232例急性髓细胞白血病免疫表型及与细胞遗传学关系分析

目的探讨初治成人急性髓细胞性白血病（acute myeloid leukemia,AML）的免疫表型特征,并对其与FAB分类、细胞遗传学的关系进行分析。方法采用CD45/SSC双参数散点图设门方法、三色流式细胞术对232例急性髓细胞白血病细胞进行免疫表型分析,染色体G显带技术对其中的172例进行核型分析。结果AML患者中,CD38、CD33和CD13的表达最常见,CD117、CD11b分别有助于区分髓系和淋系白血病,在淋系抗原中,以CD9、CD7较常见。CD7可能是一个独立的预后因素。某些免疫表型特征与FAB分类具有相关性,包括M3中缺乏表达HLA-DR和CD34,而CD9表达增加。CD11b有助于M5与M1、M2、M3的区分,M5中CD14的表达率增加,其阳性率明显高于M2。CD15可能有助于M5亚型的鉴别。本组AML核型异常率为71.6%,t（8;21）（q22;q22）主要见于M2（79.0%）,还见于M5。单纯t（8;21）（q22;q22）易位10例（52.6%）,伴其它染色体异常的为9例（47.4%）,主要附加异常染色体类型为性染色体的丢失。CD13、CD9的表达与染色体异常显著性相关。CD117、CD15同时表达的AML少有预后较差染色体的异常。伴t（8;21）（q22;q22）异常的AML表达CD15、CD33、CD38显著增加。结论白血病免疫表型的检测有助于AML的诊断和分类。免疫表型与细胞遗传学的相关性提示AML抗原的异常表达可能与基因的异常改变密切相关。     

t(8;21)急性髓系白血病患者MICM分型及预后的回顾性分析

 目的　分析t(8;21)急性髓系白血病（AML）患者的细胞形态学、免疫表型、遗传学、分子生物学（MICM）分型及临床治疗疗效。方法　运用瑞特染色法、FAB细胞形态分类标准、流式细胞术（FCM）直接免疫荧光标记技术、遗传学染色体吉姆萨显带技术及RT-PCR技术对70例确认有t(8;21)与AML1-ETO融合基因双阳性的AML患者及70例正常染色体核型的AML患者进行分析和比较。结果　70例t(8;21)AML患者中M1 1例,M2 64例,M4 3例,无法分型的急性白血病（AL）2例;免疫表型分析发现CD13、CD33、CD34、CD117高表达,40 %表达CD19,11 %表达CD15,10 %表达CD11b,7 %表达CD7;遗传学显示50 %的t(8;21) AML患者有附加染色体异常,主要为性染色体丢失、9q-及超二倍体;RT-PCR检测AML1-ETO融合基因100 %阳性。CD+19 t(8;21) AML患者完全缓解（CR）率72 %,CD+19伴CD+7 t(8;21)AML患者CR率为0,正常核型CR率31 %。结论　t(8;21) AML患者主要在M2中集中出现,附加染色体异常较多见。CD19表达较高,而CD7表达极低,CD34、CD117高表达,这些抗原的表达可能与核型密切相关。CD+19 是预后良好的指标,但同时出现CD+7,则预后不良。     

急性白血病首次复发后免疫表型及细胞遗传学改变

目的 :分析成人急性白血病首次复发前后免疫表型和细胞遗传学改变。方法 :采用间接荧光法分析急性白血病患者的免疫表型 ,用 G分带技术研究患者的染色体核型。结果 :5例中 4例急性淋巴细胞白血病 ( ALL )复发后的患者发生免疫表型变化 ,均涉及 CD3 4 抗原表达 ;CD3 4 抗原的表达与再诱导治疗结果呈负相关。 10 /12例急性髓细胞白血病 ( AML )复发患者免疫表型发生改变 ,涉及 CD1 4 、CD1 5 、CD1 3 、CD3 3 、CD3 4 、CD7、HLA-DR等抗原 ;CD1 4 、CD3 3 、CD3 4 发生改变的患者再诱导治疗效果差 ;CD1 5 由阴性转为阳性的患者再诱导效果较好。 7例患者复发前后均进行了染色体核型分析 ,4例出现主要的染色体核型改变 ,其中 3例为异常核型转为正常核型 ;染色体核型发生改变的病例再诱导治疗效果均较差。结论 :成人急性白血病复发后免疫表型和细胞遗传学均可发生改变 ,这些改变与再诱导治疗的结果有关。     

