Contributions
Abstract: PB1864
Type: Publication Only
Background
One of the important issues that should be considered within the studies concerning pathogenesis of the immune cytopenia in chronic lymphocytic leukemia (CLL) is impairment of the cytokine balance resulting from the disorders of the intercellular interactions between cytokine producing blood cells.
Aims
of the study were to investigate the level of certain regulatory cytokines in patients with CLL, including those with development of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP), which frequently may complicate the course of leukemia.
Methods
68 CLL patients aged 45-77 years, including 39 without immune complications and 29 with presence of immune cytopenia not related to previous therapy were investigated. The male to female ratio was 1.3:1, the distribution by Rai stage was as follows: stage II – 15 patients, stage III – 31 patients, stage IV - 13 patients. The control group consisted of 12 healthy subjects aged 50-80 years. The concentration of IL-2, IL-6, IL-17A and IL-33 was measured using the validated commercial ELISA kits.
Results
39 patients with CLL without autoimmune complications appeared to have significantly increased IL-2 and IL-6 levels compared to healthy individuals, while IL-17A and IL-33 concentrations did not significantly differ from the control group (Tab.1). Positive DAT, elevated serum indirect bilirubin (55,27±18,6 umol/l), reticulocytosis (4,7±1,0%), and erythroid hyperplasia in bone marrow have been confirmed in 15 patients with CLL AIHA. There is a significant increase of IL-2, IL-6 and IL-17A levels compared to the healthy individuals in this group of patients (Tab.1). The concentration of IL-33 was 3 times higher than in the healthy individuals, but the difference was unreliable due to significant fluctuations of the results in some patients (Tab.1). In 14 patients with CLL mean platelet count was 37,6±10,7*109/l, ITP was established on the basis of rapid blood thrombocytopenia and hypermegakaryocytosis in the bone marrow. Just like in patients from the previous two groups, their IL-2 and IL-6 levels were also significantly higher than those in healthy subjects. The concentration of IL-17A did not differ significantly from the control group and patients without immune complications, but was significantly lower than in subjects with AIHA. The level of IL-33 in this group was not significantly different from healthy individuals and patients from other groups (Tab.1).
Conclusion
The obtained results reflect activation of the IL-17 production in patients with CLL-associated AIHA. Similar but not statistically significant changes were found also for IL-33, elevation of which was also reported in certain publications for cases of AIHA without leukemic background. However, in patients with CLL ITP levels of these cytokines were lower as compared to CLL AIHA, and did not significantly differ from the healthy individuals and CLL patients without immune cytopenia. This could possibly be a result of difficulties in differentiation between metaplastic and immune thrombocytopenia in CLL. At the same time significantly increased levels of IL-2 and IL-6 were observed in all three groups of patients which apparently reflects major impairments of the spectrum of regulatory cytokines in patients with advanced stages of CLL. Investigating the dynamic changes in concentration of these cytokines may be important for prognosis of the leukemia progression as well as development of CLL-associated AIHA.
Session topic: 6. Chronic lymphocytic leukemia and related disorders - Clinical
Keyword(s): Autoimmune hemolytic anemia (AIHA), Chronic Lymphocytic Leukemia, Cytokine, Immune thrombocytopenia (ITP)
Abstract: PB1864
Type: Publication Only
Background
One of the important issues that should be considered within the studies concerning pathogenesis of the immune cytopenia in chronic lymphocytic leukemia (CLL) is impairment of the cytokine balance resulting from the disorders of the intercellular interactions between cytokine producing blood cells.
Aims
of the study were to investigate the level of certain regulatory cytokines in patients with CLL, including those with development of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP), which frequently may complicate the course of leukemia.
Methods
68 CLL patients aged 45-77 years, including 39 without immune complications and 29 with presence of immune cytopenia not related to previous therapy were investigated. The male to female ratio was 1.3:1, the distribution by Rai stage was as follows: stage II – 15 patients, stage III – 31 patients, stage IV - 13 patients. The control group consisted of 12 healthy subjects aged 50-80 years. The concentration of IL-2, IL-6, IL-17A and IL-33 was measured using the validated commercial ELISA kits.
Results
39 patients with CLL without autoimmune complications appeared to have significantly increased IL-2 and IL-6 levels compared to healthy individuals, while IL-17A and IL-33 concentrations did not significantly differ from the control group (Tab.1). Positive DAT, elevated serum indirect bilirubin (55,27±18,6 umol/l), reticulocytosis (4,7±1,0%), and erythroid hyperplasia in bone marrow have been confirmed in 15 patients with CLL AIHA. There is a significant increase of IL-2, IL-6 and IL-17A levels compared to the healthy individuals in this group of patients (Tab.1). The concentration of IL-33 was 3 times higher than in the healthy individuals, but the difference was unreliable due to significant fluctuations of the results in some patients (Tab.1). In 14 patients with CLL mean platelet count was 37,6±10,7*109/l, ITP was established on the basis of rapid blood thrombocytopenia and hypermegakaryocytosis in the bone marrow. Just like in patients from the previous two groups, their IL-2 and IL-6 levels were also significantly higher than those in healthy subjects. The concentration of IL-17A did not differ significantly from the control group and patients without immune complications, but was significantly lower than in subjects with AIHA. The level of IL-33 in this group was not significantly different from healthy individuals and patients from other groups (Tab.1).
Conclusion
The obtained results reflect activation of the IL-17 production in patients with CLL-associated AIHA. Similar but not statistically significant changes were found also for IL-33, elevation of which was also reported in certain publications for cases of AIHA without leukemic background. However, in patients with CLL ITP levels of these cytokines were lower as compared to CLL AIHA, and did not significantly differ from the healthy individuals and CLL patients without immune cytopenia. This could possibly be a result of difficulties in differentiation between metaplastic and immune thrombocytopenia in CLL. At the same time significantly increased levels of IL-2 and IL-6 were observed in all three groups of patients which apparently reflects major impairments of the spectrum of regulatory cytokines in patients with advanced stages of CLL. Investigating the dynamic changes in concentration of these cytokines may be important for prognosis of the leukemia progression as well as development of CLL-associated AIHA.
Session topic: 6. Chronic lymphocytic leukemia and related disorders - Clinical
Keyword(s): Autoimmune hemolytic anemia (AIHA), Chronic Lymphocytic Leukemia, Cytokine, Immune thrombocytopenia (ITP)