Abousamra Nashwa Khayrat, El-Din Manal Salah, Azmy Emad
Department of Clinical Pathology, Hematology Unit, Faculty of Medicine, Mansoura University, Egypt.
Hematol Oncol. 2009 Jun;27(2):82-9. doi: 10.1002/hon.877.
B-cell chronic lymphocytic leukaemia (B-CLL) is a heterogeneous disease with some patients having an indolent course never needs treatment, while others having rapidly progressive one requires intensive treatment. In recent decades, numerous prognostic markers, such as immunoglobulin variable region heavy-chain (IgVH) mutational status, ZAP-70 and the expression of CD38 on leukaemic cells were introduced to screen for patients likely to have progressive course of B-CLL bearing the potential to facilitate risk-adapted treatment strategies. In B-CLL, T cell function is shown to be dysregulated. CD38 has been demonstrated to be an important transmembrane signalling molecule of T cell with a direct effect on its function. The present study was conducted to analyse CD38 expression on T cells by flow cytometry to evaluate its impact on the clinical course of 88 unselected B-CLL patients and correlate it with other risk factors. CD38 expression level on T cells was shown to predict the clinical course of B-CLL in male patients but not in female patients. Male patients showed CD38 expression on T cells in a stage-dependent manner, in contrast to female patients who showed higher expression irrespective to clinical staging. CD38 expression on T cells negatively interacted with treatment-free survival in male patients. Multivariate analysis revealed that CD38 expression level on T cells is an independent prognostic factor in B-CLL male patients. Simultaneous evaluation of CD38 expression on both B-CLL cells and T cells allowed predicting male patient groups with the most favourable prognosis as well as those with the worst.
B细胞慢性淋巴细胞白血病（B-CLL）是一种异质性疾病，一些患者病程进展缓慢，无需治疗，而另一些患者病情迅速进展，则需要强化治疗。近几十年来，引入了许多预后标志物，如免疫球蛋白重链可变区（IgVH）突变状态、ZAP-70以及白血病细胞上CD38的表达，以筛选可能具有B-CLL进展性病程的患者，从而有助于制定风险适应性治疗策略。在B-CLL中，T细胞功能显示失调。CD38已被证明是T细胞的一种重要跨膜信号分子，对其功能有直接影响。本研究通过流式细胞术分析T细胞上CD38的表达，以评估其对88例未经选择的B-CLL患者临床病程的影响，并将其与其他危险因素相关联。结果显示，T细胞上CD38的表达水平可预测男性B-CLL患者的临床病程，但不能预测女性患者。男性患者T细胞上的CD38表达呈阶段依赖性，而女性患者无论临床分期如何，其表达均较高。男性患者T细胞上的CD38表达与无治疗生存期呈负相关。多变量分析显示，T细胞上CD38的表达水平是B-CLL男性患者的独立预后因素。同时评估B-CLL细胞和T细胞上的CD38表达，可以预测预后最有利和最差的男性患者群体。
