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Clinical significance of CD34 expression in childhood acute lymphoblastic
leukemia
CH Pui, ML Hancock, DR Head, GK Rivera, AT Look, JT Sandlund and FG Behm
Department of Hematology-Oncology, St Jude Children's Research Hospital,
Memphis, TN 38101.
The CD34 antigen was detected on > or = 10% of the blast cells in 235
(70%) of 335 cases of newly diagnosed childhood acute lymphoblastic
leukemia (ALL) treated in two consecutive chemotherapy trials. By
immunophenotype, the distribution of positive cases favored early pre-B ALL
(83%; n = 180) followed by pre-B ALL (61%; n = 89) and then T-cell ALL
(46%; n = 61) (P < .001). Among the B-lineage cases, CD34 expression was
significantly associated with favorable presenting features: age 1 to 10
years, white race, absence of central nervous system (CNS) leukemia, low
serum lactate dehydrogenase level, CD10 expression, and leukemic cell
hyperdiploidy (> 50 chromosomes or DNA index > or = 1.16). Event-free
survival was clearly superior for patients with CD34+ leukemia (P = .01),
with an estimated 83% +/- 6% (SE) of the cohort remaining free of adverse
events at 5 years post diagnosis, as compared to 63% +/- 10% of the group
without this feature. Multivariate analysis showed that the prognostic
influence of the antigen was independent of age, leukocyte count, and other
well- recognized factors, suggesting that it would add discriminatory power
to current systems of risk assignment. Findings in T-cell ALL were the
reverse: CD34 expression showed positive correlations with initial CNS
leukemia and CD10 negativity but not with any good-risk presenting
characteristics. Log-rank analysis indicated no adverse effect on treatment
outcome by CD34 antigen expression, although additional patients with need
to be studied to obtain a definitive answer. The opposed clinical
associations of CD34 expression in B- and T-lineage ALL may reflect
fundamental biologic differences between these leukemia species.
Volume 82,
Issue 3,
pp. 889-894,
08/01/1993
Copyright © 1993 by The American Society of Hematology
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