Pui C H, Hancock M L, Head D R, Rivera G K, Look A T, Sandlund J T, Behm F G
Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38101.
Blood. 1993 Aug 1;82(3):889-94.
The CD34 antigen was detected on > or = 10% of the blast cells in 235 (70%) of 335 cases of newly diagnosed childhood acute lymphoblastic leukemia (ALL) treated in two consecutive chemotherapy trials. By immunophenotype, the distribution of positive cases favored early pre-B ALL (83%; n = 180) followed by pre-B ALL (61%; n = 89) and then T-cell ALL (46%; n = 61) (P < .001). Among the B-lineage cases, CD34 expression was significantly associated with favorable presenting features: age 1 to 10 years, white race, absence of central nervous system (CNS) leukemia, low serum lactate dehydrogenase level, CD10 expression, and leukemic cell hyperdiploidy (> 50 chromosomes or DNA index > or = 1.16). Event-free survival was clearly superior for patients with CD34+ leukemia (P = .01), with an estimated 83% +/- 6% (SE) of the cohort remaining free of adverse events at 5 years post diagnosis, as compared to 63% +/- 10% of the group without this feature. Multivariate analysis showed that the prognostic influence of the antigen was independent of age, leukocyte count, and other well-recognized factors, suggesting that it would add discriminatory power to current systems of risk assignment. Findings in T-cell ALL were the reverse: CD34 expression showed positive correlations with initial CNS leukemia and CD10 negativity but not with any good-risk presenting characteristics. Log-rank analysis indicated no adverse effect on treatment outcome by CD34 antigen expression, although additional patients with need to be studied to obtain a definitive answer. The opposed clinical associations of CD34 expression in B- and T-lineage ALL may reflect fundamental biologic differences between these leukemia species.
在两项连续化疗试验中接受治疗的335例新诊断儿童急性淋巴细胞白血病（ALL）中，235例（70%）患者的原始细胞上检测到CD34抗原，其比例≥10%。通过免疫表型分析，阳性病例分布以早前B-ALL为主（83%；n = 180），其次是前B-ALL（61%；n = 89），然后是T细胞ALL（46%；n = 61）（P <.001）。在B系病例中，CD34表达与良好的临床表现显著相关：年龄1至10岁、白种人、无中枢神经系统（CNS）白血病、低血清乳酸脱氢酶水平、CD10表达以及白血病细胞超二倍体（> 50条染色体或DNA指数≥1.16）。CD34 +白血病患者的无事件生存率明显更高（P =.01）；估计该队列中83%±6%（标准误）在诊断后5年仍无不良事件，而无此特征组为63%±10%。多因素分析表明，该抗原对预后的影响独立于年龄、白细胞计数和其他公认因素，提示它将增加当前风险评估系统的鉴别能力。T细胞ALL中的发现则相反：CD34表达与初始CNS白血病和CD10阴性呈正相关，但与任何良好风险表现特征无关。对数秩分析表明，CD34抗原表达对治疗结果无不良影响，尽管需要研究更多患者以获得确切答案。B系和T系ALL中CD34表达相反的临床关联可能反映了这些白血病类型之间的根本生物学差异。
