Mittelman M, Karcher D S, Kammerman L A, Lessin L S
Department of Medicine, George Washington University Medical Center, Washington, DC 20037.
Am J Hematol. 1993 Jul;43(3):165-71. doi: 10.1002/ajh.2830430302.
The FAB classification of myelodysplastic syndromes (MDS) has been useful in predicting prognosis; however, additional methods are required to detect patients at high risk for early conversion to acute nonlymphoblastic leukemia (ANLL). Using a panel of monoclonal antibodies to myelomonocytic surface antigens (MMSA) and flow cytometry, we studied bone marrow cells from 26 patients with MDS of all five FAB subtypes. The MMSA studied included Ia (HLA-DR), CD11b (Mo1), CD14 (Mo2, My4), CD13 (My7), and CD33 (My9). Marrows were considered "positive" for a given MMSA if the percentage of reactive cells exceeded the upper limit of the normal range. Twenty-four of twenty-six patients (92.3%) were CD13 (My7)+, suggesting that CD13 may serve as a diagnostic marker for MDS. Ten of twelve patients who developed ANLL during a median follow-up of 44 weeks were Ia(HLA-DR)+. The Kaplan-Meier estimated median time to leukemia (TTL) was 16 weeks for Ia+ patients and 88 weeks for Ia- patients (P = 0.004). All six patients who developed ANLL before 16 weeks from diagnosis were Ia+, while none of the Ia- patients converted to ANLL before 24 weeks. Nine of thirteen patients with low CD11b (Mo1) expression (< 53% reactive cells) developed ANLL, compared with only two of 11 patients with high CD11b expression (> 53% reactive cells). Kaplan-Meier estimated TTL was 29 weeks for patients with low CD11b, compared to 160 weeks for patients with high CD11b (P < 0.05). Patients who met both criteria, Ia+ and low CD11b, represented the poorest prognostic subgroup, with median TTL of 13 weeks compared with 88 weeks for the others (P = 0.017). Ia and CD11b patterns were not specific for MDS subtype, and their expression did not correlate with blast count. These data suggest that MDS patients whose bone marrow cells demonstrate high Ia (HLA-DR) and low CD11b (Mo1) expression represent a poor prognostic subgroup with short TTL. These patients may be candidates for early aggressive or investigational treatment.
骨髓增生异常综合征（MDS）的FAB分类有助于预测预后；然而，还需要其他方法来检测有早期转化为急性非淋巴细胞白血病（ANLL）高风险的患者。我们使用一组针对骨髓单核细胞表面抗原（MMSA）的单克隆抗体和流式细胞术，研究了26例所有五种FAB亚型MDS患者的骨髓细胞。所研究的MMSA包括Ia（HLA - DR）、CD11b（Mo1）、CD14（Mo2，My4）、CD13（My7）和CD33（My9）。如果反应性细胞百分比超过正常范围上限，则骨髓被认为对给定的MMSA呈“阳性”。26例患者中有24例（92.3%）CD13（My7）呈阳性，这表明CD13可能作为MDS的诊断标志物。在中位随访44周期间发生ANLL的12例患者中有10例Ia（HLA - DR）呈阳性。Ia阳性患者的Kaplan - Meier估计白血病发生中位时间（TTL）为16周，Ia阴性患者为88周（P = 0.004）。从诊断起16周内发生ANLL的所有6例患者均为Ia阳性，而Ia阴性患者在24周前均未转化为ANLL。CD11b（Mo1）表达低（反应性细胞<53%）的13例患者中有9例发生ANLL，而CD11b表达高（反应性细胞>53%）的11例患者中只有2例发生ANLL。CD11b低表达患者的Kaplan - Meier估计TTL为29周，而CD11b高表达患者为160周（P < 0.05）。同时符合Ia阳性和CD11b低表达这两个标准（均符合）的患者代表预后最差的亚组，中位TTL为13周，而其他患者为88周（P = 0.017）。Ia和CD11b模式对MDS亚型不具有特异性，且它们的表达与原始细胞计数无关。这些数据表明，骨髓细胞显示高Ia（HLA - DR）和低CD11b（Mo1）表达的MDS患者代表预后不良的亚组，TTL较短。这些患者可能是早期积极治疗或试验性治疗的候选者。
