Sarfati M, Chevret S, Chastang C, Biron G, Stryckmans P, Delespesse G, Binet J L, Merle-Beral H, Bron D
Hôpital Notre-Dame, University of Montreal, Quebec, Canada.
Blood. 1996 Dec 1;88(11):4259-64.
Prognosis of B-cell chronic lymphocytic leukemia (CLL) is based on clinical staging whose limitation is the failure to assess whether the disease will progress or remain stable in early stage (Binet A, or Rai 0, I, II) patients. We previously reported that soluble CD23 (sCD23), a protein derived from the B-cell membrane CD23 Ag, is selectively elevated in the serum of CLL patients. This prospective study assessed the predictive value of serum sCD23 level measured at study entry on the overall survival of all CLL patients and on disease progression of stage Binet A patients. Prognostic value of repeated measurements of sCD23 over time in stage A patients was also analyzed. One hundred fifty-three CLL patients were prospectively followed with a median follow-up of 78 months. Eight clinical or biological parameters were collected from the date of the first sCD23 measurement. At study entry, by Cox model, Binet staging (P = .0001) and serum sCD23 level (P = .03) appeared as prognostic factors for survival. Patients with sCD23 level above median value (> 574 U/mL) had a significantly worse prognosis than those with lower values (median survival of 53 v 100+ months, P = .0001). During follow-up, sCD23 doubling time increased by 3.2 the risk of death (P = .001). Among stage A patients (n = 100), sCD23 determination at study entry was the sole variable predictive of disease progression, patients with sCD23 level above 574 U/mL had a median time progression of 42 months versus 88 months for those with lower levels (P = .0001). Stage A patients who doubled their sCD23 level exhibited a 15-fold increased risk of progression (P = .0001) and, in addition, the sCD23 increase preceded by 48 months disease progression. We conclude that in CLL patients, serum sCD23 level provides significant additional prognostic information in terms of overall survival. Most interestingly, among early stage patients, sCD23 determination at diagnosis and during the course of the disease may help to the early identification of patients who will rapidly progress to upper stages.
B 细胞慢性淋巴细胞白血病（CLL）的预后基于临床分期，其局限性在于无法评估疾病在早期（Binet A 期，或 Rai 0、I、II期）患者中是否会进展或保持稳定。我们之前报道过，可溶性CD23（sCD23）是一种源自B细胞膜CD23抗原的蛋白质，在CLL患者血清中选择性升高。这项前瞻性研究评估了研究入组时测得的血清sCD23水平对所有CLL患者总生存期以及Binet A期患者疾病进展的预测价值。还分析了A期患者随时间重复测量sCD23的预后价值。对153例CLL患者进行了前瞻性随访，中位随访时间为78个月。从首次测量sCD23之日起收集了8项临床或生物学参数。在研究入组时，通过Cox模型，Binet分期（P = .0001）和血清sCD23水平（P = .03）显示为生存的预后因素。sCD23水平高于中位数（> 574 U/mL）的患者预后明显差于水平较低者（中位生存期分别为53个月和100多个月，P = .0001）。在随访期间，sCD23倍增时间使死亡风险增加3.2倍（P = .001）。在A期患者（n = 100）中，研究入组时测定的sCD23是疾病进展的唯一预测变量，sCD23水平高于574 U/mL的患者中位进展时间为42个月，而水平较低者为88个月（P = .0001）。sCD23水平翻倍的A期患者进展风险增加15倍（P = .0001），此外，sCD23升高比疾病进展提前48个月。我们得出结论，在CLL患者中，血清sCD23水平在总生存期方面提供了重要的额外预后信息。最有趣的是，在早期患者中，诊断时和疾病过程中测定sCD23可能有助于早期识别将迅速进展到更高分期的患者。
