International Journal of Multidisciplinary and Current Research ISSN: 2321-3124 Research Article Available at: http://ijmcr.com 646|Int. J. of Multidisciplinary and Current research, Vol.4 (July/Aug 2016) Prognostic Significance of HLA-DR Expression in Sudanese Patients with Chronic Lymphocytic Leukemia Alaaeddin M. Elzubeir 1 , Namarq Alaaldeen S.A 2 , Rania Osman A.M. 2 , Duaa Ali A.A 2 , Almustafa Mohamad A.A. 2 , A.M.Angi 2 , H.M.Rahoum 2 , I. Ismail. A 2 , M.Mohammed.E 2 , M.M.Yousef 2 , S.M.Khair 2 and Osama Ali 3 1 Sudan international University, FMLS, Hematology and immunohematology department -Khartoum, Sudan 2 University of Khartoum, FMLS, Hematology and immunohematology department-Khartoum, Sudan 3 Flow cytometry Training Center, Khartoum, Sudan Accepted 15 July 2016, Available online 23 July 2016, Vol.4 (July/Aug 2016 issue) Abstract Background: The clinical course of patients with chronic lymphocytic leukemia (CLL) is heterogeneous, The Rai and Binet clinical staging systems are used to predict survival. An evaluation of prognostic factors at the time of diagnosis can guide the timing and strategy of treatment. Aim: To evaluate the prognostic significance of HLA-DR in patient with CLL. Method: Thirty five (27 male/ 8 female) newly diagnosed chronic lymphocytic leukemia (CLL) were analyzed using flow cytometry and finding were correlated with the clinical course of the disease. Results: The mean of HLA-DR expression on subject were (38.1 ± 8.2) compared (79.1 ± 6.8) which was the mean of 35 normal volunteers tested at the same period of time. Analysis of the data revealed that the decrease of HLA-DR expression observed in stage 0 to IV was statistically significant (P.value < 0.00). Conclusion: The present study demonstrated that the low HLA-DR expression correlate with stage III and IV Rai classification that indicate this parameter may play role in prognosis of disease. Keywords: Chronic lymphocytic leukemia (CLL), HLA-DR, monocyte. Introduction Chronic lymphocytic leukemia (CLL) is a molecularly heterogeneous disease[1]. Is associated with immune suppression in the host which contributes to the failure to mount an effective immune response against the cancer cell [2]. typically affects elderly patients concomitant one or more pathological conditions or functional limitations with reduction of patient's life expectancy and represent major limitations in the adoption of standard therapies [3]. novel strategies for treatment and prognostication of chronic lymphocytic leukemia (CLL) evolve, the traditional Rai and Binet systems. Identification of novel prognostic markers of chronic lymphocytic leukemia such as immunoglobulin heavy-chain variable gene (IGHV) mutation status, leukemia-cell expression of CD38, ZAP- 70, and CD49d, β-2-microglobulin, cytogenetic abnormalities detected by fluorescent in situ hybridization (FISH) and patient characteristics which include sex and age[4,5]. Rai stage 0: Lymphocytosis and no enlargement of the lymph nodes, spleen, or liver, and with near normal red blood cell and platelet counts[6]. Rai stage I: Lymphocytosis plus enlarged lymph nodes. The spleen and liver are not enlarged and the red blood cell and platelet counts are near normal Rai stage II: Lymphocytosis plus an enlarged spleen (and possibly an enlarged liver), with or without enlarged lymph nodes. The red blood cell and platelet counts are near normal Rai stage III: Lymphocytosis plus anemia (too few red blood cells), with or without enlarged lymph nodes, spleen, or liver. Platelet counts are near normal Rai stage IV: Lymphocytosis plus thrombocytopenia (too few blood platelets), with or without anemia, enlarged lymph nodes, spleen, or liver [6]. Doctors separate the Rai stages into low-, intermediate, and high-risk groups when determining treatment options. Stage 0 is considered low risk. Stages I and II are considered intermediate risk. Stages III and IV are considered high risk [6] . HLA-DR is an MHC class II cell surface receptor encoded by human leukocyte antigen complex on chromosome 6 .the complex HLA-DR (human leukocyte antigen –antigen