Asian Pacific Journal of Cancer Prevention

  • 제16권14호
  • /
  • Pages.6007-6010
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  • 2015
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  • 1513-7368(pISSN)
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  • 2476-762X(eISSN)
아시아태평양암예방학회 (Asian Pacific Journal of Cancer Prevention)
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Direct Coombs Test Positivity in B-Chronic Lymphoid Leukemia: a Marker of Advanced Clinical Disease

  • Abbas, Syeda Alia (Hematology Department, Liaquat National Hospital and Medical College) ;
  • Zeeshan, Rozina (Hematology Department, Liaquat National Hospital and Medical College) ;
  • Sultan, Sadia (Hematology Department, Liaquat National Hospital and Medical College) ;
  • Irfan, Syed Mohammad (Hematology Department, Liaquat National Hospital and Medical College)
  • 발행 : 2015.09.02
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초록

Background: Chronic lymphoid leukemia (CLL) is a malignant hematopoietic disorder, the most common of all adult leukemias with a distinctive immunophenotype. It is well established that CLL patients can have autoimmune complications, amongst them autoimmune hemolytic anemia as the most frequent. This study was carried out to determine the frequency of direct Coombs Test positivity in CLL patients and its possible correlation with Rai staging, hematological parameters and biochemical markers. Materials and Methods: This descriptive cross sectional study was carried at Liaquat National Hospital from January 2011 to June 2013. Sixty untreated patients with B- chronic lymphoid leukemia were enrolled. Complete blood count, direct Coombs test, serum urea, creatinine, uric acid and LDH levels were determined. Data were compiled and analyzed using SPSS version 21. Results: Out of 60 patients, 42(70%) were males and 18(30%) were females. Mean age was $59{\pm}9.2years$. Male to female ratio was 2.1: 1. The frequency of direct antiglobulin test (DAT) positivity was found to be 23.3%. The monospecific IgG was positive in 11 patients (18.3%); C3d positivity was evident in 1 patient (1.6%) and 2 patients (3.3%) had dual IgG and C3d positivity. The mean hemoglobin was $10.8{\pm}2.4gm/dl$. Significantly low mean hemoglobin of $8.3{\pm}3.0gm/dl$ was seen in Coombs positive patients compared with negative patients having a mean hemoglobin level of $11.7{\pm}1.6gm/dl$ (P<0.001). DAT positivity also demonstrated a positive association with advanced Rai stage III disease (P<0.01). No associations were noted with age, gender and biochemical markers. Conclusions: Direct Coombs test positivity in CLL in our patients, unlike in Western studies, appears relatively high, indicating significant autoimmune hemolytic anemia and advanced Rai stage in our setting. DAT positivity can be considered as a surrogative marker for advanced clinical disease.

