الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
cute myeloid leukemia (AML) is the most common type of acute leukemia in adults and is fatal as a result of primary refractoriness, relapse, or treatment-related mortality. Although the majority of patients with AML enter remission upon induction chemotherapy, the risk of relapse is considerable.
Transplantation regimens can be curative, but it remains challenging to identify high risk patients suitable for early transplantation. The current risk assignment uses age, genetic subtype and response to initial therapy to stratify patients. Notably, many relapses occur in patients who initially present with favorable prognostic features.
New prognostic biomarkers may fine-tune risk assessment in adult AML and understanding their roles in leukemia may facilitate the selection of treatment options and benefit patients. Therefore, there is a clear need to improve the identification of patients at increased risk of relapse, particularly those currently stratified as favorable risk, for whom more intensive treatments are already available.
ADAM28 is a member of the ADAM (a disintegrin and metalloproteinase) gene family and consists of two isoforms, prototype membrane-type form and short secreted form. The metalloproteinase domain of ADAM28 has the zinc binding consensus sequence, and ADAM28 exhibits catalytic activity to a few substrates such as insulin-like growth factor binding protein-3.
ADAM28 in malignant cells is up-regulated by multiple mechanisms, including the cleavage of von Will brand factor (vWF), insulin-like growth factor binding protein-3 (IGFBP-3) and connective tissue growth factor (CTGF), as well as the promoting PSGL-1/P-selectin-mediated cell adhesion. Studies show that ADAM28 is highly expressed in several human tumors, such as lung, breast and bladder cancers, and chronic lymphocytic leukemia, and its tissue expression levels correlate with cancer metastasis.
ADAM28, a member of the ADAM family of metalloproteinases, is over-expressed in several human tumors and is related to cell proliferation and metastasis. Previous studies had demonstrated that the expression level of ADAM28 is significantly elevated in patients with relapsed acute lymphoblastic leukemia, which was associated with poor prognosis. However, the impact of ADAM28 on relapse and the prognosis of patients with AML remain unclear.
To date, there has been no information available on the function and the prognostic relevance of increased ADAM28 levels in adult AML patients. Therefore, we aimed to evaluate ADAM28 expression in newly diagnosed adult Egyptian Acute Myeloid Leukemia patients and to assess its impact on outcome.
This was a prospective case control study was conducted at Ain Shams university hospitals. Clinical hematology division of internal medicine department including 60 participants: 30 adult patients with newly diagnosed AML and 30 healthy age and sex matched control. The duration of the study was 6 months.
The main findings of the study revealed that:
• There was no statistically significant difference between the studied groups as regard demographic data
• There was high statistically significant difference between the studied groups as regard BMI.
• According to FAB score there were 8 (26.7%) M1, 10 (33.3%) M2, 8 (26.7%) M3 and 4 (13.3%) M4.
• There was high statistically significant difference between the studied groups as regard WBCs, Plts, blast and ESR and statistically significant difference as regard Hb.
• There was no statistically significant difference between the studied groups as regard Liver and kidney function tests.
• There was no viral infection detected.
• According to Cytogenetic risk category there were 4 (13.3%) favorable, 18 (60%) intermediate and 8 (26.7%) unfavorable.
• There was high statistically significant difference between the studied groups as regard ADAM-28m and ADAM-28s.
• According to MRD there were 17 (56.7%) <0.1 and 13 (43.3%) >0.1 and there were 6 who died.
• There was significant correlation between ADAM-28 and MRD at follow-up.
Based on our findings, we recommend for further studies on larger sample size and on large geographical scale to emphasize our conclusion.