Iraqi Journal of Hematology · Published 2025-07-01 · DOI 10.4103/ijh.ijh_103_25
BACKGROUND: Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy. The altered immunological response in AML is profound, encompassing impaired T-cell proliferation and a perturbed cytokine profile. Immune markers, such as CD3+ CD56+ lymphocytes and interleukin-35 (IL-35), may reflect the immunosuppressive landscape in AML, which helps explain disease burden and treatment response. OBJECTIVES: This study aimed to evaluate the immunological profiles of AML patients by quantifying CD3+ CD56+ circulating lymphocytes and the serum level of IL-35 in newly diagnosed and treated patients using treatment status and blast cell burden as indicators. MATERIALS AND METHODS: This is a case–control study conducted on 50 AML patients (25 newly diagnosed and 25 on treatment) and 20 healthy controls. To assess the percentages of CD3+ CD56+ lymphocytes, the flow cytometry technique was used. The enzyme-linked immunosorbent assay technique was used to quantify IL-35 serum levels. RESULTS: The newly diagnosed patients exhibited a significant reduction in the percentage of CD3+ CD56+ lymphocytes (28.0% ±18.1%) and elevated IL-35 levels (320.0 ± 102.7 pg/mL) compared to controls (15.0% ±7.7% and 208.2 ± 47.6 pg/mL, respectively; P = 0.001). The AML patients treated showed a significant increase in the percentage of CD3+ CD56+ lymphocytes (52.3 ± 21.4%) and a reduction in IL-35 levels (263.4 ± 58.7 pg/mL). Additionally, treated patients in remission had a higher percentage of CD3+ CD56+ lymphocytes (58.0% ±18.4%) and lower IL-35 levels (241.1 ± 37.7 pg/mL) compared to nonremission AML patients. A significant negative correlation was observed between the percentage of CD3+ CD56+ lymphocytes and blast cell count (r = −0.267, P = 0.028), while the IL-35 level showed a significant positive correlation (r = 0.349, P = 0.004). CONCLUSION: This study demonstrates that CD3+ CD56+ lymphocytes and IL-35 serve as critical immunological biomarkers in AML, reflecting the balance between anti-tumor immunity and immune suppression. The inverse relationship between these markers and disease burden highlights their prognostic value, with CD3+ CD56+ depletion indicating impaired tumor surveillance and elevated IL-35 signifying a suppressive microenvironment.
Abstract from DOAJ. Public domain (CC0 1.0).
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