Abstract
Background: High levels of MCL-1 and BCL-2 proteins have been found in Chronic Lymphocytic Leukemia (CLL), and inversely correlated with response to treatment. BCL-2/Bax ratio is the main director of apoptosis in CLL. The study aimed to clarify the prognostic role of MCL-1, BCL-2 and BCL-2/ Bax ratio in B-CLL. Patients & method: Estimation of MCL-1, BCL-2 and Bax expressions by a flow cytometry in 45 B-CLL patients and the prognostic value of these markers were correlated with other well-known established prognostic markers and treatment response. Results: MCL-1 was expressed in 60% of cases while BCL-2 was expressed in 82.2% of cases. MCL-1 expression was significantly high in male gender, short lymphocyte doubling time (LDT), and high expression of CD 38 (p β2M, CD38 expression), low ZAP-70 expression, splenomegaly and higher Rai stage were significantly increased in patients with high expression of BCL-2 (p β2M, high C-D38 expression, low ZAP-70 expression, the poor cytogenetic and splenomegaly in patients with high expression of BCL-2/ Bax ratio (p < 0.001). Among the 39 patients who started treatment when indicated responding patients had statistically significant lower BCL-2/Bax ratio than non-responding patients, although their lower mean of MCL-1 and BCL2 expressions values were insignificant. In conclusion: MCL-1, BCL-2 expressions and BCL-2/Bax ratio could be useful potential predictive and prognostic markers in B-CLL.
Highlights
The most prevalent form of adult leukemia is B-Chronic lymphocytic leukemia (B-Chronic Lymphocytic Leukemia (CLL)); it is characterized by accumulation of CD5+ and CD23+ B-cell lymphocytes [1]
Patients & method: Estimation of MCL-1, BCL-2 and Bax expressions by a flow cytometry in 45 B-Chronic lymphocytic leukemia (B-CLL) patients and the prognostic value of these markers were correlated with other well-known established prognostic markers and treatment response
MCL-1 was expressed in 60% of B-CLL cases with mean ± SD (60.6 ± 41.98), MCL-1 expression was significantly high in male patients, short lymphocytic doubling time (LDT), and high expression of CD 38 (p < 0.001) as shown in Table 2, BCL-2 was expressed in 82.2% of B-CLL cases, with mean ± SD (52.93 + 29.05)
Summary
The most prevalent form of adult leukemia is B-Chronic lymphocytic leukemia (B-CLL); it is characterized by accumulation of CD5+ and CD23+ B-cell lymphocytes [1]. Some studies showed that high BCL-2 levels and low expression of bax protein are connected to treatment resistant in CLL cells [8]. We evaluated the effect of MCL-1, BCL-2, and BCL-2/Bax ratio on tumor response, survival, and relation to other established markers in CLL. High levels of MCL-1 and BCL-2 proteins have been found in Chronic Lymphocytic Leukemia (CLL), and inversely correlated with response to treatment. Patients & method: Estimation of MCL-1, BCL-2 and Bax expressions by a flow cytometry in 45 B-CLL patients and the prognostic value of these markers were correlated with other well-known established prognostic markers and treatment response. In conclusion: MCL-1, BCL-2 expressions and BCL-2/Bax ratio could be useful potential predictive and prognostic markers in B-CLL
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