Flowcytometric Measurement of CD5, CD23, and CD38 expression as a diagnostic and prognostic markers in CLL patients

Abstract

Background: B-Chronic lymphocytic leukemia (B-CLL) is a monoclonal malignancycharacterized by an accumulation of terminally differentiated small and anergic B lymphocytes inthe blood, bone marrow and other tissues. CLL is typically characterized by CD5+, CD23+,CD22 -, CD79b-, with weak expression of surface Ig. CD5 also is expressed in B1 subset ofhuman B –lymphocytes. Mature B cell malignancies, such as B-cell chronic lymphocyticleukemia, are mostly CD5 +. CD23 promotes the activation and proliferation of normal Blymphocytes and has an important role in the process of malignant transformation in BCLL.CD38 is expressed on the surface of leukemic cells in a significant percentage of patientswith B-cell chronic lymphocytic leukemia (B-CLL).Its expression has prognostic value in CLL.The current immunophynotype antigens is used to diagnosed as CLL cases, and by using themodern multicolor Flow Cytometry, which made it possible to determine the expression ofseveral such antigens on specific cell populations of the CLL cases.Objectives: To measure the expression of CD5, CD23, and CD38 antigens on the B-cells ofmorphologically diagnosed CLL cases, and showing their correlation with the hematologicalparameters, and with each other.Material and methods: A prospective cohort study including 20 patients including 11 femalesand 9 males morphologically diagnosed with CLL. The patients were attending the NationalCenter of Hematology, Al-Yarmouk teaching hospital for the period from November 2012 toMarch 2013. A total of 2 ml of venous blood were collected from all patients who were selectedrandomly with respect to age, sex, duration and stage of the disease. The diagnosis was done by measuring and calculating the total number of blood cells and lymphocytes and hemoglobin andother by using autoanalyzer blood counter, then flowcytometry was used to measure theappearance of antigens surface CD5 and CD23 CD38.Results: The mean of age of all patients included was 61.95+8.88 SD, and a range of (45-75)years old. There were 11 (55%) males patients, the most common symptoms of patients is anenlarged spleen (45%). 85% of patients who were in Binet stage C, the most advanced stage ofthe disease. Within Binet stage C there was 94.1% percent of patients showed moderate intensityexpression of CD5 and CD23, while 64.7% of them for CD38. There was no statisticalsignificance of CD5, CD23 in relationship to age, hemoglobin or platelet, while CD5 showed asignificant relationship with lymphocytes count and the total number of white blood cells (P<0.05).CD38 showed significant relationship with hemoglobin (P <0.05). There is a significantcorrelation between the CD5 and CD23 P) <0.05), while the CD38 show positive correlation withCD23) P <0.05.Conclusions1-There is a significant correlation between CD5 expression and absolute lymphocyte count, sohigher peripheral blood lymphocyte associated with greater CD5 antigen expression.2-There is a significant correlation between CD5, and CD23 expression, so high CD5 expressionassociated with high CD23 expression.3-There is a significant negative correlation between CD38 expression and Hb level thatreflects a prognostic significance.4-There is a correlation between CD38 expression and CD23 expression.5-No correlation between the intensity of expression of CD5, CD23, and CD38 and stage of thedisease.6-No correlation between CD38 expression and age, WBC count, and lymphocyte count