CD34＋/CD38low/-/CD123＋细胞表达水平对急性髓系白血病预后的意义

Prognostic Significance of the Percentage of Blasts with CD34^+/CD38^(low/-)/CD123^+ Phenotype in Acute Myeloid Leukemias

目的:探讨急性髓系白血病(AML)患者CD34^+/CD38^(low/-)/CD123^+细胞表达水平,并分析CD34^+/CD38^(low/-)/CD123^+表达水平与预后的相关性。方法:采用流式细胞术检测148例初诊AML患者骨髓单个核细胞中CD34^+/CD38^(low/-)/CD123^+表达水平,分析CD34^+/CD38^(low/-)/CD123^+细胞表达水平与完全缓解率、无病生存率和总体生存率相关性。结果:初诊AML患者骨髓细胞中CD34^+/CD38^(low/-)/CD123^+阳性细胞中位表达率为2.8%(0.01%-67%)。AML患者CD34^+/CD38^(low/-)/CD123^+高表达与NPM1野生型呈正相关(x^2=5.194,P=0.023),而与FLT3-ITD突变阳性无相关性(x^2=0.418,P>0.05)。多变量回归分析显示,CD34^+/CD38^(low/-)/CD123^+高表达与较低的完全缓解率(P=0.035)、较差的无病生存(P<0.001)、较短的总生存(P<0.001)相关。结论:CD34^+/CD38^(low/-)/CD123^+表达率与AML患者治疗的反应及生存密切相关,在临床中可做为快速识别患者治疗失败的风险预后指标。

Objective：To investigate the percentage of blasts with the CD34＋/CD38low/-/CD123＋ phenotype in de novo acute myeloid leukemia（AML） patients and analyse its correlation with prognosis.Methods;The percentage of CD34＋/CD38low/-/CD123＋ cells in the blast population of 148 newly diagnosed patients with AML was determined by using flow cytometry and its correlation with complete response,disease-free survival and overall survival were evaluated.Results：The median percentage of CD34＋/CD38low/-/CD123＋ cells in newly diagnosed patients was 2.8%（ranged from 0.01 to 67%）.The high expression of CD34＋/CD38low/-/CD123＋ in AML patients positively correlated with the NPM1 wild-type（x2 =5.194,P 〈0.05）,but did not relate with the positive FLT3-ITD mutations（x2 =0.418,P〉0.05）.Further multivariable analysis showed that the higher expression of the CD34＋/CD38low/-/CD123＋ was associated with lower complete remission（P〈 0.05）,worse disease-free survival（P 〈0.01） and shorter overall survival（P〈 0.01） in AML patients.Conclusion：The percentage of CD34＋/CD38low/-/CD123＋ cells at diagnosis significantly correlates with the response to treatment and survival.This prognostic marker may be used to rapidly identify the risk of treatment failure in clinical practice.