Ahmed Shimaa A, Abdallah Ghada E M, Aly Mai M, Abdelsalam Eman M Nagiub, Mohammed Saleh Mostafa F
Department of Internal Medicine, Faculty of Medicine, South Valley University, Qena, Egypt.
Clinical Hematology Unit, Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
J Blood Med. 2021 Apr 13;12:225-234. doi: 10.2147/JBM.S296225. eCollection 2021.
A positive direct antiglobulin test (DAT) with or without autoimmune hemolytic anemia is a frequent finding in chronic lymphocytic leukemia (CLL). The heterogenic clinical course of CLL mainly depends on different pathogenetic mechanisms which appears in a form of variable biological and clinical features. These features allow stratification of patients into subsets with different outcomes.
We evaluated the DAT as a prognostic marker in 120 CLL patients treated with chemoimmunotherapy. Clinical and laboratory features, treatment response, and survival outcomes of CLL patients were assessed in relation to their DAT test status. Additionally, the English literature was extensively reviewed regarding the prognostic impact of a positive DAT in CLL.
DAT positivity was detected in 36 patients (30%) and was associated advanced disease staging ( = 0.03). No correlations were found with other clinical, laboratory, or biological factors such as ZAP-70 or CD38. Both a positive DAT and an Eastern Cooperative Oncology Group performance status >2 were predictors for non-response to first-line treatment in the multivariate analysis (OR = 0.3, 95% CI: 0.12-0.8 and OR = 0.2, 95% CI: 0.08-0.8, respectively). The five-year progression-free survival was significantly lower in the DAT-positive group ( = 0.004). No significant association was found with overall survival ( = 0.2). Sixteen reports analyzing more than 11,000 patients were identified in our review.
In conclusion, DAT positivity in CLL patients is associated with poor response to treatment and disease progression.
直接抗人球蛋白试验（DAT）阳性伴或不伴有自身免疫性溶血性贫血是慢性淋巴细胞白血病（CLL）中的常见表现。CLL的异质性临床病程主要取决于不同的致病机制，这些机制以可变的生物学和临床特征形式出现。这些特征有助于将患者分层为具有不同预后的亚组。
我们评估了120例接受化疗免疫治疗的CLL患者的DAT作为预后标志物。根据DAT检测状态评估CLL患者的临床和实验室特征、治疗反应及生存结果。此外，还广泛回顾了英文文献中关于DAT阳性对CLL预后影响的内容。
36例患者（30%）检测到DAT阳性，且与疾病晚期分期相关（=0.03）。未发现与其他临床、实验室或生物学因素如ZAP-70或CD38存在相关性。在多变量分析中，DAT阳性和东部肿瘤协作组体能状态>2均是一线治疗无反应的预测因素（OR分别为0.3，95%CI：0.12 - 0.8和OR为0.2，95%CI：0.08 - 0.8）。DAT阳性组的五年无进展生存率显著较低（=0.004）。未发现与总生存率有显著关联（=0.2）。在我们的综述中，共识别出16篇分析超过11,000例患者的报告。
总之，CLL患者的DAT阳性与治疗反应不佳和疾病进展相关。
