成人急性髓系白血病（AML）中P-糖蛋白（P-170）和CD34的表达

P-glycoprotein (P-170) and CD34 expression in adult acute myeloid leukemia (AML).

作者信息

Lamy T, Goasguen J E, Mordelet E, Grulois I, Dauriac C, Drenou B, Chaperon J, Fauchet R, le Prise P Y

机构信息

Service d'Hématologie Clinique, Hôpital Pontchaillou, Rennes, France.

出版信息

Leukemia. 1994 Nov;8(11):1879-83.

PMID:7526090

Abstract

We investigated the prognosis value of CD34 and P-170 expression in blast cells of adult patients affected by de novo acute myeloid leukemia (AML). CD34 antigen was analyzed by indirect immunofluorescence (IFI) and alkaline phosphatase-labeled streptavidin biotine (AP-LSAB) in 62 patients (median age: 51 years). P-170 expression was determined by AP-LSAB in 51 cases using JSB1 and C219 monoclonal antibodies. All patients were treated with conventional chemotherapy induction regimen. Follow-up was from 6 to 79 months. Complete remission (CR) rate was not statistically different between CD34+ and CD34- patients (67 vs. 84%, p = 0.2). The duration of CR and survival were not influenced by CD34 expression. Karyotype abnormalities were more frequent among MDR+ patients (65 vs. 21%, p < 0.01). CR rate was statistically lower in MDR+ patients as compared to MDR- patients (63 vs. 96%, p = 0.01). Median disease-free survival (DFS) was shorter for MDR+ patients but the difference was not significant (5 vs. 10 months, p = 0.09). Patients who were positive for both parameters CD34 and P-170, had a poor prognosis with a 50 vs. 100% CR rate for CD34/P-170 negative patients, (p = 0.002), a lower median DFS (3 vs. 12 months, p = 0.01) and overall survival (OS) (3 vs. 14.5 months, p = 0.01). Results of cytogenetic analysis did not influence CR rate but the relapse rate was higher, although not significant, for the patients with unfavorable karyotype (63 vs. 33%). The seven CD34+/MDR+ patients with poor prognosis karyotype had a statistically lower CR rate, median DFS and OS than the 7 CD34-/MDR- patients with normal or favorable karyotype (CR: 29% vs. 100%, p = 0.02), (DFS: 3 vs. > 12 months, p = 0.01), (OS: 4 vs. > 12 months, p = 0.02). Our data indicate that P-170 but not CD34 expression is predictive for a lower CR rate. The identification of a bad prognosis subgroup of CD34+/MDR+ AML patients (and especially those with poor prognosis karyotype) has to be confirmed on larger series using uniform methodology.

摘要

我们研究了CD34和P-170表达在初发急性髓系白血病（AML）成年患者原始细胞中的预后价值。采用间接免疫荧光法（IFI）和碱性磷酸酶标记链霉亲和素生物素法（AP-LSAB）对62例患者（中位年龄：51岁）的CD34抗原进行分析。采用AP-LSAB法，使用JSB1和C219单克隆抗体对51例患者的P-170表达进行测定。所有患者均接受传统化疗诱导方案治疗。随访时间为6至79个月。CD34阳性和CD34阴性患者的完全缓解（CR）率无统计学差异（67%对84%，p = 0.2）。CR持续时间和生存期不受CD34表达的影响。多药耐药（MDR）阳性患者的核型异常更为常见（65%对21%，p < 0.01）。与MDR阴性患者相比，MDR阳性患者的CR率在统计学上更低（63%对96%，p = 0.01）。MDR阳性患者的无病生存期（DFS）中位数较短，但差异不显著（5个月对10个月，p = 0.09）。CD34和P-170两个参数均为阳性的患者预后较差，CD34/P-170阴性患者的CR率为100%，而前者为50%（p = 0.002），DFS中位数较低（3个月对12个月，p = 0.01），总生存期（OS）也较低（3个月对14.5个月，p = 0.01）。细胞遗传学分析结果不影响CR率，但核型不利的患者复发率较高，尽管不显著（63%对33%）。7例预后不良核型的CD34+/MDR+患者的CR率、DFS中位数和OS在统计学上低于7例核型正常或良好的CD34-/MDR-患者（CR：29%对100%，p = 0.02），（DFS：3个月对>12个月，p = 0.01），（OS：4个月对>12个月，p = 0.02）。我们的数据表明，P-170表达而非CD34表达可预测较低的CR率。CD34+/MDR+ AML患者预后不良亚组（尤其是核型预后不良者）的鉴定必须在更大系列研究中采用统一方法加以证实。