急性粒-单核细胞白血病的免疫表型及细胞遗传学特征

背景与目的:白血病中某些抗原的表达与细胞遗传学的改变密切相关。本研究旨在探讨急性粒-单核细胞白血病(acutemyelomonocyticleukemia,M4)的免疫表型特征,并分析其与细胞遗传学的关系,为其诊断及治疗提供依据。方法:采用一组系列相关单克隆抗体和三色流式细胞术对81例M4患者进行免疫表型分析,并分析有核型资料的73例患者的核型异常;同时应用双色间期荧光原位杂交(fluorescenceinsituhybridization,FISH)技术对有染色体标本的35例患者进行inv(16)检测,并分析inv(16)阳性患者的免疫表型特征。结果:81例M4患者中48例(59.3%)表达干细胞标志CD34;髓系标志以CD33(84.0%)表达最高,其次为CD13(81.5%)和CD14(24.7%);分别有23例(28.4%)和10例(12.3%)患者表达T系和B系相关抗原。11例M4Eo患者中CD13均阳性,10例CD33阳性,7例CD34阳性,5例CD2阳性。FISH检测发现14例患者inv(16)阳性,其中CD13阳性13例,CD33阳性11例,CD34阳性8例,CD14阳性5例,CD7阳性3例,CD2阳性3例。73例M4患者中,异常染色体检出率为41.1%(30/73),共检出11种主要异常核型。CD2和CD34在染色体异常患者中表达明显增高,而CD14表达减低。CD2在M4Eo中表达增高,但其表达与inv(16)无显著性相关。结论:急性粒-单核细胞白血病以髓系抗原表达为主,CD2和CD34在染色体异常患者中表达明显增高;CD2在M4Eo中表达增高。Inv(16)在M4中占40%,各抗原表达与inv(16)无显著相关性。     

CD14+单核细胞系白血病细胞来源树突细胞体外刺激特异抗白血病T细胞应答

背景与目的:白血病细胞能在体外分化为树突细胞(dendriticcells,DCs),从而有希望用于白血病的免疫治疗。本研究旨在探讨CD14高表达的单核细胞系白血病(M4、M5)细胞分化而来的DCs体外诱导抗白血病T细胞应答的能力。方法:取5例初诊CD14高表达的M4或M5型白血病患者的骨髓标本,分离单个核细胞(bonemarrowmononuclearcells,BMMNCs),将白血病细胞分为3组:贴壁白血病细胞组、非贴壁白血病细胞组及总白血病细胞组。流式细胞术(flowcytometry,FCM)比较3组细胞的CD14表达。用含GM-CSF、IL-4和TNF-α或不含细胞因子的培养液培养细胞7～10天后,通过细胞形态学观察及FCM检测细胞表型,鉴定单核白血病细胞来源的DCs(monocyticleukemiacell-deriveddendriticcells,Mo-LDCs);采用异基因混合淋巴细胞反应(allogeneicmixedlymphocytereaction,Allo-MLR)以及细胞毒性T淋巴细胞(cytotoxicTlymphocytes,CTL)抗白血病细胞毒分析检测Mo-LDCs的免疫功能,染色体核型分析结合异常表面抗原确定Mo-LDCs的白血病来源。结果:3组中贴壁白血病细胞的CD14含量最高,在细胞因子联合诱导下,可分化为大量CD83 成熟DCs。在同一病例的3组细胞以及不同病例的总单核细胞组间,培养前CD14的表达率与诱导后CD83 DCs的产率成正相关(r=0.967,P=0.007)。Mo-LDCs具有典型的成熟DCs的形态及表型特征,在Allo-MLR中能刺激同种T细胞明显增殖,并能刺激扩增特异性抗白血病CTL。同时,Mo-LDCs持续存在所起源白血病的核型异常和异常表达的髓系抗原。结论:在细胞因子组合诱导下,M4、M5亚型AML的CD14 细胞可分化为具有免疫功能的Mo-LDCs,单核系白血病细胞的CD14表达高低可能预示其DCs分化能力。Mo-LDCs具有经典的DCs的表型及功能,还具有白血病的克隆异常,可用于M4、M5患者的免疫治疗。     

