sensitive and specific marker for the identification of aggressive chronic lymphocytic leukemia (CLL) and to distinguish AML with monocytic differentiation from other types of AML. Aim and Methods0 Therefore, in the current study, we investigated the diagnostic impact of ILT3 receptor expression in 72 Egyptian patients having AML with monocytic differentiation and 20 healthy volunteer using flow cytometry technique. Results Our results demonstrated significant overexpression of ILT3 receptor (P < 0.001) in all AML cases displaying monocytic differentiation patients. ILT3 receptor expression was positively correlated with CD4, CD14, CD64, CD11c, MPO and NSE. Conclusion These data present a significant role for ILT3 receptor expression in combination with CD14, CD64, MPO and NSE in diagnosis of AML with monocytic differentiation. Further clinical studies should be directed towards ILT3 receptor blockade as a future target for AML immunotherapy.
  1,776 134 -
Interleukin-10 (−1082G/A) gene promotor polymorphism in Egyptian non-Hodgkin lymphoma patients: relation to other prognostic factors
Mohammed Ibrahim Sayed Ahmed, Doaa Ibrahim Hashad, Alshimaa E Hassen
July-September 2014, 39(3):156-163
Background and Objectives Interleukin-10 (IL-10) is an important immunoregulatory cytokine in. It is part of a balanced network of cytokines and can be cancer promoting (immunosuppressive; stimulation of cell proliferation) or cancer inhibiting. The present study aimed at investigating possible association between IL10 (-1082G/A) gene promoter polymorphism in a sample of Egyptian Non-Hodgkin lymphoma patients and its relation to other prognostic factors. Design and Methods A case control study was carried out on fifty NHL patients at first diagnosis and twenty age and sex- matched normal controls. Results There was statistically insignificant correlation between IL10 (-1082G/A) genotype and age (P = 0.631), ESR (P = 0.087), serum LDH (P = 0.623), serum albumin (P = 0.108) serum β2 microglobulin (P = 0.578), and hemoglobin (P = 0.696) in patient group. The frequency of IL10-1082G allele was found to be higher in patients with NHL(28.3%) as compared with control subjects (12.5%)(P = 0.298) , with a higher frequency of IL-10-1082GG/GA genotypes in the former population (13.1%, 30.4%) versus (5.0%, 15.0%) χ2P = 0.073. Conclusion The frequency of IL10-1082G allele was found to be higher in patients with NHL as compared with healthy controls, which is translated into a higher frequency of IL-10-1082GG/GA genotypes, thus may be associated with higher risk of developing NHL. There was no significant correlation between IL-10 polymorphism with other prognostic factors.
  1,571 120 -
Some endocrinal changes in children with β-thalassemia major
Zeinab M Mohey El-Deen, Ahlam M Ismail, Mona M Abdel Meguid, Mohamed T Harb
July-September 2014, 39(3):103-108
Background Endocrinal disorders are well-described in patients with β-thalassemia major (BTM) and are among the most common consequences of the disease worldwide affecting patient's quality of life and causing considerable morbidity and mortality. Even with iron chelating agents, the rate of endocrinopathies remains high among thalassemia major patients. Aims To study the thyroid & parathyroid glands functions in children with Beta- thalassemia and find out the influence of iron overload on them. Patients and Methods This study was carried out on 35 children diagnosed as Beta-thalassemia major and 15 healthy children as a control group who attended the outpatient clinic as well as the inpatient Pediatric Department, Qena University Hospital. All patients were subjected to thorough medical history, clinical examination and abdominal ultrasound. Laboratory investigations were done to confirm diagnosis and severity of the disease and iron status. Calcium, phosphorus, TSH, T3 & T4 and Parathormone (PTH) levels were detected to find out the thyroid and parathyroid gland functions. Results There were significant increase in TSH and decrease in T4 and PTH levels in cases than in control. There were also significant increase in TSH and significant decrease in T4 & PTH level regarding age but not significant with sex. Height was significantly lower in cases than control. According to the clinical data, the present study showed that TSH level was significantly higher and PTH was significantly lower among patients whose duration of illness was ≥6 years, those required frequent blood transfusion and with patients on irregular iron chelation therapy (poorly chelated) and splenectomized cases. There were significant and highly significant difference between TSH and PTH levels and serum ferritin, but there were no significant difference in relation to serum iron, TIBC, HB level, calcium and phosphorus. The present study detected correlations between TSH, PTH and serum ferritin. Conclusion We concluded that there were thyroid and parathyroid endocrinal changes in thalasthemic patients and recommend careful follow up of them by assessments of thyroid and parathyroid hormones as early recognition and hence prevention of these complications might help improve the quality of life of these patients.
