Sheikholeslami M R, Jilani I, Keating M, Uyeji J, Chen K, Kantarjian H, O'Brien S, Giles F, Albitar M
Quest Diagnostics, Nichols Institute, San Juan Capistrano, CA 92675, USA.
Cytometry B Clin Cytom. 2006 Jul 15;70(4):270-5. doi: 10.1002/cyto.b.20134.
Lack of immunoglobulin heavy chain genes (IgV(H)) mutation in patients with chronic lymphocytic leukemia (CLL) is associated with rapid disease progression and shorter survival. The zeta-chain (T-cell receptor) associated protein kinase 70 kDa (ZAP-70) has been reported to be a surrogate marker for IgV(H) mutation status, and its expression in leukemic cells correlates with unmutated IgV(H). However, ZAP-70 detection by flow cytometry varies significantly dependant on the antibodies used, the method of performing the assay, and the condition of the cells in the specimen. The clinical value of ZAP-70 testing when samples are shipped under poorly controlled conditions is not known. Furthermore, testing in a research environment may differ from testing in a routine clinical laboratory. We validated an assay for ZAP-70 by comparing results with clinical outcome and the mutation status of the IgV(H). Using stored samples, we show significant correlation between ZAP-70 expression and clinical outcome as well as IgV(H) mutation at a cut-off point of 15%. While positive samples (>15% positivity) remain positive when kept in the laboratory environment for 48 h after initial testing, results obtained from samples from CLL patients tested after shipping at room temperature for routine testing showed no correlation with IgV(H) mutation status when 15% cut-off was used. In these samples, cut-point of 10% correlated with the IgV(H) mutation (P = 0.0001). This data suggests that although ZAP-70 positivity correlates with IgV(H) mutation status and survival, variations in sample handling and preparation may influence results. We show that IgV(H) mutation results, unlike ZAP-70 remain correlated with CD38 expression and beta-2 microglobulin in shipped samples, and ZAP-70 testing should not be used as the sole criterion for stratifying patients for therapy.
慢性淋巴细胞白血病(CLL)患者缺乏免疫球蛋白重链基因(IgV(H))突变与疾病快速进展及生存期缩短相关。据报道,ζ链(T细胞受体)相关蛋白激酶70 kDa(ZAP-70)是IgV(H)突变状态的替代标志物,其在白血病细胞中的表达与未突变的IgV(H)相关。然而,通过流式细胞术检测ZAP-70的结果因所用抗体、检测方法以及标本中细胞的状态而有显著差异。在控制不佳的条件下运送样本时,ZAP-70检测的临床价值尚不清楚。此外,研究环境中的检测可能与常规临床实验室中的检测有所不同。我们通过将结果与临床结局及IgV(H)的突变状态进行比较,验证了一种ZAP-70检测方法。使用储存的样本,我们发现在15%的临界值时,ZAP-70表达与临床结局以及IgV(H)突变之间存在显著相关性。虽然初始检测后在实验室环境中保存48小时时,阳性样本(阳性率>15%)仍保持阳性,但对于在室温下运送用于常规检测的CLL患者样本,使用15%临界值时获得的结果与IgV(H)突变状态无关。在这些样本中,10%的临界点与IgV(H)突变相关(P = 0.0001)。该数据表明,尽管ZAP-70阳性与IgV(H)突变状态及生存期相关,但样本处理和制备的差异可能会影响结果。我们发现,与ZAP-70不同,IgV(H)突变结果在运送样本中仍与CD38表达及β2微球蛋白相关,并且ZAP-70检测不应作为对患者进行治疗分层的唯一标准。