急性髓系白血病M2型免疫表型及细胞遗传学研究

 目的　探讨急性髓系白血病M2型的免疫表型及细胞遗传学特征。方法　采用一组单克隆抗体和三色流式细胞术对112例M2患者进行免疫表型及核型分析。结果　112例M2患者中,70例（62.5 %）表达干细胞标志CD34。髓系标志中以CD13（87.5 %）M2患者表达最高,其次是CD33（83.9 %）和CD14（2.7 %）。分别有34例（30.4 %）及24例（21.4 %）患者表达T系及B系标志。112例M2患者中,73例（65.2 %）检出异常核型,共检出28种数目异常,25种结构异常。47例（42.0 %）患者检出t（8;21）。CD19及CD34单独或共同表达在核型异常及伴t（8;21）的M2患者中显著增高（P＜0.05）。结论　M2以髓系抗原表达为主,部分有淋系抗原表达,CD19及CD34表达与t（8;21）显著相关。     

急性髓系白血病M2型免疫表型及细胞遗传学研究

目的 探讨急性髓系白血病M2型的免疫表型及细胞遗传学特征.方法 采用一组单克隆抗体和三色流式细胞术对112例M3患者进行免疫表型及核型分析.结果 112例M3患者中,70例(62.5%)表达干细胞标志CD34.髓系标志中以CD13(87.5%)M2患者表达最高,其次是CD33(83.9%)和CD14(2.7%).分别有34例(30.4%)及24例(21.4%)患者表达T系及B系标志.112例M2患者中,73例(65.2%)检出异常核型,共检出28种数目异常,25种结构异常.47例(42.0%)患者检出t(8;21).CD19及CD34单独或共同表达在核型异常及伴t(8;21)的M2患者中显著增高(P＜0.05).结论 M3以髓系抗原表达为主,部分有淋系抗原表达,CD19及CD34表达与t(8;21)显著相关.     

急性髓细胞白血病微分化型流式细胞术免疫分型分析

目的探讨流式细胞术（FCM）检测免疫表型在诊断急性髓细胞白血病微分化型（AML—M0）中的意义。方法采用多色FCM分析14例AML—M0病例的各相关抗原表达情况。结果14例AML—M0中,仅1例依据骨髓细胞形态学作出诊断,其余13例均依靠FCM作出明确诊断。在AML—M0中,髓系抗原CD33 14例（100％）表达阳性,CD13和CD117 9例（64％）表达阳性,CD34和HLA—DR12例（86％）表达阳性,一般成熟髓系相关抗原如CD16、CD10、CD14等均阴性,B和T淋巴细胞特异抗原如CD79a和CD3均为阴性,少数原始细胞表达细胞内髓过氧化物酶（MPO）、TdT。常常表达一些淋系但并不特异的抗原如CD7、CD2或CD19,但比淋巴细胞白血病表达的荧光强度弱。结论FCM免疫分型在AML—M0诊断中至关重要。     

