2D123在急性髓系白血病患者骨髓异常细胞群中的表达及预后价值

The study of expression and prognostic value of CD123 in acute myeloid leukemia bone marrow blasts

目的观察CD123在急性髓系白血病（AML）患者中的表达，探讨其与AML疗效和预后的关系。方法回顾性分析第二军医大学长海医院137例初诊AML（M3除外）患者骨髓异常细胞群中CD123的表达情况，初诊时多参数流式细胞术检测CD123表达占骨髓异常细胞群≥20％定义为阳性，对CD123^＋与CD123^-患者疗效和预后进行比较分析。结果①137例AML患者中CD123^＋组84例（61．3％），CD123^-组53例（38．7％）。所有病例根据细胞遗传学及分子生物学异常进行预后等级分层后，预后良好、预后中等、预后不良患者CD123表达差异无统计学意义（x^2=0．861，P=0．650）。而与CD123^-组相比，CD123^＋组AML患者初诊时WBC更高[47．7（1．0～264．0）对22．4（0．7～211．0），Z=-2．592，P=0．010]。②CD123^＋组首次诱导完全缓解（CR1）率为54．8％（46／84），CD123组为73．6％（39／53），差异有统计学意义（x^2=5．121，P=0．027），最优疗效达完全缓解的111例患者共有52例复发，总复发率为46．8％，CD123^＋组与CD123一组复发率分别为50．8％（32／63）对41．7％（20／48），差异无统计学意义（r=0．911，P=0．340）。③CD123^＋组与CD123组患者的中位总生存（OS）时间分别为20．000（95％a13．1～26．9）个月和44．0（95％C123．6～47．3）个月（x^2=5．874，P=0．015）；中位无病生存（DFS）时间分别为7．8（95％CI1．4～14．1）个月和18．6（95％C10～39．7）个月，差异无统计学意义（x^2=2．939，P=0．086）。④在预后中等组及年龄≤50岁组中，CD123^＋患者OS及DFS均较CD123^-患者差。结论CD123在AML患者中广泛表达，是影响患者CRl及OS的独立危险因素，对评估AML患者诱导化疗反应及生存预后具有重要意义。

Objective To study the expression of CD123 in bone marrow （BM） blasts of acute myeloid leukemia （AML） patients to explore the relationship between CD123 expression and therapeutic response and prognosis. Methods This study retrospectively analyzed expression and distribution of CD123 in BM blasts in 137 cases of newly diagnosed AML （excluded M3）, CD123 detected by flow eytometry≥20% was defined as positive, including 84 CD123^＋ AML and 53 CD123^-AML, efficacy and prognosis were compared between the two groups. Results ① Among 137 patients, 84 were in group CD123^＋ （61.3%）, and 53 in group CD123^- （38.7%）. All 137 patients were classified into risk groups based on cytogenetic and molecular biology abnormalities. No significant differences were seen between the three risk groups with regard to their CD123 levels （Z2 = 0.861, P = 0.650）. Compared with CD123- group, the CD123^＋ group had higher WBC [47.7 （1.0-264.0） vs 22.4 （0.7-211.0）, z=-2.592, P= 0.0101. ② The rates of first complete remission （CR1） and recurrence of CD123^＋ group were 54.8% （46/84） and 50.8% （32/63）, respectively; and CD123- group were 73.6% （39/53） and 41.7% （20/48）, respectively. There was significant difference of CR1 between the two groups （x^2= 5.121, P= 0.027）, whereas no significant difference of the recurrence rate （x^2=0.911, P=0.340）.③ The median dutations of OS between CD123＋ group and CD123- group were 20.0 （95%CI 13.1-26.9） months vs 44.0 （95%CI 23.6- 47.3） months, respectively （x^2 = 5.874, P= 0.015）; The median durations of DFS were 7.8 （95%CI 1.4- 14.1） months vs 18.6（95%（7/0-39.7） months, respectively, no differences were observed between the two groups （x^2 = 2.939, P = 0.086）. ④ CD123 retained an adverse prognosis value on DFS and OS within the intermediate group and patients ≤ 50 years older. Conelusions CD123 widely expressed in AML patients, which was an independent risk factor for CR1 and OS, which implicating its important role in evaluating the induction chemotherapy response and prognosis of AML.