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Year : 2013  |  Volume : 2  |  Issue : 1  |  Page : 7-13

Assessment of GM-CSF Level in the Serum of Patients with Different Stages of Chronic Myeloid Leukemia Befor and After Imatinb Mesylate Therapy

1 National Center of Hematology, Almustansiriya University
2 Department of Microbiology, College of Medicine, Al-Mustansiriya University
3 Clinical Hematologist, Baghdad Teaching Hospital/ Medical city

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Background: Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder of primitive haemopoietic progenitor cells. The cytogenetic hallmark of CML is the Philadelphia chromosome, created by a reciprocal translocation between chromosomes 9&22 (t [9;22][q34;q11]). Survival and amplification of hematopoietic progenitors are controlled by a number of regulatory molecules (hematopoietic growth factors). The role of Granulocyte- macrophage colony-stimulating factor (GM-CSF) and its receptor in pathology arises largely as a result of abnormal signaling leading to deregulated myelopoiesis. The development of the BCR-ABL-targeted Imatinib mesylate represents a paradigm shift in the treatment of CML. Data indicate that the level of immune responses against CML is low before Imatinib, rises as treatment is administered and declines again when the BCR-ABL transcript numbers fall to low levels. Objective: To assess and evaluate the significance of levels difference in GM-CSF through newly diagnosed patients, different responder groups (optimal, suboptimal and failure cytogenetic response) and advanced stages (acceleration and crisis groups) of CML Iraqi patients whom receiving Imatinib mesylate (TKI), as an indicator to assess the role of growth factor in pathogenesis of CML disease development and response to treatments. Patients and methods: In this study 128 Iraqi CML patients asses before and after receiving imatinib mesylate treatment which categorized by complete blood picture and fluorescent in situ hybridization (FISH) analysis in to different response groups and stages, then used an ELISA technique to assess serum level of GM-CSF in each response group and advance stage (acceleration and transformed) of CML patients, in comparison to level in 32 healthy control subjects. Results : Out of 128 patients the mean of GM-CSF serum level (pg/ml) for the newly diagnosed, optimal responded, suboptimal responded, failure cytogenetic and advance stage of CML were 399.53±104.50, 325.23±66.37, 428.90±45.70, 347.12±54.45, 521.56±83.73, respectively. While healthy was 269.25±86.27. Conclusion: Uncontrolled granulopoiesis in newly diagnosed patients with CML may be mediated by increased plasma CSF concentrations caused by BCR-ABL activity which may give an idea regarding the role of colony stimulating factors in the pathogenesis of CML disease.

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