Tian Yun, Wang Xiaojiao, Ai Hao, Lyu Xiaodong, Wang Qian, Wei Xudong, Song Yongping, Yin Qingsong
Department of Hematology, Henan Institute of Hematology Affiliated Cancer Hospital of Zhengzhou University Henan Cancer Hospital Zhengzhou Henan China.
EJHaem. 2022 Mar 25;3(2):443-452. doi: 10.1002/jha2.414. eCollection 2022 May.
The prognostic effects of the CD20 positivity have been studied extensively in B-lineage acute lymphocyte leukemia (B-ALL) patients, but the results remain controversial. The aim of this study is to investigate the different predictive effects of the intensity and proportion of CD20 expression on the prognosis for B-ALL patients by retrospective analysis. The mean fluorescence intensity (MFI) and percentage of CD20 on B-ALL cells from 206 patients with B-ALL were dynamically measured by flow cytometry, and their optimal cut-off values were determined using the receiver operating characteristic curve. Changes in MFI and percentage of CD20 at various time points and their relationship with prognosis were analyzed. We found that a low baseline CD20 MFI or high CD20 proportion was significantly associated with shorter 5-year overall survival and progression-free survival, and the combination of these two factors could more accurately predict worse survival for B-ALL patients. Furthermore, low CD20 MFI or a high CD20 proportion had different predictive effects for ALL patients with different clinical characteristics and could serve as an independent risk factor for adverse prognosis. There were significant decreases in both the intensity and proportion of CD20 after recurrence in the absence of rituximab treatment, particularly with CD20 intensity. Notably, the decrease of CD20 intensity after recurrence indicated a more shortened survival time. Finally, we conclude that a low intensity or high proportion of CD20 expression may be used as an indicator for inferior prognosis for B-ALL patients. CD20 intensity is more likely to be a more universal biomarker for worse prognosis.
CD20阳性的预后影响已在B系急性淋巴细胞白血病（B-ALL）患者中进行了广泛研究，但结果仍存在争议。本研究旨在通过回顾性分析，探讨CD20表达强度和比例对B-ALL患者预后的不同预测作用。采用流式细胞术动态检测206例B-ALL患者B-ALL细胞上CD20的平均荧光强度（MFI）和百分比，并使用受试者工作特征曲线确定其最佳截断值。分析不同时间点CD20的MFI和百分比变化及其与预后的关系。我们发现，低基线CD20 MFI或高CD20比例与较短的5年总生存期和无进展生存期显著相关，这两个因素的联合可更准确地预测B-ALL患者较差的生存期。此外，低CD20 MFI或高CD20比例对具有不同临床特征的ALL患者具有不同的预测作用，可作为不良预后的独立危险因素。在未使用利妥昔单抗治疗的复发后，CD20的强度和比例均显著下降，尤其是CD20强度。值得注意的是，复发后CD20强度的下降表明生存时间更短。最后，我们得出结论，低强度或高比例的CD20表达可作为B-ALL患者预后较差的指标。CD20强度更有可能是预后较差的更普遍生物标志物。
