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Use of surface marker analysis to predict outcome of adult acute
myeloblastic leukemia
JD Griffin, R Davis, DA Nelson, FR Davey, RJ Mayer, C Schiffer, OR McIntyre and CD Bloomfield
In order to investigate the clinical significance of surface antigen
analysis in acute myeloblastic leukemia (AML), the blasts from 196 patients
with AML were analyzed prospectively with a panel of 16 monoclonal
antibodies. The antibodies were selected to identify
differentiation-associated antigens of either the myeloid lineage (MY9,
PM-81, AML-2-23, MY7, MCS-1, MY8, Mo1, MY1, MY4, Mo2), T cell lineage
(T101, T11), B cell lineage (B1, B4) or multiple lineages [J5 (CALLA),
HLA-DR]. Independent morphological review and classification by French-
American-British (FAB) criteria was performed in 161 of the 196 cases. One
or more myeloid surface antigens were detected on the blasts of 195 cases,
while B and T cell markers were detected on 0% to 2% of cases. When both
blood and marrow samples were studied on the same patient, very few
differences were noted between the antigenic profiles of the paired
specimens. The frequency of expression of individual myeloid antigens
ranged from 91% (PM-81) to 29% (Mo2). Expression of individual antigens was
found to correlate significantly with several clinical parameters including
FAB classification, cytochemical staining for alpha naphthyl acetate
esterase, leukocyte count, and the presence of extramedullary disease at
presentation. Two myeloid antigens (MY4 and MY7) predicted for a low rate
of complete remission (CR) to standard induction chemotherapy. MY4+ cases
(37% of the total population) had a CR rate of 53%, while M4- cases had a
CR rate of 69% (P = .03). MY7+ cases (57% of the total population) had a CR
rate of 55% while MY7- cases had a CR rate of 73% (P = .01). Neither MY4
nor MY7 antigen expression was correlated with patient age. Paired
combinations of antigens were also examined. The [MY4- MY7-] phenotype was
exhibited by 32% of all cases and was associated with an 82% CR rate while
the CR rate of all other cases was 54% (P = .001). The expression of three
antigens (HLA-DR, MY8, Mo1) was associated with a decreased continuous
complete remission (P less than .05, median follow-up time of 19 months).
Expression of MY8 antigen was also associated with decreased survival (P =
.03). These results confirm earlier reports of antigenic heterogeneity in
AML, and indicate that immunologically defined subgroups of AML patients
which are of potential clinical significance can be identified.
Volume 68,
Issue 6,
pp. 1232-1241,
12/01/1986
Copyright © 1986 by The American Society of Hematology
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