急性早幼粒细胞白血病CD34表达及其意义

Significance of CD34 expression in patients with acute promyelocytic leukemia

目的探讨急性早幼粒细胞白血病(APL)患者的CD34表达与其临床特点、分子生物学特性的关系以及其在不同亚型APL中表达对疾病预后的影响。方法回顾性分析安徽医科大学附属第一医院2009年12月至2013年10月收治并获得系统治疗的64例急性早幼粒细胞白血病患者的临床资料,了解其抗原表达与临床特点间的关系,并采用χ2检验及Log-Rank检验对可能影响患者预后的危险因素进行统计学分析。结果 CD34+患者12例(18.8%),高表达于PML/RARα-S型患者(9/19,47.4%),且常与CD2+、HLA-DR+共表达(7/13,53.8%对5/8,62.5%),差异有统计学意义(P<0.05)。CD34+与低完全缓解(CR)率密切相关(P<0.05)。WBC<10×109/L组、CD34-组的总体生存(OS)率、无事件生存(EFS)率显著高于WBC≥10×109/L组、CD34+组,L型组、CD2+组EFS率显著高于S型组、CD2-组,差异均有统计学意义(P<0.05);但L型与S型组、CD2+组与CD2-组OS差异无统计学意义(P>0.05)。结论对CD34免疫表型分析可以区分不同生物学特性及具有不同预后的APL亚型。

Objective To explore the relationship between the expression of CD34 and clinical characteristics or biological characteristics and its impact on the disease outcome in patients with acute promyelocytic leukemia （APL）. Methods Sixty-four patients with APL, from December 2009 to October 2013 in our hospital were studied retrospectively to demonstrate the relationship between its antigen expression and clinical features. Univariate analysis of the potential factors influencing survival of these patients was carried out with the Chi-square test and Log-Rank method. Results CD34 was highly expressed in 12 （18.8%） of cases with type PML/RARa-S （9/19, 47.4%） as compared with that in patients with type PML/RARa-L isoform. CD34＋cases were often associated with CD2＋, HLA-DK＋ （7/13, 53.8% vs. 5/8, 62.5%）. In addition, CD34＋ expression was significantly associated with decreased incidence of complete remission （CR）. The overall survival （OS） and event-free survival （EFS） of patients with WBC count I〉 10xl09/L or CD34~ was inferior to patients with WBC count 〈10xl09/L or CD34-. The EFS of patients with CD2~ or PML/ RARa-S isoform was inferior to patients with CD2- or PM_L/RARa-L isoform, but no significant differences were observed in the OS between CD2＋ and CD2- or between PML/RARa-L isoform and PML/RARa-S isoform groups. Conclusion Immunophenotypic analysis for CD34 could distinguish an APL subset with different biological characteristics and adverse prognostic outcome.