急性髓细胞白血病表达CD7抗原的临床意义以及与细胞遗传学的相关性

Clinical significance of CD7 expression in associated with cytogenetics in acute myeloid leukaemia

目的:了解急性髓细胞白血病(AML)表达CD7抗原的临床意义以及与细胞遗传学的相关性。方法:对我院诊治的52例AML患者的免疫表型、细胞遗传学以及临床特点进行分析。结果:15例(28.8%)患者的骨髓白血病细胞表达CD7抗原。根据FAB分型,M2(18.5%)和M3型(20%)的CD7+率较低。CD7+组早期细胞抗原CD34、HLA-DR、CD117的表达率以及老年患者(大于60岁)比例高于CD7-组,白细胞计数、染色体异常率、肝脾肿大及髓外白血病发生率均低于CD7-组。CD7+组完全缓解(CR)率高于CD7-组,无病生存期(DFS)短于CD7-组,但差异均无统计学意义(P>0.05)。70%以上的CD7+AML患者分布在中等预后核型组。随着预后好、预后中等、预后差核型组的变化,AML所有病例、CD7-组、CD7+组的CR率均呈逐渐下降趋势。结论:与CD7-AML相比,CD7+AML更容易获得CR,可能与低的白细胞计数、低的染色体异常率以及低的肝脾肿大与髓外白血病发生率有关;CD7+AML患者年龄较大或同时表达早期细胞抗原,可能影响DFS。AML无论是否表达CD7抗原,染色体核型是判断预后最重要的因素。

Objective： To investigate the clinical outcome of CD7 expression in associated with chromosomal karyotype in acute myeloid leukemia （AML）. Method：The immunophenotype, chromosomal karyotype and clinical characters of 52 AML patients diagnosed and treated at our hospital were analyzed. Result：CD7 was expressed on leukemia cells in 15（28.8%） patients. CD7 expression was lower in M2 （18.5%） and M3 （20%） than other subtypes according to French-American-British （FAB） classification. The expression of immature antigens CD34, HLA-DR,and CD117 and percentage in older age group（more than 60 years old） were slightly higher in CD7 positive AML than those in CD7 negative AML. The WBC count, incidence of abnormal karyotype, splenohepatomegalia and extramedullary disease was slightly lower in CD7 positive AML than those in CD7 negative AML. Patients expressing CD7 had slightly higher complete remission （CR） rate but slightly shorter disease free survival （DFS） than patients without CD7. More than seventy percentage of AML expressing CD7 had intermediate eytogenetics. The CR rate decreased stepwise from the cases with favourable cytogeneties to the cases with intermediate and unfavourable cytogenetics in all patients, CD7 negative patients or CD7 positive patients. Conclusion：Patients expressing CD7 were more likely to achieve CR, which may be associated with lower WBC count, incidence of abnormal karyotype, splenohepatomegalia and extramedullary disease. Patients expressing CD7 had shorter DFS, which may be associated with old age or expression immature antigens. Chromosomal karyotype was the most valuable prognostic factor in AML with regardless of patients with or without CD7.