Gu Long-Jun, Tie Li-Jun, Jiang Li-Min, Chen Jing, Pan Ci, Dong Lu, Chen Jing, Xue Hui-Liang, Tang Jing-Yan, Wang Yao-Ping, Ye Hui
Department of Hematology/Oncology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2009 Apr;11(4):241-5.
The prognostic significance of immunophenotyping in acute myeloid leukemia (AML) has been controversial. This study investigated the relationship of immunophenotypes with French-American-British (FAB) subtypes and chromosomal abnormalities and assessed the prognostic value of immunophenotyping in children with AML.
From January 1998 to May 2003, 75 children with newly diagnosed AML were enrolled on protocol AML-XH-99. Immunophenotypes were measured with the flow cytometry. According to the McAbs used, the patients were classified into five groups: panmyeloid antigens (CD13, CD33, and MPO), myeloid-lineage associated antigens (CD14, CD15), lineage-specific antigens (CD41, GlyA), progenitor-associated antigens (CD34, HLA-DR) and lymphoid-associated antigens (CD19, CD7). The probability of event-free survival (EFS) was estimated by Kaplan-Meier analysis. The distributions of EFS were compared using the log-rank test. Chi-square analysis or Fisher exact test was used to compare the differences in the distribution of biologic presenting features. A Cox proportional hazards model was used to identify independent prognostic factors.
At least one of panmyeloid antigens CD13, CD33 and MPO was expressed in 72 patents (97.3%). Two or more panmyeloid antigens were expressed in 45 patients (60.8%). The proportion of children with AML expressing one or more of the lymphoid-associated antigens was 24.3%. Lymphoid-associated antigen CD19 was expressed by blast cells in most of FAB M2 patients. The patients with acute promyelocytic leukemia were characterized by the absence of HLA-DR and lymphoid-associated antigens CD19 and CD7. Monovariate analysis showed immunophenotypes were not related to the complete remission rate after the first induction course and the 5-year-EFS. Multivariate analysis suggested immunophenotyping had no independent prognostic value in AML.
Immunophenotyping can not be used independently in the evaluation of risk classification in children with AML. However, it is useful in the reorganization of special types of AML.
免疫表型分析在急性髓系白血病（AML）中的预后意义一直存在争议。本研究调查了免疫表型与法美英（FAB）亚型及染色体异常之间的关系，并评估了免疫表型分析对儿童AML的预后价值。
1998年1月至2003年5月，75例新诊断的儿童AML患者纳入AML-XH-99方案。采用流式细胞术检测免疫表型。根据所使用的单克隆抗体，将患者分为五组：全髓系抗原（CD13、CD33和MPO）、髓系相关抗原（CD14、CD15）、谱系特异性抗原（CD41、GlyA）、祖细胞相关抗原（CD34、HLA-DR）和淋巴系相关抗原（CD19、CD7）。采用Kaplan-Meier分析估计无事件生存（EFS）概率。使用对数秩检验比较EFS分布。采用卡方分析或Fisher精确检验比较生物学表现特征分布的差异。使用Cox比例风险模型识别独立预后因素。
72例患者（97.3%）表达了全髓系抗原CD13、CD33和MPO中的至少一种。45例患者（60.8%）表达了两种或更多全髓系抗原。表达一种或多种淋巴系相关抗原的儿童AML患者比例为24.3%。大多数FAB M2患者的原始细胞表达淋巴系相关抗原CD19。急性早幼粒细胞白血病患者的特征是不表达HLA-DR以及淋巴系相关抗原CD19和CD7。单因素分析显示免疫表型与首次诱导疗程后的完全缓解率及5年EFS无关。多因素分析提示免疫表型分析在AML中无独立预后价值。
免疫表型分析不能独立用于评估儿童AML的风险分类。然而，它在特殊类型AML的诊断中有用。
