Chopra Anita, Bakhshi Sameer, Pramanik Suman Kumar, Pandey Ravindra Mohan, Singh Saroj, Gajendra Smeeta, Gogia Ajay, Chandramohan Jagan, Sharma Atul, Kumar Lalit, Seth Rachna, Rai Sandeep, Kumar Rajive
Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India.
Eur J Haematol. 2014 Mar;92(3):211-8. doi: 10.1111/ejh.12238. Epub 2014 Jan 10.
T-cell antigens [CD5,CD1a,CD8] define early T-cell precursor acute lymphoblastic leukemia (ETP-ALL). To understand immature T-ALL of which ETP-ALL is part, we used these antigens to subcategorize non-ETP T-ALL for examining expression of myeloid/stem cell antigens (M/S) and clinical features. Using CD5 (+/-) to start categorization, we studied 69 routinely immunophenotyped patients with T-ALL. CD5(-) was a homogenous (CD8,CD1a)(-) M/S(+) ETP-ALL group (n = 9). CD5(+) cases were (CD8,CD1a)(-) pre-T-ALL (n = 22) or (CD8,CD1a)(+) (n = 38) thymic/cortical T-ALL; M/S(+) 20/22 (90.91%) in former and 22/38 (57.89%) in latter (P = 0.007). ETP- and pre-T-ALL together (CD1a(-) ,CD5(-/+) immature T-ALL group) were nearly always M/S(+) (29/31; 93.55%). In multivariate analysis, only ETP-ALL predicted poor overall survival (P = 0.02). We conclude (i) CD5 negativity in T-ALL almost always means ETP-ALL. CD1a and CD8 negativity, as much as CD5, marks immaturity in T-ALL, and the CD5(+/-) /CD1a(-) /CD8(-) immature T-ALL group needs further study to understand the biology of the T-ALL-myeloid interface. (ii) ETP-ALL patients may be pre-T-ALL if CD2(+) ; CD2(+) , conversely, CD5(-) /CD1a(-) /CD8(-) pre-T ALL patients are ETP-ALL. (iii) Immunophenotypic workup of T-ALL must not omit CD1a, CD5, CD8 and CD2, and positivity of antigens should preferably be defined as recommended for ETP-ALL, so that this entity can be better evaluated in future studies of immature T-ALL, a group to which ETP-ALL belongs. (iv) ETP-ALL has poor prognosis.
T细胞抗原[CD5、CD1a、CD8]可定义早期T细胞前体急性淋巴细胞白血病（ETP-ALL）。为了解ETP-ALL所属的未成熟T细胞急性淋巴细胞白血病（T-ALL），我们利用这些抗原对非ETP T-ALL进行亚分类，以检测髓系/干细胞抗原（M/S）的表达及临床特征。以CD5（+/-）开始分类，我们研究了69例常规免疫表型分析的T-ALL患者。CD5（-）是一个均一的（CD8、CD1a）（-）M/S（+）ETP-ALL组（n = 9）。CD5（+）病例为（CD8、CD1a）（-）前T-ALL（n = 22）或（CD8、CD1a）（+）（n = 38）胸腺/皮质T-ALL；前者中M/S（+）为20/22（90.91%），后者中为22/38（57.89%）（P = 0.007）。ETP-ALL和前T-ALL合在一起（CD1a（-）、CD5（-/+）未成熟T-ALL组）几乎总是M/S（+）（29/31；93.55%）。在多变量分析中，只有ETP-ALL预示总体生存率较差（P = 0.02）。我们得出结论：（i）T-ALL中的CD5阴性几乎总是意味着ETP-ALL。CD1a和CD8阴性与CD5一样，标志着T-ALL中的未成熟状态，而CD5（+/-）/CD1a（-）/CD8（-）未成熟T-ALL组需要进一步研究以了解T-ALL-髓系界面的生物学特性。（ii）如果CD2（+），ETP-ALL患者可能是前T-ALL；相反，如果CD2（+），CD5（-）/CD1a（-）/CD8（-）前T-ALL患者则是ETP-ALL。（iii）T-ALL的免疫表型检查绝不能遗漏CD1a、CD5、CD8和CD2，抗原的阳性结果最好按照ETP-ALL的推荐定义，以便在未来对ETP-ALL所属的未成熟T-ALL组的研究中能更好地评估这一实体。（iv）ETP-ALL预后较差。
