SOUSA, Daniel Willian Lustosa de. Expressão da L-selectina e do CD44 nas leucemias linfóides agudas em crianças e adolescentes. 2009. 118 f. Dissertação (Mestrado em Patologia) - Universidade Federal do Ceará. Faculdade de Medicina, Fortaleza, 2009. / Submitted by denise santos (denise.santos@ufc.br) on 2013-12-03T12:41:12Z
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Previous issue date: 2009 / Introduction – Altered expression or function of adhesion molecules on leukemic blasts may contribute to the evolution of acute leukemia and its biological behavior. The elevated expression of adhesion molecules in ALL might be correlated with the extramedullary dissemination of blast cells, CNS involvement and leukemia tumor burden. Purpose – To analyze the expression of L-selectin and CD44 in ALL in children and adolescents. As well as to evaluate the prognostic factors (age, gender, initial leukocyte count, immunophenotype, FAB and EGIL classification, DNA index and early response to treatment) and the extramedullary presentation of ALL, to finally correlate the prognostic factors with these adhesion molecules. Patients and Methods – From November 2007 to November 2008, 76 patients with newly diagnosed ALL started on Brazilian GBTLI-ALL Protocol. The diagnosis was based on cytological, immunophenotypic, and cytogenetic methods. The mean fluorescence intensity (MFI) and the percentage of the adhesion molecules blasts cells was measured by flow cytometry using triple staining with McAb directly conjugated. CD45-PerCP positive cells were gated for blasts analysis. Anti-CD44-PE (Clone HP2/9 - Immunostep®) and CD62L-FITC (Clone HI62L - Immunostep®) were used to mark the adhesion molecules. The Cell Quest program was used for data acquisition and analysis. Statistical analysis was done by SPSS 16.0 Software. The association of features, prognosis and response to treatment was assessed by Chi-square, Fisher exact and Mann-Whitney tests. Overall survival curves were constructed by the Kaplan-Meier method and the log-rank test. Multivariate Cox regression analysis showed independent prognostic factors. Results – The mean age at diagnosis was 6.3±0.5 years (range 9mo to 17yr) and 65% of them were boys. Clinical findings were hepatomegaly (63%), splenomegaly (58%), lymphadenopathy (44%). CNS involvement was detected in 6.6% of cases and mediastinal mass appeared in 11.8% of them. Patients were classified into low risk (54%) and high risk (46%). FAB classification identified 83% as L1 and 17% as L2. Immunophenotypically, 89.5% of patients were classified as B-lineage ALL and 10.5% as T-lineage ALL. The most frequent EGIL subtype was B common and pre-B-ALL (51.5% and 45.5%, respectively). DNA index greater than 1.16 was found in 19% of the patients and was associated with favorable prognosis. On the D8 evaluation, 95% of the patients had blast count lower than 1.000/mm3 and leukocyte count lower than 5.000/mm3. The remission induction rate was 95% and there was a rate of 2.6% of death during induction therapy. CD44 had greater expression to the rate of 87.5% in T-cell ALL (MFI=150.44±20.29) with no statistical correlation. A significant positive correlation was demonstrated between 84% of CD44 expression and Leukemia burden tumor cases (p=0.01; OR=4.8). There was statistical correlation between L-selectin expression (87.5%/MFI=272.33±52.72) and T-cell ALL (p=0,004). No significant correlation was detected between L-selectin and CD44 expression and other prognostic factors. Multivariate statistical analysis (adjusted for overall survival) indicated that initial leukocyte count, gender, T immunophenotype and L-selectin were independent factors. Conclusion – L-selectin and CD44 expressions were elevated in ALL studied, mainly in T-cell ALL. The research demonstrated that there is an association between CD44 expression and leukemia tumor