在急性髓系白血病患者中探讨CD33的量化水平跟核仁磷酸蛋白和FMS样酪氨酸激酶3基因突变的关系

Investigate the relationship between the CD33 levels quantified by mean fluorescence intensity and antibody binding capacity and the presence/absence of nucleophosmin and FMS-like tyrosine kinase-3 gene mutations

目的在初诊的AML病例中通过平均荧光强度（MFI）和抗体结合能力（ABC）研究CD33的量化水平与NPM1和FLT3基因突变的存在或缺失之间的关系。方法选择常规检查诊断出的64名AML患者,通过流式细胞仪对筛选出的AML患者进行免疫表型分析。结果 64名患者白细胞的CD33表达量集中在69%（范围12%-91%）。存在NPM1突变的病例和不存在的相比,CD33的MFI和ABC值有显著的差异（P〈0.05）。其中28名NPM1突变的患者MFI中心值为436（范围16~1 830）,而36名不存在NPM1突变的患者的MFI中心值为215（范围32~986）,差异显著（P〈0.05）。选择27个病例研究CD33的ABC值,结果显示,10个存在NPM1突变病例的ABC值集中在12 236（范围2 580~18 356）,剩余17个没突变病例的ABC值集中在4 205（范围366~16 720）（P〈0.05）。此外,在存在NPM1突变的患者中白血病患者的CD33的MFI值与正常人相比明显增高（P〈0.05）。相反,不存在NPM1突变的白血病患者与正常人的MFI值之间没有发现差异（P〉0.5）。通过对NPM1＋/FLT3＋和NPM1＋/FLT3-两个患者组的检测发现,两个组的CD33的MFI值（平均456.3 vs.536.2,P〉0.5）和ABC值（平均9243.6 vs.10150.2,P〉0.5）无显著差异。结论携带NPM1突变的AML患者显示出较高的CD33表达强度,这可为AML的一个更好的相关治疗方案提供思路,具有重要的临床意义。

【Objective】 Investigate the relationship between the CD33 levels quantified by mean fluorescence intensity and antibody binding capacity and the presence/absence of NPM1 and FLT3 gene mutations in newly diagnosed acute myeloid leukemia case.【Methods】 Sixty-four adult AML samples,routinely investigated at diagnosis were selected.And then analyze the immunophenotype using flow cytometry in adult myeloid leukemia patients that selected.【Results】 All 64 cases expressed the CD33 antigen on a median proportion of 69 of cells（range12%-91%）.Considering the NPM1-positive and NPM1-negative cases,significant differences in CD33 MFI and ABC values were found： a median MFI value of 436（range 16-1830） was found in the 28 NPM1-mutated patients,while in the 36 NPM1-unmutated patients the median value was 215（range32-986）.This difference was highly significant（P 〈0.05）.CD33 ABC values were studied in 27 cases.This analysis demonstrated that 10 of 27 NPM1-mutated cases showed a median ABC value of 12236（range 2580-18356）,while 16 of 27 NPM1-unmutated cases had a median value of 4205（range 366-16720）（P 〈0.05）.Furthermore,in NPM1-mutated patients a significantly higher MFI expression of the CD33 antigen was recorded in the leukemia cells compared to the normal residual myeloid population（P 〈0.05）.On the contrary,no difference was observed between the leukemia and normal myeloid population in NPM1-unmutated patients;and through studying the NPM1＋/FLT3＋ and NPM1＋/FLT3-groups,no differences were observed in terms of CD33 MFI（average 456.3 vs.536.2,P 〉0.5） and ABC（average 9243.6 vs.1015.2,P 〉0.5） values.【Conclusion】 AMLs with NPM1 mutations show a significantly higher degree of expression of the CD33 antigen and suggest that this observation may have implications in the clinical management of this important subgroup of AML patients.