成人急性淋巴细胞白血病免疫表型及细胞遗传学特征分析

目的：对110例成人急性淋巴细胞白血病（ALL）患者进行免疫表型及细胞遗传学特征分析.方法：采用CD45/SSC参数设门四色流式细胞术检测110例成人ALL患者治疗前骨髓细胞的免疫表型,染色体R显带技术对其中的73 例进行核型分析.结果：110例ALL患者中,21.8%为T-ALL,78.2%为B-ALL.47.3%的ALL患者表达髓系抗原 （MyAg）,CD13是成人ALL中最常见的MyAg （32.1%）.T-ALL髓系相关抗原表达总的阳性率（45.8%）与B-ALL（47.7%）无统计学差异.可供核型分析的73例中核型异常者37例（50.7%）,最常见的遗传学异常为Ph染色体,占23.3%.结论：免疫表型对ALL的诊断与分型至关重要,免疫表型与患者的异常核型改变及临床特征关系密切.     

132例初发儿童急性淋巴细胞白血病免疫表型及细胞遗传学特征分析

目的：探讨儿童急性淋巴细胞白血病（ALL）的免疫表型及细胞遗传学特征,为其诊断及治疗提供依据。方法：采用多参数流式细胞术（FCM）对132例初发儿童 ALL 患者进行免疫表型分析,并应用荧光原位杂交（FISH）技术检测其细胞遗传学特点。结果：132例 ALL 患者中,12.9%（17/132）为 T 淋巴细胞急性淋巴细胞白血病（T - ALL）,87.1%（115/132）为 B 淋巴细胞急性淋巴细胞白血病（B - ALL）。46.2%（56/132）的ALL 患者表达髓系抗原,CD13是 ALL 中最常见的髓系抗原,其阳性率为28.0%。T - ALL 髓系相关抗原表达阳性率为47.1%,与 B - ALL 的46.1%比较,差异无统计学意义（χ2=0.006,P =0.940）。可供核型分析的96例 ALL 中,核型异常者50例（52.1%）,其中染色体数目异常26例,染色体结构异常24例。96例 ALL 患者中,TEL/ AML1融合基因阳性21例（21.8%）,BCR/ ABL 融合基因阳性14例（14.6%）,TCF3/ PBX1融合基因阳性5例（5.2%）,MLL 重排3例（3.1%）。对不同免疫分型患者细胞遗传学异常检出率进行比较,差异均无统计学意义（P >0.05）。结论：儿童 ALL 免疫表型和细胞遗传学具有一定的特点,两者联合检测对 ALL 的诊断及分型具有重要的价值。     

Aberrant expression of HOXA9, DEK, CBL and CSF1R in acute myeloid leukemia

Previous gene function analyses have indicated that HOXA9, DEK, CBL and CSF1R are aberrantly expressed in acute myeloid leukemia (AML). We analyzed the expression of these genes in a series of 41 adult patients with AML using quantitative real-time RT-PCR, and tested the association of the expression with the following hematologic and clinical parameters: age, FAB, immunophenotype and karyotype aberrations. A high proportion of the patients showed over- or underexpression of the analyzed genes. DEK was overexpressed in 98% of the cases, whereas CBL, CSF1R and HOXA9 were either overexpressed in 20%, 17% and 78% or underexpressed in 20%, 42% and 15% of the cases, respectively. Patients whose karyotype contained t(8;21)(q22;q22), showed lower relative expression of HOXA9 at a statistically significant level (p < 0.05). Bone marrow samples without expression of CD34 antigen were associated with either overexpression of DEK or HOXA9. Furthermore, an association was found between the AML-M2 subtype and lower expression of CBL, CSF1R or HOXA9, and between the AML-M5 subtype and CBL or CSF1R overexpression.     