  1,401 216 -
Fibrinogen -455G/A promoter polymorphism in acute ST elevation myocardial infarction in Egyptian patients
Nadia I Sewelam, Akram A Ahmed, Hanan A Alwakeel, Mohamed Y Khaled
July-September 2014, 39(3):98-102
Background Coronary artery diseases (CAD) are complex disorders resulting from interactions of different predisposing factors. Aim to evaluate the role of -455 G/A Fibrinogen polymorphism (rs1800790) in Egyptian patients with CAD. Subjects and Methods Plasma fibrinogen levels were assayed and PCR-RFLP was used to evaluate fibrinogen -455 G/A polymorphism in CAD. Patients with stable CAD and STEMI compared to a control group with negative stress Tc 99m sesta MIBI myocardial perfusion scan. Results 137 patients were studied. No significant difference between the patients and controls as regards different genotypic distribution of -455 G/A Fibrinogen polymorphism. However, the AA genotype was more prevalent among the control group. No significant correlation between the genotypic variants and the fibrinogen levels was detected. Conclusion The A allele of fibrinogen -455 gene promoter may confer some protection against CAD, however, GG genotype maybe more common among Egyptian CAD patients.
  1,305 217 -
Antiplatelet antibodies in chronic hepatitis C patients: correlation with platelet count and viral load
Aida S Omar, Abeer S Elhadidi, Nadia E Zaki, Rania H Tawfik
July-September 2014, 39(3):114-121
Background HCV associated thrombocytopenia is one of the most frequent manifestations of hepatitis C virus (HCV) infection; which typically worsens with progression of the liver disease and can become a major clinical complication that prevents chronic HCV patients from receiving the standard peg-interferon/ribavirin therapy. The aim of the present work was to study the role of anti-platelet antibodies in the pathogenesis of HCV-associated thrombocytopenia and to correlate it with the extent of thrombocytopenia, level of viremia, and ALT level in patients with chronic HCV infection. Patients and Methods This study was conducted on 200 patients with chronic HCV, divided into 2 groups, group I included 100 patients with normal platelet count (platelet count ≥150 × 109 /L), whereas group II included 100 patients with thrombocytopenia (platelet count <150 × 109 /L). Direct and indirect anti-platelet antibodies were detected by flowcytometry and immunofluorescence respectively. The results demonstrated statistically significant correlations between presence of anti-platelet antibodies and degree of thrombocytopenia, viral load, and the extent of the liver damage.
  1,258 144 -
CD200 is an independent prognostic factor in multiple myeloma
Amany A Osman, Doaa G Eissa, Mohamed M Moussa
July-September 2014, 39(3):177-181
Background CD200 is a membrane glycoprotein belonging to the immunoglobulin superfamily and seems to play an immunosuppressive and protumor role. However, the diagnostic and prognostic role of its expression in multiple myeloma is not fully examined. Aim of work The aim of this study was to detect the expression of CD200 in patients with plasma cell myeloma (PCM) and correlate its expression with other known clinical and laboratory prognostic factors. Patients and methods A total of 68 PCM patients were enrolled and divided into 50 newly diagnosed and 18 treated patients with residual disease. Flow cytometry was applied on bone marrow samples from all patients to detect CD200 expression using monoclonal anti-CD200. Results Our results showed CD200-positive expression in 76.5% of the studied PCM patients. A significant relation was found between CD200 expression and many prognostic factors such as advanced age, lytic bone lesions, advanced clinical staging, hematopoietic dysfunction, low level of residual polyclonal g-globulins, and elevated serum creatinine. Moreover, CD200 expression was strongly related to factors associated with tumor burden and activity, such as low serum albumin, high lactate dehydrogenase, high β2 microglobulin level, and elevated bone marrow plasma cell count. Follow-up of patients revealed a significantly shorter event-free survival of CD200-positive patients. Receiver operating characteristic curve showed that 78% is the best prognostic cutoff for CD200 expression, with 92% specificity and 66.7% sensitivity. Conclusion CD200 is an independent prognostic factor that should be measured to determine PCM patients who are at risk of developing residual disease after standard treatment and thus must be subjected to intensified chemotherapy regimens from the start.
