Cytokine profiling as a prognostic markers in chronic myeloid leukemia patients.

Chronic myeloid leukemia (CML) accounts for 20% of all adult leukemias worldwide. Most Egyptian patients are diagnosed in the chronic phase and progress to the accelerated or blastic phase, which is related with decreased survival. Various pro-inflammatory cytokines are involved in the pathogenesis of chronic leukemia but their prognostic significance is unknown. The aim of the current study is to determine the validity of TNF-alpha, IL-6, IL-18 and CRP levels as prognostic markers in CML patients. These parameters were monitored with clinical routine tests in 25 CML patients besides ten healthy control subjects at National Cancer Institute, Cairo, Egypt. IL-6 and IL-18 levels before hydroxyurea treatment were significantly higher in all patients compared to controls (P<0.001 for both levels). At hematological remission, significant reductions were observed for IL-6 (P<0.001), IL-18 (P<0.001) and CRP (P<0.001) whereas reduction in the levels of TNF were non-significant. Moreover, an inverse correlation was observed between both of TNF (P<0.05) and CRP (p<0.01) on one side and megakaryocytic dysplasia on the other side. These findings offer evidence that TNF may have potential prognostic role in megakaryocytic dysplasia detection.

Role of TNF-alpha as a survival prognostic marker in chronic lymphocytic leukemia patients.

Pro-inflammatory cytokines play a central role in the pathogenesis of chronic leukemia. This pilot study assesses the potential value of measuring TNF-alpha, IL-6, IL-18 and CRP levels as prognostic markers for disease monitoring in CLL patient. These parameters were evaluated in 45 CLL patients and 25 healthy control subjects IL-6 on contraire to the other cytokines, was significantly higher (P<0.05) in patients compared to controls. At hematological remission, only CRP was significantly reduced (P<0.005). IL-6 is inversely correlated with Hb (P<0.05). In the meantime, IL-18 is correlated to splenomegaly, and CRP (P<0.05; for both). TNF-alpha level in non-survived patients was significantly higher than both survived patients (P<0.05), and controls (P<0.01). In conclusion, TNF-alpha can be potentially used as a survival prognostic factor in CLL.

Interpretation of symptom presentation and distress. A Southeast Asian refugee example.

Symptom expression or the manifestation of distress is greatly influenced by one's cultural background. This exploratory study investigated symptom presentation of distress among a community sample of Vietnamese, Chinese-Vietnamese, Cambodian, and Lao refugees. The study examined whether or not the Western-designed distress measure used in the study was culturally sensitive enough to accurately capture culturally framed expressions of distress. The results of the factor analyses showed that the four Southeast Asian refugee groups did not express distress in three separate factors as devised in the original measure. Instead, a single robust factor emerged. The single factor comprised items from the depression, anxiety, somatic, and psychosocial dysfunction subscales. The items that made up the single factor strongly resemble the construct for the diagnosis of neurasthenia. Researchers have found neurasthenia to be a culturally sanctioned Asian cultural idiom of distress. The findings strongly suggested that this Southeast Asian refugee population expressed distress in a pattern of symptoms more consistent with Asian nosology. The clinical and research implications of the results of this exploratory study are also discussed.