Domingo-Domènech Eva, Domingo-Clarós Alicia, Gonzàlez-Barca Eva, Beneitez David, Alonso Ester, Romagosa Vicens, De Sanjos Sílvia, Petit José, Grañena Albert, Fernández de Sevilla Alberto
Department of Clinical Hematology, Institut Català d'Oncologia and Hospital Princeps d'Espanya, Ciutat Sanitaria i Universitaria de Bellvitge, Barcelona, Spain.
Haematologica. 2002 Oct;87(10):1021-7.
To investigate whether CD38 expression at diagnosis is an independent predictor of survival and assess its associations with other clinical parameters used in the staging of B-cell chronic lymphocytic leukemia (B-CLL).
CD38 expression was analyzed in 155 consecutive unselected patients newly diagnosed with B-CLL from January 1991 to July 1997. In all cases CD38 expression was evaluated at diagnosis and patients were classified into two groups: those with > or = 30% were considered positive (CD38+) and those with < 30% were considered negative (CD38-). Statistical differences between each group were analyzed using c2 tests for categorical variables and Student's t-tests for continuous variables. Survival analysis was performed at the univariate level by the Kaplan Meier technique and at the multivariate level by Cox hazard models.
Thirty (19%) patients were CD38+. CD38+ was associated with atypical morphology (p=0.004), a diffuse bone marrow pattern (p=0.016), Rai stage > or =2 (p=0.009), high lactate dehydrogenase (p=0.02), high b2 microglobulin (p=0.004), and higher lymphocyte count (p=0.02). Furthermore, CD38+ patients required treatment more frequently (p=0.006) and CLL-related mortality was significantly higher (p=0.012). When we divided the study group into patients with Rai 0-1 and Rai 2-4 stages, CD38 positivity was only significantly associated with mortality in the early stage patients (p= 0.012 vs p= 0.68). CD38 expression in the multivariate analysis lost its statistical significance. None of these results was modified when the CD38 cut-off was set at 20%.
CD38 expression identifies a subgroup of B-CLL patients with aggressive clinical presentation and worse outcome. Its expression is probably associated with other prognostic factors, but the feasibility of determining this parameter makes it easily reproducible and adds prognostic information at diagnosis to aid prediction of the clinical course and outcome of B-CLL.
研究诊断时CD38表达是否为生存的独立预测因素，并评估其与B细胞慢性淋巴细胞白血病（B-CLL）分期中使用的其他临床参数的相关性。
对1991年1月至1997年7月连续确诊的155例未经选择的B-CLL患者的CD38表达进行分析。所有病例均在诊断时评估CD38表达，患者分为两组：CD38表达≥30%者为阳性（CD38+），CD38表达<30%者为阴性（CD38-）。分类变量采用c2检验，连续变量采用学生t检验分析两组间的统计学差异。单因素生存分析采用Kaplan-Meier技术，多因素生存分析采用Cox风险模型。
30例（19%）患者为CD38+。CD38+与非典型形态（p=0.004）、弥漫性骨髓模式（p=0.016）、Rai分期≥2（p=0.009）、高乳酸脱氢酶（p=0.02）、高β2微球蛋白（p=0.004）及较高淋巴细胞计数（p=0.02）相关。此外，CD38+患者更频繁需要治疗（p=0.006），CLL相关死亡率显著更高（p=0.012）。当我们将研究组分为Rai 0-1期和Rai 2-4期患者时，CD38阳性仅与早期患者的死亡率显著相关（p=0.012对p=0.68）。多因素分析中CD38表达失去统计学意义。当CD38临界值设定为20%时，这些结果均未改变。
CD38表达可识别出具有侵袭性临床表现和较差预后的B-CLL患者亚组。其表达可能与其他预后因素相关，但该参数测定的可行性使其易于重复，并在诊断时增加预后信息以辅助预测B-CLL的临床病程和结局。
