CD34阳性及阴性成年人急性T淋巴细胞白血病临床分析

Clinical features of CD34-positive and CD34-negative adult patients with acute T-lymphoblastic leukemia

目的分析CD34阳性及阴性成年急性T淋巴细胞白血病（T-ALL）患者的临床特点及预后，探讨CD34表达对T-ALL预后的价值。 方法回顾性分析郑州大学第一附属医院血液科2012年1月至2015年7月收治的75例初治成年T-ALL患者。根据CD34的表达情况，分为CD34阳性组与阴性组，对两组患者的临床特点及预后进行比较。 结果75例初治成年T-ALL患者中，CD34阳性组24例（32.0%），CD34阴性组51例（68.0%）。CD34阳性组与阴性组在性别、年龄、肝脾大、淋巴结肿大、血小板减少、白细胞增高、染色体异常、4周完全缓解（CR）率、中枢神经系统白血病（CNSL）方面，差异均无统计学意义（均P〉0.05）；初诊时CD34阳性组血红蛋白（Hb）〈90 g/L、伴髓系抗原表达者的比例高于阴性组，差异均有统计学意义（χ2=5.888，P=0.015；χ2=10.758，P=0.001）。18例选择造血干细胞移植（HSCT），57例未选择HSCT。在未选择HSCT的患者中，CD34阳性组中位生存期为5个月，阴性组为32个月，两者差异有统计学意义（χ2=9.172，P=0.002）。 结论成年T-ALL患者CD34表达与Hb〈90 g/L及髓系抗原表达有关；未选择HSCT患者的CD34表达可能与预后呈负相关。

ObjectiveTo analyze the clinical features and prognosis of CD34-positive and CD34-negative adult patients with acute T-lymphoblastic leukemia （T-ALL）, and to explore the value of CD34 expression for prognosis of patients with T-ALL. Methods75 adult patients diagnosed with T-ALL from January 2012 to July 2015 in the Department of Hematology, the First Affiliated Hospital of Zhengzhou University, were analyzed retrospectively. According to the expression of CD34, the patients were divided into CD34-positive group and CD34-negative group, and then the clinical characteristics and prognosis of both groups were analyzed. ResultsIn 75 patients, CD34-positive group had 24 （32.0%） patients and CD34-negative group had 51 （68.0%） patients. Between the two groups, there was no significant difference in these factors, such as sex, age, infiltration of liver, spleen and lymph nodes, thrombocytopenia, high white blood cell count, abnormal karyotype, complete remission within 4 weeks and central nervous system leukemia （CNSL）. The proportions of patients with hemoglobin （Hb）〈90 g/L and expression of myeloid lineage marker were higher in the CD34-positive group than those in the CD34-negative group （χ2=5.888, P=0.015; χ2=10.758, P=0.001, respectively）. There were only 18 patients treated with hematopoietic stem cell transplantation （HSCT）, 57 patients were not. In patients without HSCT, the median survival time in the CD34-positive group and CD34-negative group was significant different （5 months vs. 32 months, χ2=9.172, P=0.002）. ConclusionsCD34 expression in adult patients with T-ALL appears to be associated with Hb〈90 g/L and the expression of myeloid lineage markers. For the patients without HSCT, CD34 is likely negatively related with the prognosis.