The role of tumor necrosis factor alpha and its soluble receptors in infection complicating acute leukaemia

الملخص EN

Septic shock is the major cause of death in patients with acute myeloid leukaemia (AML).

Cytokines especially TNF-a and others are implicated in the severe problems associated with septic shock causing the activation of the pro-inflammatory mediators.

Aim: This study was designed to examine the changes that occur in the levels of TNF-a and its soluble receptors in infection in patients with AML and the changes that occur in these parameters during the neutropenic state.

Patients: Forty-seven patients of newly diagnosed AML (With age range 12-60 years) as well as twenty-five age and sex-matched healthy subjects were included in this study.

Results, patients group was subdivided into 4 subgroups according to the presence or absence of fever and neutropenia.

Patients who were febrile and non neutropenic showed statistically significant rise in TNF-a level compared to control (P< 0.001) also TNF-RI and TNF-RI1 were significantly higher than controls (P< 0.001).

The same results were obtained with the febrile, non neutropenic andfebrile, neutropenic patients.

The febrile, neutropenic patients haVE a mild but significant elevation of sTNF-PJ and sTBF-RIl when compared to control (P< 0.05).

Patients with mild sepsis showed significant (P< 0.01) elevation in TNF-a only.

Patients with severe sepsis showed significant elevation in sTNFR-1.

sTNFR-11 (P< 0.05) for each.

Patients with septic shock showed significant elevation in TNF-a, sTNFR-1andsTNFR-11(P<0.05) for each.

All groups of sepsis were compared with afebrile, neutropenic patients.

Conclusion: The levels of soluble receptors of TNF-a in the serum may reflect the inflammatory status better than TNF-a levels and the rise in their levels iS correlated with the severity of sepsis