Immunophenotype of blast cells in acute myeloid leukemia may be a useful predictive factor for outcome

The immunophenotype of peripheral blood blast cells was tested in 92 patients with acute myeloid leukemia (AML), who were diagnosed and treated at single centre, St Bartholomew's Hospital, from 1978-1987 with a standard adriamycin, cytosine arabinoside and 6-thioguanine regimen. Immunological analysis involved standard fluorescence flow cytometry and utilized 31 monoclonal antibodies to known myeloid antigens (of CD groups 11b, 11c, 13, 14, 15, 16, w17, 31, w32, 33, 34, 35 and 36), a number of relatively less well studied antibodies with potential specificity for AML, and a series of control antibodies to T and B lymphocytes, platelets, erythrocytes and of widespread distribution (CD45, leucocyte common; HLA-DR). The results highlighted a number of antibodies with wide myeloid reactivity, in addition to CD13 and 33 (present in 66 per cent and 76 per cent of cases, respectively), which may be of immunodiagnostic use. A number of correlations between AML cell immunophenotype and FAB morphology subtype were found; in particular five antibodies (CD11c, 10.1, Tu3, CD15 and CD16), of both predominant granulocytic and monocytic reactivity, reacted with cells of AML-M5 subtype (p less than 0.05). There was no significant correlation between immunophenotype and clinical and pathological features at presentation. Correlation with clinical outcome was not a prominent feature, in contrast to some reports based on multicentre data. However, of particular note was the strong association between early death (at less than 2 months) and the coexpression of Leucocyte Function Associated (LFA) antigens, CD11b and 11c, on patient's blast cells (p = 0.003). The relationship was independent of clinical features and persisted even if AML-M5 cases were excluded. The significance of this latter finding is unclear, but may be related to the known role of CD11b and 11c LFA antigens in the cellular response to infection.     

新疆地区450例急性白血病的免疫分型研究

 目的　研究新疆地区急性白血病（AL）患者免疫表型分布特点。方法　采用间接免疫荧光法对450例AL患者进行免疫表型分析。结果　106例急性淋巴细胞白血病（ALL）,334例急性髓系白血病（AML）,10例为FAB不能分类的急性白血病（UAL）;ALL中髓系抗原的表达15 %,AML中淋系抗原的表达25 %,表达最频繁的是CD7;研究了295例AL患者MPO mRNA基因表达,81例ALL中有1例表达MPO基因;所有髓系均不同程度地表达MPO基因,9例UAL有6例表达MPO基因;ALL免疫分型特点在汉族和维吾尔族（简称维族）中差异无统计学意义（P＞0.05）,在AML中,汉族髓系抗原的表达率依次为CD33＞CD13＞CD15,维族髓系抗原的表达率依次为CD15＞CD33＞CD14。结论　免疫表型的检测对AL更精确地诊断和分型有重要意义。联合分析AL形态学、细胞化学、免疫学及MPO mRNA表达等特点,对于AL的诊断和指导治疗均有重要意义。     

cDNA microarray analysis of non-selected cases of acute myeloid leukemia demonstrates distinct clustering independent of cytogenetic aberrations and consistent with morphological signs of differentiation

Acute myeloid leukemia (AML) is a heterogeneous disease with respect to biology and clinical course. Until now the basis for prognostic evaluation and therapeutic decision has been the karyotype, genetic FLT3 abnormalities and the initial chemotherapy response. A question that has emerged is if extensive gene expression analysis may supplement or partly replace current diagnostics. In an attempt to address this question, we performed cDNA microarray analysis on peripheral blood samples of 25 patients with newly diagnosed AML with high blast counts. The patients were randomly selected from a large group of consecutive patients. Leave-one-out crossvalidation (LOOCV) showed with high accuracy that gene expression classifiers could predict if leukaemia samples belonged to the FAB AML-M1 or to the FAB AML-M2 groups. An unsupervised two-dimensional hierarchical cluster analysis generated 3 patient subgroups. Except for an accumulation of samples classified as FAB M1 and M2 in cluster 3, there was no evident relationship between the clusters and the FAB classification. Each subgroup displayed clearly distinguished gene expression patterns validated using real-time quantitative PCR analysis. The identification of specific gene expressions that together constitute regulatory modules must complement cluster analyses in order to achieve an accurate basis for prognosis and prediction.     

Minimally differentiated acute myeloid leukemia in Taiwan: predominantly occurs in children less than 3 years and adults between 51 and 70 years.

