CD34和末端脱氧核苷酸转移酶（TdT）测定在初发未经治疗的急性髓系白血病患者中的意义

The significance of CD34 and TdT determinations in patients with untreated de novo acute myeloid leukemia.

作者信息

Lee E J, Yang J, Leavitt R D, Testa J R, Civin C I, Forrest A, Schiffer C A

机构信息

Division of Hematologic Malignancies, University of Maryland Cancer Center, Baltimore 21201.

出版信息

Leukemia. 1992 Nov;6(11):1203-9.

PMID:1279324

Abstract

The results of intensive chemotherapy given to 247 adults at the University of Maryland Cancer Center with previously untreated de novo acute myeloid leukemia (AML) were reviewed with respect to expression of terminal deoxynucleotidyl transferase (TdT) and CD34. Of the 228 patients with data for TdT, 32 (14%) had > 5% of the leukemia cells positive by an immunofluorescence assay. The median age of the TdT-positive patients was approximately 10 years less than the TdT-negative patients (50 versus 60 years). Patients with TdT-positive AML had similar median survival (12 versus 10.5 months) and complete remission (CR) rates (53 versus 59%), but a greater frequency of long-term complete responders (60 of complete remitters versus 20%, p = 0.08) than TdT-negative patients. Of 126 patients tested, 59% were CD34-negative (< 20% reactivity with leukemia cells). These 74 patients (median age 60 years) had a greater CR rate (71 versus 48%, p = 0.008) than the 52 CD34-positive patients (median age 60 years), and improved survival (p = 0.013 by Wilcoxon) although there was no difference in the duration of CR between the CD34-positive and negative groups. Of CD34-positive patients 12/52 remain in continuous CR, and 16/74 CD34-negative patients remain in continuous CR. None of eight patients strongly positive for CD34 (> 70% reactivity) remain disease-free. Positivity for TdT or CD34 was associated with less differentiated AML. Of CD34-positive patients, 44% had FAB M0/M1 morphology versus 13% of CD34-negative patients (p = 0.0001); similarly, 47% of TdT-positive patients were FAB M0/ML1 versus 25% of TdT-negative patients (p = 0.01). Of seven patients with FAB M4E0, five were CD34-positive. Of the 12 CD34-positive survivors, four had FAB M4E0. Thus CD34 expression predicts for CR rate and overall survival in adults with AML. TdT expression does not significantly affect overall outcome but may be associated with longer CR durations.

摘要

对马里兰大学癌症中心247例先前未经治疗的初发性急性髓系白血病（AML）成年患者进行强化化疗的结果，就末端脱氧核苷酸转移酶（TdT）和CD34的表达进行了回顾。在228例有TdT数据的患者中，32例（14%）通过免疫荧光测定法显示>5%的白血病细胞呈阳性。TdT阳性患者的中位年龄比TdT阴性患者小约10岁（50岁对60岁）。TdT阳性AML患者的中位生存期（12个月对10.5个月）和完全缓解（CR）率相似（53%对59%），但长期完全缓解者的比例高于TdT阴性患者（完全缓解者中为60%对20%，p = 0.08）。在126例接受检测的患者中，59%为CD34阴性（与白血病细胞的反应性<20%）。这74例患者（中位年龄60岁）的CR率高于52例CD34阳性患者（71%对48%，p = 0.008），且生存期有所改善（Wilcoxon检验p = 0.013），尽管CD34阳性和阴性组之间CR持续时间无差异。在CD34阳性患者中，12/52仍处于持续CR状态，16/74例CD34阴性患者仍处于持续CR状态。8例CD34强阳性（反应性>70%）患者中无一例无病生存。TdT或CD34阳性与分化程度较低的AML相关。在CD34阳性患者中，44%具有FAB M0/M1形态，而CD34阴性患者为13%（p = 0.0001）；同样，47%的TdT阳性患者为FAB M0/M1，而TdT阴性患者为25%（p = 0.01）。在7例FAB M4E0患者中，5例为CD34阳性。在12例CD34阳性幸存者中，4例为FAB M4E0。因此，CD34表达可预测成人AML患者的CR率和总生存期。TdT表达虽不显著影响总体预后，但可能与更长的CR持续时间相关。