Nur OGUZ DAVUTOGLU, Eren GUNDUZ, Fatih YAMAN, Serap ARSLAN, Oğuz ÇİLİNGİR, Sevgi IŞIK, Beyhan DURAK ARAS

Kronik Faz Kronik Miyeloid Lösemi Hastalarının Akış Sitometrik Analizi

Morfoloji ve sitogenetik için kemik iliği aspiratı ve periferik kan hücrelerinde kalitatif revers transkriptaz polimeraz zincir reaksiyonu, kronik miyeloid lösemi (KML) tanısı için zorunludur. Seçilmiş hastalarda kemik iliği biyopsisi ve floresan in situ hibridizasyon gerekli olabilir. Diğer testlerin ve teşhis prosedürlerinin uygulanması, bireysel hastanın özelliklerine bağlıdır. Akış sitometrisi birçok hematolojik malignitenin tanısında ve izlenmesinde önemli bir araç olmasına rağmen, KML'de sınırlı bir rolü vardır. Bu çalışmada KML hastalarımızın tanı anında ve takip sırasındaki CD45 dağılım sonuçlarını değerlendirdik. İmatinib ile tedavi edilen kronik fazdaki toplam 56 KML hastası (22 kadın ve 34 erkek) çalışmaya dahil edildi. Hastalar ortalama 8 (3-19) aylık takipliydi. Hastaların tanı ve takipteki tam kan sayımı parametreleri ile CD45/SSC sonuçları retrospektif olarak değerlendirildi. İki grup arasındaki ortalamaları karşılaştırmak için Wilcoxon T testi kullanıldı. p<0.05 değeri istatistiksel olarak anlamlı kabul edildi. Hepsinde lökosit ve trombosit sayıları azalmıştı. Hemoglobin değerinde farklılık görülmedi. Tanı ve takipteki CD45/SSC sonuçlarının karşılaştırılmasında granülosit ve blast yüzdelerinde azalma, lenfosit, monosit, normoblast yüzdelerinde artış saptandı. Hastaları MMR pozitif veya MMR negatif olarak 2 gruba ayırdığımızda tam kan sayımı ve CD45/SSC sonuçları farklı değildi. MMR pozitif ve negatif hastaların sağkalımı da benzer bulundu. Çalışmamızın sonuçlarına göre, CD45/SSC'nin rutin tanı ve/veya takip aracı olarak kullanılmasını öneremedik. Ancak çalışmamızın sınırlı hasta sayısı, MMR değerlendirme zamanı ile sadece bir zaman noktasındaki değerlendirme gibi kısıtlılıkları vardı. Seri CD45/SSC analizi ve farklı tirozin kinaz inhibitörleri ile yapılan daha büyük çalışmalarda sonuçlar değişebilir.

Anahtar Kelimeler:

kronik miyeloid lösemi, CD45/SSC, imatinib

Flow Cytometric Analysis of Chronic Phase Chronic Myeloid Leukemia Patients

Bone marrow aspirate for morphology and cytogenetics and qualitative reverse transcriptase polimerase chain reaction on peripheral blood cells is mandatory for the diagnosis of chronic myeloid leukemia (CML). Bone marrow biopsy and fluorescence in situ hybridisation may be necessary in selected patients. Performing other tests and diagnostic procedures depends on characteristics of the individual patient. Although flow cytometry is an essential tool in the diagnosis and monitoring of many hematological malignancies, it has a limited role in CML. In this study, we evaluated the CD45 side scatter results of our CML patients at diagnosis and during follow up. Totally 56 CML patients (22 female and 34 male) in chronic phase treated with imatinib were included. Patients were also evaluated after 8 (3-19) months follow up. Complete blood cound parameters and CD45/SSC results of the patients at diagnosis and follow up were evaluated retrospectively. The Wilcoxon T test was used to compare the means between the two groups. p<0.05 was considered statistically significant. All of them had decreased leukocyte and platelet counts. There was no difference in hemoglobin value. Comparison of CD45/SSC results at diagnosis and follow up revealed a decrease in granulocyte and blast percentages, and an increase in lymphocyte, monocyte, normoblast percentages. Complete blood counts and CD45/SSC results were not different when we divided patients into 2 groups according to being MMR positive or MMR negative. Survival of MMR positive and negative patients were also found similar. According to the results of our study, we were unable to suggest using CD45/SSC as a routine diagnostic and/or follow up tool. However, there were limitations of our study such as the limited number of patients, the variance between the time of MMR evaluation and the evaluation at only one time point. The results may change in larger studies with serial CD45/SSC analysis and with different tyrosine kinase inhibitors.

Keywords:

chronic myeloid leukemia, CD45/SSC, imatinib,

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