Acute myeloid leukemia (AML) with minimal differentiation was usually referred to as acute undifferentiated leukemia in the past. With the help of immunophenotyping, this subtype of leukemia was shown to express myeloid antigens on the blasts and was designated AML-M0 by FAB Cooperative Study Group in 1991. Among the 423 consecutive newly diagnosed de novo AML at our institution, 12 (2.8%) were of M0 subtype. The proportion of M0 in AML was higher in children than in adults (8.2% vs 1.7%). Four other M0 patients referred from outside hospitals for immunophenotyping were also included in this study. There were two peaks in age distribution of these 16 patients: less than 3 years and between 51 and 70 years, respectively. Organomegaly was more common in patients with AML-M0 than in those with other subtypes (56.3% vs 29.2%, P = 0.025). The former patients had higher incidences of CD7 and CD34 expression on the leukemic cells than the latter ones (50% vs 16.9%, P = 0.003 and 69.2% vs 37.9%, P = 0.019, respectively). The patients with AML-M0 showed more frequent clonal chromosomal abnormalities in the leukemic cells than other AML patients (83.3% vs 53.9%, P = 0.039); the same is also true for complex cytogenetic aberrations (50% vs 11. 4%, P = 0.004). Adults with AML-M0 showed a lower complete remission (CR) rate and significantly poorer survival than those with non M0-AML. However there was no significant difference in outcome between the two groups of pediatric patients. In conclusion, AML-M0 is a unique subtype of leukemia that has distinct age distribution and shows different clinical and biological characteristics from other AML. Adult patients have poor prognosis. Whether pediatric patients had better outcome than adults needs to be clarified in further studies.     

Incidence of lineage promiscuity in acute myeloblastic leukemia: diagnostic implications of immunoglobulin and T-cell receptor gene rearrangement analysis and immunological phenotyping

Sixty-nine blood or bone marrow samples from both children and adults with acute myeloblastic leukemia (AML) were investigated to elucidate the frequency of immunoglobulin (IG) and T-cell receptor (TCR)-gene rearrangements. Non-germline configuration for the IG heavy chain (h) gene was detected in the specimens of nine patients of various subtypes according to the French-American-British classification (FAB), including FAB M1, M2, M4 and M5. Rearrangement of the IG kappa chain (k) gene was present in one of these cases which simultaneously revealed a rearranged TCR-beta (b) chain gene. In another two AML samples we found TCR-b gene rearrangements, in one case in combination with an IG-h gene rearrangement. IG-h gene rearrangements were detected in 10 cases, in one case in conjunction with an IG-kappa (k) and TCR-b gene rearrangement. A highly significant correlation between the occurrence of DNA rearrangements of the IG-h locus and nuclear staining with the enzyme terminal deoxynucleotidyl transferase (TdT) and surface expression of the CD 19 and CD 34 antigen could be identified: all 10 TdT positive AML samples rearranged IG-h. Similarly, six out of 69 AML samples exhibited surface expression of CD 19, five of these in combination with CD 34 and all of them rearranged the IG-h gene. The one leukemia with TCR-b gene rearrangement only was TdT positive as well, but did not express CD 19 or CD 34. We conclude that IG-h gene is rearranged in a substantial proportion of AML, strongly associated with a specific immunophenotype (TdT+, CD19+, CD34+), whereas TCR-b gene rearrangement appears more rarely. No positive correlation between occurrence of IG-h and TCR-b gene-rearrangements and one AML FAB-subtype was found, although a clustering of M1 and M4 FAB subtypes in the AML group showing reconstructed IG-h gene became evident.     

