Study of the expression of survivin and mutant p53 in pediatric acute lymphoblastic leukemia

Childhood acute lymphoblastic leukemia is the most common malignancy in children with a yearly incidence of 31/1000000 children younger than 15 years old. The peak incidence of childhood ALL is between 3 and 6 years of age with male predominance. The relative frequency of pediatric ALL in the NCI-Cairo University is 35.5% for the years 2003-2004. In this study survivin and mutant p53 expressions were studied in 64 newly diagnosed pediatric ALL patients. Their associations to the different prognostic factors of ALL and their association to each other were studied. In this study, 21 out of 64 ALL cases [32.8%] showed positive expression of survivin [17 patients were moderately positive, 2 patients were strong positive and 2 patients were weak positive] and 24 out of 64 studied ALL cases [37.5%] demonstrated positive expression of p53 [20 patients were strong positive, 3 patients were moderately positive and 1 patient was weak positive]. On comparing survivin expression with the different prognostic factors of ALL, the results were statistically significant as regards the percentage of blasts in the peripheral blood [p-value = 0.0068], and the percentage of blasts in the bone marrow [p-value = 0.05]. As regards LDH, ALP, and uric acid serum concentrations, no statistically significant differences were found [p-value = 0.154, 0.52 and 0.41 respectively]. No significant association was found between survivin expression and hepatosplenomegaly. As regards p53 expression compared with the different prognostic factors no statistically significant results were found. According to immunophenotyping [IPT], survivin was positive in 5 out of 14 cases [35.7%] of proB-ALL, 0% [0/11] C-ALL, 29.2% [7/24] preB-ALL, 75% [6/8] mature B-ALL and 42.9%[3/7] T-ALL. The results were statistically significant [p-value = 0.046], while p53 was positive in 4 out of 14 cases [28.5%] of proB-ALL, 36.4% [4/11] C-ALL, 41.6% [10/24] preB-ALL, 50% [4/8] mature B-ALL and 28.6% [2/7] T-ALL. The results were statistically non significant. No significant correlation was found between survivin and p53 expression in the studied ALL cases [p-value = 0.872]. In this study, a total of 23 patients successfully completed induction phase. All of them achieved complete remission. Two patients developed isolated bone marrow relapse at a median period of 7.5 months. The disease free survival for the 23 patients was 89.6% at a median of 11 months. The DFS for P53 positive [12/23] and p53 negative [11/23] patients was 91.7% and 90.9% respectively [p= 0.90]. The DFS for survivin positive [11/23] and survivin negative [12/23] patients was 85.7% and 93.7% respectively [p=0.49]. In conclusion, we could not find any association between p53 and survivin expressions and the different prognostic factors of pediatric ALL patients, [the only statistically significant results were obtained when comparing the blast count% in both the peripheral blood, and the bone marrow between survivin positive and survivin negative cases]. As regards the comparison of survivin expression and phenotyping of the studied patients, it was not expressed in C-ALL cases which are known to have a good prognosis. Further we could not decide whether positive p53 or survivin in ALL patients had an impact on DFS. Further studies with larger number of patients and longer duration of follow up are recommended to throw more light on the significance of p53 and survivin in relation to ALL patients

Assessment of immunological response to schistosma hematobium in patients with urinary tract morbidity and its correlation to clinical findings and pathological changes

Schistosomiasis is one of the most widespread parasitic infections. United Arab Emirates is a country free of Schistosomiasis. Cases enrolled in our study were all expatriate. The risk of developing overt urinary tract pathology is well known to be related to the extent of host inflammatory response to surface egg antigen [SEA]. This study examined the hypothesis that nature of the host response to Schistosoma ova is considered a risk factor for urinary tract morbidity. In this study, 50 patients with proven Schistosoma haematobium infection were subjected to estimation of serum level of soluble egg specific antibody [SEA IgG], TNF-alpha, IFN-gamma, IL-4 and IL-10 production. Correlation between these parameters and both clinical data and the severity of bladder pathology as determined by ultrasonography and cystoscopic examination of lower urinary tract. We found strong association between increased TNF-alpha, decreased IFN-gamma production and IL-10 diminished release and bladder pathology in those patients. The level of anti-SEA IgG was positively correlated with bladder pathology. We can conclude that modulation of immune response by different cytokines can be helpful in the management of schistosoma hematobium infected patients