Plasma cytokeratin-18 fragment in adult patients with newly diagnosed acute myeloid leukemia

Background Febrile neutropenia (FN) is a common complication in hematological patients receiving intensive chemotherapy for acute myeloid leukemia (AML). During apoptosis, intracellular cytokeratin-18 (CK-18) is cleaved by caspase-3 at two sites and the released fragments can be measured from blood using antibody directed against exposed M30 neoepitope. Patients and methods This study was conducted on 50 adult AML patients who were recruited from the Hematology Department, Ain Shams University, Cairo, Egypt. Result Mean plasma CK-18 level was significantly higher on day 1 of FN in comparison to its initial level at diagnosis ( P <0.001). A positive correlation was found between mean CK-18 at onset of FN and mean values of C-reactive protein and procalcitonin measured concurrently ( P= 0.001 and 0.002, respectively). Significant positive correlations were observed between CK-18 both initially and at onset of FN and patients’ outcome including mean hospitalization days ( P =0.001 for both), ICU admission ( P= 0.006 and <0.001) and early mortality ( P= 0.015 and <0.001). On the other hand, a negative correlation was found between CK-18 both initially and at onset of FN and response to induction therapy was observed ( P =0.001 for both). Initial CK-18 level greater than 180 (U/L) predicted non-response to therapy with sensitivity of 100% and a specificity of 76.92%, while a level greater than 239 (U/L) at the onset of FN predicted patient deterioration and ICU admission with a sensitivity of 66.67%, specificity of 94.12%. Conclusion CK-18 is possibly a valuable prognostic marker of FN outcome, response to induction therapy, and early mortality in adult Egyptian patients with AML.