Multipl miyelomlu hastalarda çevresel kan lenfosit alt tiplerinin klinik laboratuvar parametreleri ve prognoz ile ilişkisi The relationship between peripheral lymphocyte subtypes and clinical course, laboratory parameters and prognosis in patients with multiple myeloma
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Tarih
2006
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info:eu-repo/semantics/openAccess
Özet
ÖZET Multipl miyelom (MM), plazma hücrelerinin malign klonal bir hastalığıdır. Bu hematolojik malign hastalıkta gerek humoral gerekse hücresel immünitede, infeksiyonlara eğilim yaratan, ciddi bozukluklar geliştiği bilinmektedir. Çalışmamızda MM'lu hastalarda tanı konulduğu dönemde CD4 (T yardımcı) , CD8 (T sitotoksik/supressor) ve CD19 (B lenfosit) hücre oranlarının tespit edilerek, kontrol grubu ile karşılaştırıldı ve bu hücrelerin MM hastalardaki klinik, laboratuvar bulguları ve prognoz ile ilişkisi araştırıldı. Bunun için, Trakya Üniversitesi Tıp Fakültesi İç Hastalıkları Anabilim Dalı, Hematoloji Bilim Dalında gerçekleştirilen ileri yönelik çalışmamıza, 2003'den 2006'ya kadar takip edilen 34 MM hastası ve kontrol grubu olarak 38 gönüllü alındı. CD4+ lenfosit sayıları MM'li hasta grubunda kontrol grubuna göre belirgin olarak daha düşüktü (p=0.003). CD8+ lenfosit sayıları hasta grubu ile kontrol grubu arasında istatistiksel olarak farksızdı (p=0.074). CD4/CD8 oranı hasta grubunda kontrol grubuna göre istatistiksel olarak anlamlı derecede daha düşüktü. CD19+ lenfosit sayıları hasta grubunda kontrol grubuna göre belirgin olarak daha düşüktü (p=0.007). Tanı konulduğu dönemde infeksiyonu olan ve olmayan hastalar arasında CD4+, CD8+, CD19+ lenfosit sayıları ve CD4/CD8 oranı karşılaştırıldığında istatistiksel fark yoktu. CD4+, CD8+, CD19+ lenfosit sayısı ve CD4/CD8 oranı 3 kür kemoterapi öncesi ve sonrası farklı değildi. Ortalama sağkalım 12.94±13.73 ay idi. CD4+, CD8+ ve CD19+ lenfosit sayılarının ve CD4/CD8 oranın total sağkalım üzerinde bir etkisi olmadığı bulundu (p> 0.05). Sonuç olarak çalışmamız, miyelom hastalarında tanı konulduğu dönemde immün sistem hücrelerinde önemli sayısal bozuklukların olduğunu ve bu bozuklukların KT altında devam ettiğini göstermektedir. Tanı konulduğu dönemde immün sistem hücrelerin sayısı ile hastaların genel sağkalım süreleri arasında ilişki bulunmamış ve yine bu hücrelerin sayılarındaki farklılıkların miyelomda infeksiyon gelişimine katkısı, çalışmamızın verileri ile desteklenmemiştir. Miyelomdaki yaşam süresini belirleyen faktörlerin çokluğu ve infeksiyon eğilimini yaratan faktörlerin kompleksliği, bu konuda daha geniş ve homojen hasta gruplarını içeren prospektif çalışmaların gerekliliğini ortaya koymaktadır. Anahtar kelimeler: Multipl miyelom, lenfosit alt tipleri, infeksiyon, CD4/CD8 oranı
THE RELATIONSHIP BETWEEN PERIPHERAL LYMPHOCYTE SUBTYPES AND CLINICAL COURSE, LABORATORY PARAMETERS AND PROGNOSIS IN PATIENTS WITH MULTIPLE MYELOMA SUMMARY Multiple myeloma is malignant clonal disease of plasma cells. Multiple myeloma is characterized by severe deficiency of humoral and cellular immunity, leading infectious complications. We evaluated the counts of peripheral CD4 (T hepler cells), CD8 (cytotoxic/supressor T lymphocytes) and CD19 (B lymphocytes) positive cells at diagnosis, and tried to find out the relationship between these cells and clinical course, laboratory parameters and prognosis in myeloma patients. Our prospective study included 34 myeloma patients who were treated in Trakya University Hematology Clinic in a time period March 2003-July 2006 and also 38 sex and age matched healthy controls. CD4 and CD19 positive lymphocyte counts in myeloma patients were found to be lower than controls (p=0.003, and p=0.007, respectively). CD8 positive lymphocyte counts showed no statistical difference between patients and controls (p=0.074). CD4/CD8 ratio in myeloma patients were significantly lower than controls. CD4 (+), CD8 (+), CD19 (+) lymphocyte counts and CD4/CD8 ratios at diagnosis were not correlated with infectious complications. CD4 (+), CD8 (+), CD19 (+) lymphocyte counts and CD4/CD8 ratios were not different before and after treatment. Mean survival of patients was 12.94±13.73 months. CD4 (+), CD8 (+), CD19 (+) lymphocyte counts and CD4/CD8 ratios were not correlated with overall survival (p>0.05). In conclusion, our findings showed that myeloma patients at diagnosis had significant quantitative abnormalities of immune system cells, which was persisted after chemotherapy. Overall survival of patients and infectious complications were independent of immune system cell counts. As there are many complex factors affecting survival and infections in myeloma, we need prospective studies including large and homogen patient groups. Key words: Multiple myeloma, lymphocyte subtypes, infection, CD4/CD8 ratio
THE RELATIONSHIP BETWEEN PERIPHERAL LYMPHOCYTE SUBTYPES AND CLINICAL COURSE, LABORATORY PARAMETERS AND PROGNOSIS IN PATIENTS WITH MULTIPLE MYELOMA SUMMARY Multiple myeloma is malignant clonal disease of plasma cells. Multiple myeloma is characterized by severe deficiency of humoral and cellular immunity, leading infectious complications. We evaluated the counts of peripheral CD4 (T hepler cells), CD8 (cytotoxic/supressor T lymphocytes) and CD19 (B lymphocytes) positive cells at diagnosis, and tried to find out the relationship between these cells and clinical course, laboratory parameters and prognosis in myeloma patients. Our prospective study included 34 myeloma patients who were treated in Trakya University Hematology Clinic in a time period March 2003-July 2006 and also 38 sex and age matched healthy controls. CD4 and CD19 positive lymphocyte counts in myeloma patients were found to be lower than controls (p=0.003, and p=0.007, respectively). CD8 positive lymphocyte counts showed no statistical difference between patients and controls (p=0.074). CD4/CD8 ratio in myeloma patients were significantly lower than controls. CD4 (+), CD8 (+), CD19 (+) lymphocyte counts and CD4/CD8 ratios at diagnosis were not correlated with infectious complications. CD4 (+), CD8 (+), CD19 (+) lymphocyte counts and CD4/CD8 ratios were not different before and after treatment. Mean survival of patients was 12.94±13.73 months. CD4 (+), CD8 (+), CD19 (+) lymphocyte counts and CD4/CD8 ratios were not correlated with overall survival (p>0.05). In conclusion, our findings showed that myeloma patients at diagnosis had significant quantitative abnormalities of immune system cells, which was persisted after chemotherapy. Overall survival of patients and infectious complications were independent of immune system cell counts. As there are many complex factors affecting survival and infections in myeloma, we need prospective studies including large and homogen patient groups. Key words: Multiple myeloma, lymphocyte subtypes, infection, CD4/CD8 ratio
Açıklama
Anahtar Kelimeler
Hematoloji, Hematology
