初诊急性髓系白血病骨髓CD34^+ CD38^-细胞群比例是初次诱导缓解率的预后因素

Proportion of CD34^+ CD38^- Cell Population in Bone Marrow of Patients with De Novo AML as Prognostic Factor of Complete Rimission at First Course of Induction Chemotherapy

为了研究非M3急性髓系白血病(AML non-M3)CD34+CD38-细胞群及其G0期比例与临床和实验室特征的关系,使用流式细胞仪检测40例初治AML non-M3骨髓单个核细胞CD34和CD38的表达,测定各群细胞的细胞周期,并分析CD34+CD38-细胞群及其G0期比例与临床实验室特征及初次诱导缓解率的关系。结果显示,CD34+CD38-细胞群及其G0期的比例与染色体核型、初诊WBC计数及FLT3/ITD阳性均无明显相关性,但与诱导治疗后骨髓中幼稚细胞比例相关。诱导停疗第7天骨髓中有幼稚细胞患者CD34+CD38-细胞比例为(12.47±26.26)%,诱导停疗第7天无幼稚细胞患者CD34+CD38-细胞比例为(2.62±7.20)%(p=0.031)。诱导停疗第1天骨髓中可见幼稚细胞患者CD34+细胞群比例为(17.40±21.20)%,而诱导停疗第1天无幼稚细胞患者该比例为(5.64±6.96)%(p=0.001)。CR组患者治疗前CD34+CD38-细胞群的比例为(2.51±9.72)%,明显低于非CR组患者(24.92±27.04%)(p=0.001)。而在AML non-M2b患者中,CR组患者治疗前CD34+CD38-细胞群的比例为(1.60±4.82)%,较非CR组患者更为降低(p<0.001)。单因素分析显示,诱导化疗后是否取得CR与年龄(p=0.022)、CD34+CD38-细胞群比例(p=0.008)、诱导停疗第7天骨髓幼稚细胞比例(p=0.011)相关。多因素分析显示,仅有CD34+CD38-细胞群的比例与是否获得CR有相关趋势(p=0.052)。结论:初治AML患者CD34+CD38-细胞群的比例是AML初次诱导缓解率的预后因素。

This study was to investigate the relationship between the CD34＋CD38-cell population and its proportion in G0 phase of de novo AML non-M3 at diagnosis and the clinical and experimental characteristics.The flow cytometry was used to detect the expression of the cell surface antigen CD34 and CD38 in the bone marrow mononuclear cells（MNC） of the AML non-M3 at diagnosis and investigate the cell cycle of the subpopulations,and then the relationships between the proportion of CD34＋CD38-cell population and its G0 state and the complete remission（CR） rate after the first induction chemotherapy was analyzed.The results showed that the proportion of the CD34＋CD38-cell population and its G0 phase had no relationship with the karyotypes and WBC count at new diagnosis and the Flt3/ITD status,but correlate with the blasts in the bone marrow after the first course induction chemotherapy.The proportion of the CD34＋CD38-cells in patients who have visible blasts in the bone marrow at day 7 after completion of the first course induction chemotherapy was（12.47±26.26）%,but the counterparts was（2.62±7.20）% in the group of patients whose bone marrow had no visible blasts（p = 0.031）.The proportion of the CD34 ＋ cell population in patientswho had visible blasts in the bone marrow at day 1 after completion of the first course induction chemotherapy was（17.40 ±21.20） %,yet the proportion of the CD34 ＋ cell populations was（5.64 ±6.96） % in the patients who had novisible blasts in the bone marrow（p = 0.001）.The proportion of the CD34 ＋ CD38-cell populations in the patients whoachieved CR after the first course induction chemotherapy was（2.51 ± 9.72） %,which was lower than the proportion（24.92 ±27.04%） of the non-CR patients（p =0.001）.Furthermore,the proportion（1.60 ±4.82%） of the CD34 ＋CD38-cell population in the AML non-M2b CR patients was more obviously lower than that in the non-CR patients（p 0.001）.In univariate analysis,whether or not achieved CR after the first course induction chemotherapy correlated withage（p = 0.022）,the proportion of the CD34 ＋ CD38-cell population（p = 0.008） and the proportion of the visibleblasts in the bone marrow at day 7 after induction therapy（p = 0.011）.Multivariate analysis showed that only theproportion of the CD34 ＋ CD38-cells had correlation tendency with CR rate.It is concluded that the proportion of theCD34 ＋ CD38-cells in bone marrow of de novo AML non-M3 is a prognostic factor to anticipate the CR rate of the firstcourse for induction therapy.