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참고문헌

  1. Agrawal N, Naithani R, Mahapatra M, et al (2007).Chronic lymphocytic leukemia in India-a clinico-hematological profile. Hematology, 12, 229-33. https://doi.org/10.1080/10245330701255064
  2. Barcellini W, Capalbo S, Agostinelli RM, et al (2006). Relationship between autoimmune phenomena and disease stage and therapy in B-cell chronic lymphocytic leukemia. Haematologica, 91, 1689-92.
  3. Clive S. Zent, MD, Neil E, Kay (2010). Autoimmune complications in chronic lymphocytic leukemia. Best Pract Res Clin Haematol, 23, 47-59. https://doi.org/10.1016/j.beha.2010.01.004
  4. De Rossi G, Granati L, Girelli G, et al (1988). Incidence and prognostic significance of autoantibodies against erythrocytes and platelets in chronic lymphocytic leukemia. Nouvelle Revue Francaise D’hematologie, 30, 403-6.
  5. Dearden C, Wade R, Else M, et al, (2008). The prognostic significance of a positive direct anti-globulin test in chronic lymphocytic leukemia: a beneficial effect of the combination of fludarabine and cyclophosphamide on the incidence of hemolytic anemia. Blood, 111, 1820-6. https://doi.org/10.1182/blood-2007-07-101303
  6. Diehl LF, Ketchum LH (1998). Autoimmune disease and chronic lymphocytic leukemia: autoimmune hemolytic anemia, pure red cell aplasia and autoimmune thrombocytopenia. Semin Oncol, 25, 80.
  7. Ehsan A, Lone A, Khan MA (2013). Autoimmune complications in chronic lymphocytic leukemia: a single center experience. Biomedica, 9, 37-41.
  8. Engelfriet CP, Overbeeke MAM, Von dem Borne AEGKR (1992). Autoimmune hemolytic anemia. Semin Hematol, 29, 3.
  9. Foon KA, Rai KR, Gale RP (1990). Chronic lymphocytic leukemia: new insights into biology and therapy. Ann Intern Med, 113, 525-39. https://doi.org/10.7326/0003-4819-113-7-525
  10. Hamblin TJ, Oscier DG, Young BJ (1986). Autoimmunity in chronic lymphocytic leukaemia. J Clin Pathol, 39, 713-6. https://doi.org/10.1136/jcp.39.7.713
  11. Hallek M, Cheson BD, Catovsky D, et al (2008). International Workshop on Chronic Lymphocytic Leukemia. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines. Blood, 111, 5446-56. https://doi.org/10.1182/blood-2007-06-093906
  12. Hodgson K, Ferrer G, Montserrat E, Moreno C (2011). Chronic lymphocytic leukemia and autoimmunity: a systematic review. Haematologica, 96, 752-61. https://doi.org/10.3324/haematol.2010.036152
  13. Kermani IA, Dehdilani M, Dolatkhah R (2007). Chronic lymphocytic leukemia in the recent 10 years and treatment effects of Fludarabin. Asian Pac J Cancer Prev, 8, 367-71.
  14. Kyasa MJ, Parrish RS, Schichman SA, et al (2003). Autoimmune cytopenia does not predict poor prognosis in chronic lymphocytic leukemia/small lymphocytic lymphoma. Am J Hematol, 74, 1-8. https://doi.org/10.1002/ajh.10369
  15. Lischner M, Prokocimer M, Zolberg A, et al (1988). Autoimmunity in chronic lymphocytic leukaemia. Postgrad Med J, 64, 590-2. https://doi.org/10.1136/pgmj.64.754.590
  16. Mauro FR, Foa R, Giannarelli D, et al (1999). Clinical characteristics and outcome of young chronic lymphocytic leukemia patients: a single institution study of 204 cases. Blood, 94, 448-54.
  17. Mauro FR, Foa R, Cerretti R, et al (2000). Autoimmune hemolytic anemia in chronic lymphocytic leukemia: clinical, therapeutic, and prognostic features. Blood, 95, 2786-92.
  18. Moreno C, Hodgson K, Ferrer G, et al (2010). Autoimmune cytopenia in chronic lymphocytic leukemia: prevalence, clinical associations, and prognostic significance. Blood, 116, 4771-6. https://doi.org/10.1182/blood-2010-05-286500
  19. Moreno C, Montserrat E (2008). New prognostic markers in chronic lymphocytic leukemia. Blood, 22, 211-9. https://doi.org/10.1016/j.blre.2008.03.003
  20. Mozaheb Z, Hasanzadeh N, Abadi MH, Aghaee MA (2012). Chronic lymphocytic leukemia and prognostic factors. Asian Pac J Cancer Prev, 13, 3009-13. https://doi.org/10.7314/APJCP.2012.13.7.3009
  21. Polliack A, Lugassy C (1992). Autoimmunity and auto-immune syndromes associated with and preceding the development of lymphoproliferative disorders. Leukemia, 6, 152.
  22. Ricci F, Tedeschi A, Vismara E, et al (2013). Should a positive direct antiglobulin test be considered a prognostic predictor in chronic lymphocytic leukemia? Clin Lymphoma Myeloma Leuk, 13, 441-6. https://doi.org/10.1016/j.clml.2013.02.024
  23. Rozman C, Montserrat E (1995). Chronic lymphocytic leukemia. N Engl J Med, 1333, 1052-7.
  24. Shahjahani M , Mohammadiasl J, Noroozi F, et al (2015). Molecular basis of chronic lymphocytic leukemia diagnosis and prognosis. Cell Oncol Dordr, 38, 93-109. https://doi.org/10.1007/s13402-014-0215-3
  25. Xu W, Li JY, Miao KR, et al (2009). The negative prognostic significance of positive direct antiglobulin test in Chinese patients with chronic lymphocytic leukemia. Leuk Lymphom, 50, 1482-7. https://doi.org/10.1080/10428190903111930
  26. Zent CS, Ding W, Schwager SM, et al (2008). The prognostic significance of cytopenia in chronic lymphocytic leukaemia/ small lymphocytic lymphoma. Br J Haematol, 141, 615-21. https://doi.org/10.1111/j.1365-2141.2008.07086.x
  27. Zeeshan R, Sultan S, Irfan SM, Kakar J, Hameed MA (2015). Clinico-hematological profile of patients with B-chronic lymphoid leukemia in Pakistan. Asian Pac J Cancer Prep, 16, 793-6. https://doi.org/10.7314/APJCP.2015.16.2.793
  28. Zeeshan R, Irfan SM, Sultan S, Bhimani S (2015). ZAP-70 protein expression in B-cell Chronic Lymphoid Leukemia: A single center experience from Pakistan. Asian Pac J Cancer Prev, 16, 1587-90. https://doi.org/10.7314/APJCP.2015.16.4.1587
  29. Zwiebel JA, Cheson BD (1998). Chronic lymphocytic leukemia: staging and prognostic factors. Semin Oncol, 25, 42-59.

피인용 문헌

  1. Autoimmune cytopenias in chronic lymphocytic leukemia: a concise review and treatment recommendations vol.11, pp.8, 2018, https://doi.org/10.1080/17474086.2018.1489720