  1,195 157 1
Circulating endothelial progenitor cells as a prognostic marker in childhood acute lymphoblastic leukemia
Hany A Labib, Ahmed G Siam
July-September 2014, 39(3):139-142
Introduction Angiogenesis has been associated with the growth, the dissemination, and the metastasis of many tumors; it may also enhance the survival, the proliferation, and the chemoresistance of leukemic blasts cells. Circulating endothelial cells are proposed to be a noninvasive marker for the assessment of angiogenesis. The aim of this work was to evaluate, for the first time, the number of circulating endothelial progenitor cells (CEPCs) in the peripheral blood in childhood acute lymphoblastic leukemia (ALL) as a prognostic marker. Materials and methods We quantified the number of CEPCs by flow cytometry in 50 childhood ALL patients at the time of diagnosis and in 30 healthy controls. Results We found, statistically, that the CEPC number was significantly higher in the patient group than in the control group. There was a significant association between a high CEPC number with a higher total leukocytic count, the high-risk patient group, and a poor response to therapy, but no statistically significant difference regarding the hemoglobin concentration, the platelet count, cytogenetic analysis, immunophenotyping, and the French-American-British classification. Conclusion The number of CEPCs is higher in childhood ALL patients and significantly linked to a high-risk disease status and chemoresistance.
  1,144 101 -
Analysis of human platelets brain-derived neurotrophic factor as a predictor of response in depressed patients
Mai A Eissa, Amany H Mansour, Rokia Saad Ayyad, Maha Ragab, Abdulrahman Fahmi Alshaik
July-September 2014, 39(3):149-155
Background Despite the significant progress in the management of major depressive disorder, little is known about the biological alterations that underlie the pathophysiology or the treatment of depression. Previous studies show that the brain-derived neurotrophic factor (BDNF) may play a role in the pathophysiology of major depressive disorders. Assuming that BDNF may be implicated in the etiology of depression, we examined BDNF concentrations in patients with major depressive disorder and its correlation with therapeutic response to fluoxetine therapy. Patients and methods This study included 40 depressed patients (25 women and 15 men) and 20 healthy individuals (11 women and nine men) as a control group selected to match the study group in age and sex. All patients were subjected a semistructured clinical interview of DSM-IV-TR for the diagnosis of major depressive disorder, assessment of severity of depression using the 16-item Hamilton Rating Scale of Depression before treatment and 8 weeks after fluoxetine treatment, and estimation of the level of BDNF before treatment and 8 weeks after antidepressant treatment. Results Before treatment, the concentrations of BDNF were significantly lower in depressed patients than in the control participants. After treatment, a significant increase in the BDNF concentration occurred, with no significant difference from the control group. Serum BDNF levels in patients with poor response (17.58 ± 4.99 ng/ml) were significantly lower than those of the patients with good response (28.88 ± 7.81 ng/ml; t = 5.48, P = 0.001). However, there were no significant differences in both groups of patients compared with the normal controls (21.60 ± 8.04). Conclusion BDNFs drug-free depressed patients are lower than those of healthy controls and we propose that low BDNF levels might reflect failure of neuronal plasticity in depression. Also, The increase in BDNF after antidepressant therapy could be considered a good predictor of response to antidepressant therapy and might contribute toward the therapeutic response of patients with major depressive disorder.
  1,088 95 -
The prognostic value of CXCR4 and pCXCR4 in B-lineage acute lymphoblastic leukemia in adults
Amina M Elnaggar, Rania A Ghonaim, Tarek A El-Gohary, Maha Atfy
July-September 2014, 39(3):128-133
Background CXC chemokine receptor 4 (CXCR4) is activated by phosphorylation (pCXCR4) and is essential for the migration of hematopoietic precursors to bone marrow. Data regarding the prognostic impact of CXCR4 in patients with B-acute lymphoblastic leukemia (B-ALL) are sparse and limited to the pediatric population. Patients and methods Fifty adult patients with B-ALL were included in the study. CXCR4 was assessed by flow cytometry and pCXCR4 by immunocytochemistry. All patients received a hyper-CVAD regimen. Results Thirty-one patients had positive CXCR4 expression, of whom only 18 (58%) had positive pCXCR4 expression. The complete response rate for patients with positive expression of pCXCR4 was significantly inferior to those with negative expression (61.1 vs. 93.7%; P < 0.01). In the multivariate analysis, pCXCR4 expression was associated with a worse disease-free survival ( P < 0.027) and overall survival (P < 0.024). Positive expression of pCXCR4 was not associated with an increased incidence of extramedullary disease or had any relation to the degree of maturity of B-ALL. Conclusion The current study indicates that adult B-ALL patients with positive expression of pCXCR4 have an inferior response to chemotherapy, disease-free survival, and overall survival compared with patients with negative expression.
  1,025 126 1