دراســة فســلجيـة وكيمـوحيــوية ﻹبيضاض الدم اللمفاوي الحاد لدى اﻷطفال العراقييـن قبــل وبعــد العــلاج الكيميــاوي

A Physiological and Biochemical Study of Acute ‎Lymphoblastic Leukemia in Iraqi Children‏ ‏before and after ‎Chemotherapy ‎

“During the extended period (from the beginning of March 2019 until the end ‎of February 2020) in the Center of Oncology of Hematology in the Medical ‎City of Imam Al-Hussain in Holy Karbala. 31 children with newly diagnosis ‎of Acute Lymphoblastic Leukemia (ALL), their ages were ranged from 2-12 ‎years old (18 males and 13 females). ALL patients were follow-up until they ‎received four doses of chemotherapy. The control group included 40 healthy ‎control with age range 2-12 years old (20 males and 20 females). ‎ The present study was designed to evaluate the levels of galectins ‎‎(Galectin-9), and mannose-binding lectin (MBL), as well as numerous routine ‎hematologic parameters and indices. Additionally, evaluated the levels of the ‎index for oxidative stress which involved Nitric oxide (NO). Besides, the ‎determination of total antioxidant parameters included (T-GSH and GSSG). ‎The data of the present study comprised monitoring the levels of certain ‎hormones; such as Erythropoietin (EPO), Serotonin (ST), and Parathyroid ‎‎(PTH), as well as Total Protein (TP), Albumin (Alb), and Ferritin (FT); ‎furthermore, vitamins, including vit D3 and vit B12, in addition; certain trace ‎elements (Zn, Co, Fe, Mn, and Cu), as well as other electrolytes were assessed ‎in the sera of children with ALL (at diagnosis) until patients receiving four ‎doses of chemotherapy and the recorded outcomes of patients were compared ‎to the results of control.‎ The results of the current study were exhibited a significant increase ‎‎(p˂0.05) at the levels of WBCs, Gal-9, MBL, NO, EPO, ST, vit D3, vit B12, ‎FT, Mn, and Ca2+, while the outcomes showed a statistically significant ‎decrease (p˂0.05) at the levels of RBCs, Hgb, HCT, Plts, MCHC, T-GSH, ‎GSSG, PTH, TP, Alb, Co, and K+ in the sera samples of patients with ALL ‎‎(pre-treatment) when compared to the control group, whereas the levels of ‎MCH, Zn, Fe, Cu, Mg2+, Na+, and CL- did not vary significantly, but there ‎was a non-significant increase in MCV level in blood samples of patients. On ‎the other hand, the data have shown decreased levels in each of the following ‎parameters in ALL patients after receiving chemotherapeutic doses: WBCs, ‎Gal-9, MBL, NO, ST, vit D3, FT, Fe, Cu, Ca2+, Mg2+, Na+, CL-, and K+, ‎however; RBCs showed a fluctuating decrease, while other hematological ‎parameters presented a slight and gradual rise than their levels at diagnosis; ‎such as Hgb, HCT, Plts, MCV, MCH, MCHC, T-GSH, GSSG, TP, Alb, Zn, ‎and Co, while each of EPO, vit B12, and Mn levels remain constantly rising ‎after chemotherapy, whereas PTH also remains at a low level after treatment, ‎as it was at the time of diagnosis.‎ The present work showed acceptable statistical correlations at the ‎‎(p˂0.05 and p˂0.01) levels (positive or negative) among the evaluated ‎parameters in the study. A positively significant correlation was observed for ‎Gal-9 and MBL in the sera of ALL patients and control group with the NO, ‎ST, and EPO levels, as well as a high positive correlation, was recorded ‎within antioxidants molecules (T-GSH, GSSG) and trace elements (Zn, Co, ‎Mn, and Cu), moreover; between Zn with Co, Mn, and Cu on the one hand, ‎as well as Co with Mn and Cu on the other side, while the study recorded a ‎negative correlation relationship when comparing Gal-9 and MBL with levels ‎of antioxidants (T-GSH and GSSG), as well as with trace elements (Zn, Co, ‎Mn, and Cu), while a high negatively correlation was noticed between EPO ‎with trace elements (Zn, Co, Mn, and Cu). ‎ The FT, EPO, Gal-9 showed the highest single sensitivity (100%) ‎among the criteria assessed followed by MBL (77%), while the lowest ‎sensitivity level for patients was 39%, 29%, and 10% for T-GSH, PTH, ‎GSSG, separately in children with ALL compared to the control group.‎ It was also noted that the variance capacity of assessed standards ‎generally increased when they were linked. The maximum sensitivity rate ‎‎(100%) was observed when the FT, EPO, and Gal-9 were combined to the ‎PTH, MBL, T-GSH, GSSG, NO, and ST, as well as‎‏ ‏the sensitivity of ‎diagnostic efficiency of MBL increased to 94% and‏ ‏‎90% when evaluating‏ ‏its ‎levels with‏ ‏NO and GSSG respectively, as well as the diagnostic sensitivity ‎for T-GSH was reached (87%) when assessing its levels with MBL and NO, ‎while the lowest allergic rate was 39% and 35% for PTH with GSSG and ST.‎ Keywords: Acute Lymphoblastic Leukemia (ALL), Galectin-9 (Gal-9), ‎Mannose Binding Lectin (MBL), Hematologic Parameters and Indices, ‎Oxidants and Antioxidants, Vitamins D3 and B12, Hormones & Proteins, ‎Trace Elements, Chemotherapeutic Doses”