TdT+/nonlymphoid antigen+ acute leukemias: immunologic and karyotypic monitoring during therapy and at relapse suggests the transformation of a bipotential stem cell

Immunophenotype and karyotype were monitored in 19 adult acute leukemia patients with blast cell populations expressing terminal transferase (TdT) and nonlymphoid antigens either at presentation or at relapse. Three patterns of immunophenotypic course were observed when following the patients through at least one, sometimes two (six patients), or three relapses (one patient). Induction chemotherapy induced predominantly TdT+ leukemias with a minor monoblastic component to become TdT-negative, purely monoblastic without clinical response or change in karyotype in five patients (group 1). In group 2, relapse was associated with the disappearance (four patients) or the appearance of TdT+/nonlymphoid antigen+ features (four patients). In two instances, new nonrandom cytogenetic abnormalities, in one case, evolution of an initial abnormal cytogenetic clone, were found at relapse. Six patients (group 3) presented and relapsed with identical TdT+ myeloblastic, promyeloblastic, monoblastic immunophenotype and karyotype. In general, FAB classification did not reflect expression of TdT in nonlymphocytic leukemias or the presence of nonlymphoid blast features in lymphocytic leukemias. Lymphoid-specific antigens in addition to TdT were not detected in any of the cases at the time of nonlymphoid antigen expression. In 11 of the 19 patients, simultaneous expression of TdT and myeloid or monocytic antigens could be demonstrated at the single cell level using double-fluorescence staining. These follow-up data are best consistent with a drug-induced maturation drive of a TdT+/monocytic (majority of cases) or TdT+/myelocytic leukemic stem cell with its differentiation commitment being influenced by chemotherapy or by other as yet undefined conditions predisposing to proliferation of the leukemic cell at relapse.     

The significance of CD34 and TdT determinations in patients with untreated de novo acute myeloid leukemia.

The results of intensive chemotherapy given to 247 adults at the University of Maryland Cancer Center with previously untreated de novo acute myeloid leukemia (AML) were reviewed with respect to expression of terminal deoxynucleotidyl transferase (TdT) and CD34. Of the 228 patients with data for TdT, 32 (14%) had > 5% of the leukemia cells positive by an immunofluorescence assay. The median age of the TdT-positive patients was approximately 10 years less than the TdT-negative patients (50 versus 60 years). Patients with TdT-positive AML had similar median survival (12 versus 10.5 months) and complete remission (CR) rates (53 versus 59%), but a greater frequency of long-term complete responders (60 of complete remitters versus 20%, p = 0.08) than TdT-negative patients. Of 126 patients tested, 59% were CD34-negative (< 20% reactivity with leukemia cells). These 74 patients (median age 60 years) had a greater CR rate (71 versus 48%, p = 0.008) than the 52 CD34-positive patients (median age 60 years), and improved survival (p = 0.013 by Wilcoxon) although there was no difference in the duration of CR between the CD34-positive and negative groups. Of CD34-positive patients 12/52 remain in continuous CR, and 16/74 CD34-negative patients remain in continuous CR. None of eight patients strongly positive for CD34 (> 70% reactivity) remain disease-free. Positivity for TdT or CD34 was associated with less differentiated AML. Of CD34-positive patients, 44% had FAB M0/M1 morphology versus 13% of CD34-negative patients (p = 0.0001); similarly, 47% of TdT-positive patients were FAB M0/ML1 versus 25% of TdT-negative patients (p = 0.01). Of seven patients with FAB M4E0, five were CD34-positive. Of the 12 CD34-positive survivors, four had FAB M4E0. Thus CD34 expression predicts for CR rate and overall survival in adults with AML. TdT expression does not significantly affect overall outcome but may be associated with longer CR durations.     

Increased CD38 expression is associated with favorable prognosis in adult acute leukemia

CD38 is expressed in acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML) blasts and its prognostic significance is unknown. We investigated CD38 expression in 304 AML and 138 ALL patients. CD38 was lower in AML-M3 compared to other FAB subtypes (5% vs. 41%; P < 0.001), but was similar among ALL subtypes (56.6%; P = 0.69). Ph + ALL and AML with t(15; 17) patients showed lower CD38 expression than the other cytogenetic groups. Overall survival favored AML and ALL patients with higher CD38 levels. Multivariate analysis revealed CD38 expression to be an independent outcome predictor in AML, but not in ALL.