1.1. Introduction
Acute myeloid leukemia (AML) is a malignant clonal disorder characterized by alterations and low production of healthy hematopoietic cells; these alterations inhibit differentiation of cells and induce proliferation or accumulation of blasts. Blasts replace normal hematopoietic tissue,
triggering the appearance of cytopenias. The accumulation of immature cells begins in the bone marrow, but in most cases quickly builds up in the blood(1).

The etiology of AML is heterogeneous and complex, but it is widely accepted that both environmental and genetic factors play significant roles in the development of the disease (2).

Acute myeloid leukemia (AML) accounts for about 90% of
acute leukemia in adults, and its incidence increases with age.
Although some clinic advances including new molecule targeting
agents and hematopoietic stem cell transplantation
(HSCT) have been applied over the past three decades, the
five-year survival of adult AML still ranges from 30 to 40%
in total patients and is even lower than 15% in the refractory
and relapsed ones3.
Accurate diagnosis and classification in AML are essential for treatment decisions and assessment of prognosis. Initial assessment requires a careful history, physical exam, complete blood count (CBC) with peripheral blood (PB) smear review, bone marrow (BM) examination, flow cytometry (FC), cytogenetics, and selected molecular genetic analyses(4).

Interleukin 35 (IL 35), is a recently identified heterodimeric cytokine of an IL-12 family consisting of Epstein-Barr virus-induced gene protein 3 (EBI3) and the p35 subunit of IL 12 (7). In contrast to all other known IL 12 family members, which are not expressed by T cells, IL 35 is secreted by Treg cells and contributes to their suppressive activity, rather than acting as an immunostimulatory or proinflammatory manner (5).
Interleukin 10 (IL-10)

Interleukin-10 (IL-10) is predominately secreted by immune cells including macrophages, T lymphocytes, and natural killer (killer) NK cells, and constitutes a major determinant of viral clearance vs. persistent infection . IL-10 which still having unclear role in cancer pathogenesis, some studies showed that IL-10 involved in the development and progression of cancer in humans, as a tumor promoting (promote cancer potentially) has immune-stimulating and immuno suppressive (inhibit cancer potentially) (6).
In this study , we examined IL_35 along with IL_10 in adult AML, as a tumor promoting and tumor inhibiting factors that may regulate tumor susceptibility and development