burden, which might be involved in the dissemination of leukemic cells and the progression of the disease. / Introdução – Alterações na expressão ou função das moléculas de adesão (MA) nas células leucêmicas podem contribuir para a evolução e no comportamento biológico das leucemias agudas. A expressão aumentada nas LLAs parece relacionar-se aos mecanismos de disseminação extramedular dos linfoblastos, infiltração do SNC e formação de massas tumorais. Objetivos – Analisar a expressão da L-selectina e do CD44 nas LLAs em crianças e adolescentes. Avaliar os fatores prognósticos (idade, sexo, leucometria ao diagnóstico, imunofenótipo, classificação FAB, EGIL, índice de DNA e resposta ao tratamento de indução) e as apresentações extramedulares das LLAs e correlacioná-los com essas MA. Pacientes e Métodos – Foram avaliados 76 pacientes com LLA, tratados com o Protocolo GBTLI-LLA. O diagnóstico foi baseado em critérios FAB, imunofenotípicos (EGIL) e citogenéticos. A expressão das MA foi avaliada por citometria de fluxo, utilizando tripla marcação. O anticorpo monoclonal CD45-PerCP (Immunotech®) foi utlizado como marcador dos linfoblastos. O CD44-PE (Clone HP2/9 - Immunostep®) e o CD62L-FITC (Clone HI62L - Immunostep®) foram utilizados para a marcação das MA. Para a análise das amostras e o cálculo da intensidade média de fluorescência foi utilizado o programa Cell Quest. Na análise estatística utilizou-se o software SPSS 16.0. A associação entre as variáveis, os fatores prognósticos e resposta foi realizada com os testes de Qui-quadrado, exato de Fisher e Mann-Whitney. Sobrevida global foi determinada por curvas Kaplan-Meier e teste log-rank. Análise multivariada por modelo proporcional de Cox foi utilizada para assegurar a independência dos fatores prognósticos. Resultados – A média de idade foi 6,3±0,5 anos (5m -17a) e predominou o sexo masculino (65%). Ao diagnóstico os achados clínicos foram: hepatomegalia (63%), esplenomegalia (58%) e linfadenomegalia (44%). A infiltração SNC ocorreu em 6,6% dos casos e o alargamento de mediastino em 11,8%. Quanto ao risco, 54% eram baixo risco e 46% alto risco. A classificação FAB determinou 83% como L1 e 17% L2. Diagnóstico de LLA-B foi mais frequente (89,5%) e o da LLA-T em 10,5% dos pacientes. O subtipo EGIL mais prevalente foi B II e B III, 51,5% e 45% respectivamente. O IDNA ≥ 1.16 foi encontrado em 19% dos pacientes e associou-se a bom prognóstico. Na avaliação do D8, 95% dos pacientes apresentaram contagem de blastos <1000/mm3 e leucócitos < 5.000/mm3. A taxa de remissão de indução foi de 95% e ocorreram 2,6% de óbitos na indução. Observou-se uma maior expressão do CD44 na LLA-T (87,5%/ IMF=150,44±20,29), porém sem significância estatística. LLAs com massa tumoral apresentaram 84% de expressão do CD44, quando comparada a 52% das LLAs sem massa tumoral (p=0.01; OR=4,8). Expressão aumentada da L-selectina na LLA-T (87,5%/IMF=272,33±52,72) foi estatisticamente significante (p=0,004), comparado a LLA-B (54,5%/ IMF= 115,90±12,75). Não houve correlação entre os outros fatores prognósticos e essas MA. Na análise multivariada as variáveis de maior impacto para a sobrevida foram: a leucometria ao diagnóstico, sexo, imunofenótipo T e a L-selectina. Conclusão – A expressão da L-selectina e do CD44 estão aumentadas nas LLAs estudadas, principalmente na LLA-T. O CD44 correlacionou-se com LLAs com massas tumorais e parece estar relacionado aos mecanismos de disseminação extramedular dos linfoblastos
| Identifer | oai:union.ndltd.org:IBICT/oai:www.repositorio.ufc.br:riufc/6886 |
| Date | January 2009 |
| Creators | Sousa, Daniel Willian Lustosa de |
| Contributors | Ferreira , Francisco Valdeci de Almeida |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Source | reponame:Repositório Institucional da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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