الفهرس 
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Abstract
CML is a clonal hematopoietic stem cell disorder characterized by the presence of Philadelphia chromosome (22q-) with a specific translocation t(9;22) and progresses through 3 distinct phases: chronic phase, accelerated phase and blastic crisis .
The biological behavior of CML although predicted from the start of the disease, yet the definite timing or event which triggers the switch to a more aggressive entity of the disease is still not fully elucidated. Many prognostic models and staging systems have been advocated in order to categorize those patients who will run a long and stable chronic phase disease and those who will soon enter into the accelerated and final blast stages.
The aim of the present study was to estimate the serum level of soluble urokinase plasminogen activator receptor (su-PAR) in patients with chronic myeloid leukemia in correlation with different phases of the disease to assess any possible role as a prognostic marker.
The study included 20 patients with CML, 10 of whom in the chronic phase (group I) and 10 in the advanced stages of the disease. (group II) .
Ten healthy subjects, matched by age and sex were also included as a control group (group III) for soluble urokinase plasminogen activator receptor (su-PAR) assay.
All patients included in the study were subjected to the following:
1- Thorough history taking.
2- Thorough clinical examination.
3- Laboratory investigations including:
a- Complete blood picture.
b- Bone marrow aspiration.
c-- Leucocyte alkaline phosphatase (LAP) score.
d- BCR-ABL fusion translocation t (9,22) by RT-PCR.
e- Estimation of serum level of su-PAR by ELISA.
The highest incidence of CML patients in our cases was in the sixth decade. There was equal sex distribution in the studied groups. The most prominent complaints were fatigue, abdominal discomfort and bone pains (70% each). Splenomegaly was noted in all patients. Hepatomegaly was seen in 35% of patients and lymphadenopathy in only 2 (10%) patients in group II. A Chloroma was observed in one patient only in blastic crisis.
The mean of LAP score in group I was 6.30 1.42% ranging from 3 to 8, while in group II it had a higher mean value of 19.50±3.34 ranging from 15 to 25 . There was statistically significant difference between the two groups (t=-11.49, p=000).
The patients in the chronic phase were classified according to Sokal and Euro prognostic staging systems. 9 (90%) patients were in Sokal stage 1, 1 (10%) in stage 2, while 4 (40%) patients were in the low risk group, 5 (50%) patients were in the intermediate risk group and 1 (10%) patient was in the high risk group according to Euro score.
The only patient in Sokal stage 2 had a level of 6625.00pg/ml, while Patients in Sokal stage 1 had a mean su-PAR level of 4686.112821.51 pg/ml ranging from 2500 to 10300 pg/ml
There was no statistically significant difference between the stages as regards su-PAR (pg/ml) level (t = 0.652, p = 0.533).
As for the Euro score risk stratification, the low risk group had a mean su-PAR of 4593.752687.50 pg/ml ranging from 2500.00 to 8500.00 pg/ml, the intermediate risk group had a mean of 5485.003150.82 pg/ml ranging from 2625.00 to 10300.00 and the only patient with a high risk had a mean su-PAR level of 3000.0 pg/ml.
There was no statistically significant difference between the three risk groups as regards su-PAR (pg/ml) level (f = 0.325, p = 0.733).
There was a statistically significant difference between the three groups (chronic phase, advanced stage and the control groups) as regards su-PAR (pg/ml) level (f = 10.812, p = 0.000). Also there was a statistically significant difference between group II and group III (p = 0.000) and between group I and group III (p = 0.009). On the other hand there was no statistically significant difference between group I and group II (p=0.084).
Group II had the highest values of su-PAR in serum, the mean was 7062.503840.23 pg/ml ranging from 3875.00 to 14000.00 pg/ml. In group I the mean su-PAR level was much lower being 4880.002729.90 pg/ml ranging from 2500.00 to 10300.00 pg/ml. While the lowest level was seen in the control group (group III) with a mean value of 1450.50105.41 pg/ml ranging from 1300.00 to 1600.00 pg/ml.
In group I, serum su-PAR level positively correlated with total leukocytic counts .This correlation was statistically significant (r=0.685, p=0.029)
Similarly, there was a statistically significant correlation between serum su- PAR and total leukocytic counts in group II (r=0.653, p=0.040). As regards the age, there was a statistically significant correlation between serum su- PAR and age in group II (r=0.642, p=0.045).
To the best of our knowledge, this is the first study on su-PAR in different disease stages in CML; we believe that it will join the list of novel markers and valuable predictor of disease evolution in these patients
Further studies are recommended with emphasis on u-PAR fragments.