Kaspers G J, Veerman A J, Van Wering E R, Van Der Linden-Schrever B E, Van Zantwijk C H, Van Der Does-Van Den Berg A, Pieters R
Department of Pediatrics, Free University Hospital, Amsterdam, The Netherlands.
Leukemia. 1996 Apr;10(4):675-81.
We previously reported the favorable prognosis associated with positive peanut agglutinin (PNA) binding in childhood T cell acute lymphoblastic leukemia (ALL), and hypothesized that this may be related to glucocorticoid sensitivity (Veerman et al. Cancer Res 1985, 45: 1890). The purposes of this prospective study involving 202 children with newly diagnosed ALL were to determine the relationship between PNA binding and (1) immunophenotype; (2) in vitro resistance to prednisolone (PRD) and dexamethasone and other drugs; (3) clinical response to a systemic PRD monotherapy (plus one intrathecal injection with methotrexate); and (4) multidrug chemotherapy. PNA positivity was more frequent in T cell ALL (65% of 43 cases) than in pro-B (0% of seven cases), common (17% of 106 cases) and pre-B (16% of 45 cases) ALL (P < 0.001). PNA binding was not associated with in vitro resistance to PRD or dexamethasone. However, in 38 evaluable T cell ALL patients, nine of 13 PNA-negative cases were clinically poor responders to PRD, while all 25 PNA-positive cases were good responders to PRD clinically (P < 0.0001). The four clinically poor PRD responders with B cell precursor (BCP)-ALL were also PNA negative. Within T cell ALL, PNA-positive patients had a 3.4-fold (95% Cl, 1.1-10.4, P = 0.03) lower relative risk of any event, than PNA-negative patients. Within BCP-ALL, PNA binding was not of prognostic significance. In conclusion, PNA positivity, especially frequent in T cell ALL, is a marker for a subgroup of childhood ALL patients who are very likely to respond well to systemic PRD 'monotherapy'. In addition, PNA positivity is a favorable prognostic factor in T cell ALL.
我们之前报道了儿童T细胞急性淋巴细胞白血病（ALL）中花生凝集素（PNA）结合阳性与良好预后相关，并推测这可能与糖皮质激素敏感性有关（Veerman等人，《癌症研究》1985年，45: 1890）。这项涉及202例新诊断ALL患儿的前瞻性研究的目的是确定PNA结合与以下因素之间的关系：（1）免疫表型；（2）对泼尼松龙（PRD）和地塞米松及其他药物的体外耐药性；（3）对系统性PRD单一疗法（加一次鞘内注射甲氨蝶呤）的临床反应；（4）多药化疗。PNA阳性在T细胞ALL（43例中的65%）中比在原B细胞（7例中的0%）、普通型（106例中的17%）和前B细胞（45例中的16%）ALL中更常见（P < 0.001）。PNA结合与对PRD或地塞米松的体外耐药性无关。然而，在38例可评估的T细胞ALL患者中，13例PNA阴性病例中有9例对PRD临床反应不佳，而所有25例PNA阳性病例临床对PRD反应良好（P < 0.0001）。4例临床PRD反应不佳的B细胞前体（BCP）-ALL患者也为PNA阴性。在T细胞ALL中，PNA阳性患者发生任何事件的相对风险比PNA阴性患者低3.4倍（95%可信区间，1.1 - 10.4，P = 0.03）。在BCP-ALL中，PNA结合无预后意义。总之，PNA阳性，尤其在T细胞ALL中常见，是儿童ALL患者中一个亚组的标志物，该亚组患者很可能对系统性PRD单一疗法反应良好。此外，PNA阳性是T细胞ALL的一个良好预后因素。
