Prognostic Impact of Poliovirus Receptor Expression (PVR) (CD155) in Context to FLT3-ITD and NPM1 Mutation Status at Egyptian Acute Myeloid Leukemia

Background: Acute myeloid leukemia is a heterogeneous hematological malignancy with diversity in molecular, phenotypic and genetic alteration. Accurate assessment of prognosis is mandatory to reduce relapse, changing treatment related mortality, decision making for appropriate therapy protocols. Aim: A case control observational analytical study to assess the prognostic value of poliovirus (CD155) in acute myeloid leukemia and its significant in-patient stratification. Subject & Methods: 100 newly diagnosed de novo AML selected from oncology center, Mansoura University. Measurement of PVR (CD155) by multiparameter flow cytometry in addition to cytogenetic and molecular stratification. Results: Statistical stratification according to median cut off CD155 > 5.35. Higher expression was associated with an increased risk of death and relapse, LDH. While lower expression is associated with longer OS & DFS. Cox regression with univariate analysis revealed that LDH, molecular stratification, CD155 were significant risk factors for shorter OS, while positive expression of CD16, CD56 AML M3 were significantly associated with longer survival. Multivariate analysis revealed that CD155 was a significant risk factor for shorter OS. Conclusion: Variability in expression of CD155 in AML patients due to dual costimulatory and inhibitory function, high expression associated with tumor bulk and progression, short OS, increased relapse rate. Cox regression analysis shows its independent risk factor. It could be implemented in routine laboratory for risk stratification into low, high risk that needs more therapeutic modalities with new immunotherapy. In future could be targeted therapy such as PDL, CTLA-4 and open more therapeutic hope for those patients.

Down Protein C and S Antigen Could Be Predictor of Mortality Outcome in Critical Egyptian COVID-19 Illness

Background: One of the most serious morbidity and mortality features in COVID-19 is thrombo-embolic manifestation with disturbed hemostasis in natural anticoagulant. Protein S plays a critical role in cytokine storming and acts as cross talk between immune status and coagulation process. So, we aimed to address its role in addition to protein C in severity and outcome of disease, with its role in vaccinated people by AstraZeneca. Methods: The present study was conducted on 70 COVID-19 positive by real-time PCR. 40 of patients had moderate symptoms of respiratory, 30 cases were admitted into ICU of Mansoura University Hospital, some of them under mechanical ventilator. In addition to 40 healthy volunteers after first dose of vaccinated AstraZenka as reference, assessment of protein C&S antigen was done by ELIZA. Results: Significant increase in total leucocytic count in COVID-19 than vaccinated volunteer with significant reduction in absolute lymphocytosis, increased neutrophilia. First significant observation was higher MPV in COVID-19 than vaccinated, in addition to significantly higher C-reactive protein in severe cases than moderate and vaccinated. Prominent interesting finding in our study was significant reduction in Protein C&S in severe cases than moderate and vaccinated. Logistic regression analysis revealed that both could be predictor of mortality outcome as CRP in COVID-19 illness. Conclusion: There was significant reduction in protein C&S in severe cases than moderate and vaccinated. Regression analysis shows that could be predictor of mortality as well as CRP, D-dimer. Large extended study and follow up are needed to assess the incidence of thromboembolism and role of protein C&S in different variety protocols of vaccination programs.