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Prognostic value of lymphocyte surface markers in acute myeloid leukemia
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ED Ball, RB Davis, JD Griffin, RJ Mayer, FR Davey, DC Arthur, D Wurster-Hill, W Noll, MT Elghetany and SL Allen
Department of Medicine, Dartmouth-Hitchcock Medical Center, Hanover, NH.
We studied the expression of cell surface antigens associated with myeloid
and lymphoid leukemias on bone marrow-derived blast cells from 339 patients
with newly diagnosed de novo acute myeloid leukemia (AML) enrolled on
Cancer and Leukemia Group B (CALGB) chemotherapy protocols. Surprisingly,
of 211 cases studied for the expression of CD2 (T-cell marker, sheep
erythrocyte binding receptor for T lymphocytes) 45 were positive (21%). In
addition, of 298 patients studied for CD19 (B- lymphocyte marker), 41 were
positive (14%). Overall, of 170 patients studied for both CD2 and CD19, 56
(33%) were positive. Interestingly, central review of the
French-American-British (FAB) morphology of the CD2- and CD19-positive
cases showed that FAB M3 was twice as frequent, and M4E eight times as
frequent compared with the CD2- and CD19- negative cases. Of 22 lymphocyte
antigen-positive cases in which cells were available for studies of Ig or
T-cell antigen receptor (TCR) gene rearrangement, 20 were germline, one had
a rearranged Ig heavy chain gene, and one had rearranged TCR beta and Ig
heavy chain genes. The presence of messenger RNA for CD2 was demonstrated
in four CD2 surface antigen-positive cases, thus validating the cell
surface data. Lymphocyte antigen-positive cases had karyotypes commonly
seen in AML; 71% of cases with an abnormal clone had t(8;21)(q22;q22),
inversion 16(p13q22), t(15;17)(q22;q12), or t(9;11)(p22;q23). The patients
with lymphocyte markers had a significantly higher incidence of these
karyotypic abnormalities compared with patients with lymphocyte antigen-
negative AML (34% v 15%, P less than .02). When the outcome to therapy of
the lymphocyte antigen-positive cases was compared with that for the CD2,
CD19-negative cases, we found that the CD2, CD19-positive cases actually
had higher complete remission rates (75% v 59%, P = .04), and significantly
longer time to failure (P = .02; 32.4% +/- 6.0% v 18.0% +/- 4.1% at 2
years) and overall survival (P = .02; 43.5% +/- 6.3% v 26.0% +/- 4.5% at 2
years). CD2 antigen-positive cases also had a significantly superior
survival (P = .02; 43.8% +/- 7.9% v 29.8% +/- 3.8% at 2 years). There were
no significant differences (P less than or equal to .05) between the two
groups in age, leukocyte count at diagnosis, incidence of extramedullary
disease, or FAB classification.(ABSTRACT TRUNCATED AT 400 WORDS)
Volume 77,
Issue 10,
pp. 2242-2250,
05/15/1991
Copyright © 1991 by The American Society of Hematology
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