CD38表达对成人BCR/ABL融合基因阳性急性B淋巴细胞白血病预后的影响

Significance of CD38 expression on the prognosis of adult BCR/ABL fusion gene positive acute B lymphocytic leukemia

目的:探讨急性B淋巴细胞白血病(B-ALL)患者白细胞分化抗原38(CD38)表达与疗效及预后的关系。方法:收集2014年至2017年在我院初诊的B-ALL患者共74例,用流式细胞仪检测患者骨髓白血病细胞免疫表型,实时荧光定量PCR检测断裂点簇基区-Abelson酪氨酸激酶(BCR-ABL)融合基因。分别依据CD38表达强度分为CD38^+组和CD38-组以及BCR-ABL融合基因存在与否分为BCR-ABL^+组和BCR-ABL-组,回顾性分析不同组别患者的临床资料及预后。结果:74例B-ALL患者中,CD38^+组和CD38-组患者分别为34例及40例,BCR-ABL^+组和BCR-ABL-组分别为30例及44例。BCR/ABL^+组患者CD38表达率显著低于BCR/ABL-组(26.7%vs 73.3%,P=0.017)。CD38^+和CD38-患者的总生存期(OS)及无进展生存期(PFS)差异无统计学意义。BCR/ABL^+患者中,CD38^+组的中位OS和PFS显著低于CD38-组(15.73个月vs 25.8个月,9.27个月vs 25.8个月;分别P=0.01和P=0.021);而BCR/ABL-患者中,CD38^+组和CD38-组的中位OS和PFS差异均无统计学意义。结论:CD38表达是BCR/ABL^+ALL患者预后不良的因素,即使酪氨酸酶抑制剂(TKI)治疗也不能改变这种不良预后。

Objective:To investigate the prognostic role of CD38 expression in B-cell acute lymphoblastic leukemia(B-ALL).Methods:A total of 74 patients with newly diagnosed B-ALL in our hospital between 2014 and 2017 were enrolled.Immunophenotype of leukemic cells and breakpoint cluster region(BCR)-Abelson tyrosine kinase(ABL)fusion gene were assayed by flow cytometry and quantitative real-time PCR,respectively.Parients were divided into CD38^+and CD38-groups based on their CD38 expression,and then subdivided into BCR-ABL^+and BCR-ABL-groups based on their BCR-ABL fusion gene status.The clinical characteristics and prognosis of different groups were analyzed retrospectively.Results:CD38 expression of the BCR-ABL^+ALL(30 cases)group was significantly lower than that of the BCR-ABL-ALL group(44 cases)(26.7%vs 73.3%,P=0.017).There was no statistical difference of overall survival(OS)and progression free survival(PFS)between CD38^+(34 cases)and CD38-(40 cases)groups.However,the median OS and PFS of CD38^+patients was significantly lower than that of CD38-patients in the BCR-ABL^+subgroup(15.73 month vs 25.8 months,9.27 months vs 25.8 months;P=0.01,P=0.021),while there was no statistical difference of the median OS and PFS between CD38^+and CD38-patients in the BCR/ABL-subgroup.Conclusion:CD38 expression is a factor for poor prognostic in BCR/ABL^+ALL patients,and this poor prognostic could not be overcome by tyrosinase inhibitor(TKI)treatment.