Investigation of Treg in Pediatric Acute Lymphocytic Leukemia Patients during Chemotherapy Stages and Relapse

Abstract

A cross-sectional case-control study has been carried out on Treg cells in pediatric acutelymphoblastic leukemia (ALL) patients admitted to Al-Basrah Children Teaching SpecialtyHospital from November 2022 to May 2023. A total number of 70 patients (25 newlydiagnosed, 12 relapse, 21 during induction, and 12 during consolidation chemotherapy)were enrolled, aged 2 to 14 years, along with 54 healthy controls who were the sameage and gender as the study. Blood samples were collected from all participants for flowcytometer applied to study Treg cell markers. The results of the current study showedthat the highest percentage of ALL patients was in the age group of 2 to 5 years 54.3%followed by age group 6 to 12 years 41.4%, whereas the lowest percentage was in patientsolder than 12 year 4.3% (p-value 0.802). The p-value was considered significant if it is ?0.05 and highly significant if ? 0.001. Regarding the flow cytometry analysis results forCD3, CD4 and CD25, ALL patients had a significantly higher mean of these markers thanthe control group (p-value ? 0.005). A slightly higher level CD4 was noted in new casescompared to relapse cases, and induction and consolidation (p = 0.080). The results ofTreg levels cells in relapse, induction, consolidation and new diagnosis cases. On the otherhand, demonstrate higher levels in the relapse group, with highly significant differencesfor the two parameters: CD3–CD25 (p ? 0.005). The level of CD25 displayed a highlysignificant difference when comparing induction with consolidation (p ? 0.005). Fromthis study, we conclude that the immunological marker (CD 25) specifically provided themost highly significant value as immunosuppression parameters in all patients, whereaschemotherapy represents the key risk factor for immunosuppression in all patients variessignificantly among chemotherapy stages, with consolidation having the most impact.This effect may be due to the high dose of MTX.Background: T regulatory cells (Tregs) are immunosuppressive cells that can be dividedinto numerous subsets. Tregs comprise a small but heterogeneous population, which thephenotype may identify as CD3+CD4+CD25+. They play a crucial role in the preservation of immunological homeostasis and self-tolerance. They also play important roles In the control of cancer immunity. Tregs mayalso be important in acute leukemia.Patients and Methods: A7 0 blood samples of both sexes with the age range 2 to 14 years old were collected from patients withALL. Additionally, this investigation included 54 healthy controls included in CD3, CD4 and CD25 expression on leukemicblast cells were assessed using flow cytometry.Results: Increased values of CD3+CD25+ T cells were observed in children with all in comparison to healthy controls withsignificant differences in the markers for Tregs (mean ± SD, 14.971 ± 11.06 vs. 5.680 ± 2.96 pg/mL) (p <0.05).Following these findings, significant differences in the levels of CD25 was higher in consolidation than in the inductionchemotherapy stage (mean ± SD, 17.657 ± 13.890 vs. 5.100 ± 5.1438) pg/mL (p <0.05), children with all were also found tohave significantly higher levels of CD4 in the current study when compared to healthy controls (mean ± SD, 29.261 ± 13.828vs. 28.3465 ± 11.17146) pg/mL (p <0.05), Table 2.According to the chemotherapy stage there were significant significant differences in the levels of CD25 in the relapse state,which was higher than the chemotherapy stage for new diagnosis (mean ± SD, 22.185 ± 15.148 vs. 13.649 ± 5. 83) pg/mL (p<0.05). A further finding was that the frequency of lymphoblast that expresses CD25 was considerably higher in the high-riskgroup compared to the standard risk group (mean ± SD, 15.75 ± 4.74 vs. 7.92 ± 1.012) pg/mL (p <0.05) Table 3.Conclusion: Chemotherapy represents the interested immunosuppression risk factor in ALL patients. There is a significantvariation among chemotherapy stages in ALL patient immunosuppression. Consolidation represent the high influence on ALLpatient in immune suppression may be related to the high dose of MTX.