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CD2 antigen expression on leukemic cells as a predictor of event-free
survival after chemotherapy for T-lineage acute lymphoblastic leukemia: a
Children's Cancer Group study
FM Uckun, PG Steinherz, H Sather, M Trigg, D Arthur, D Tubergen, P Gaynon and G Reaman
Children's Cancer Group ALL Biology Reference Laboratory, University of
Minnesota, Minneapolis 55113, USA.
We examined the prognostic impact of CD2 antigen expression for 651
patients with T-lineage acute lymphoblastic leukemia (ALL), who were
enrolled in front-line Childrens Cancer Group treatment studies between
1983 and 1994. There was a statistically significant correlation between
the CD2 antigen positive leukemic cell content of bone marrow and
probability of remaining in bone marrow remission, as well as overall
event-free survival (EFS) (P = .0003 and P = .002, log-rank tests for
linear trend). When compared with patients with the highest CD2 expression
level (> 75% positivity), the life table relative event rate (RER) was
1.22 for patients with intermediate range CD2 expression level (30% to 75%
positivity) and 1.81 for "CD2-negative" patients (< 30% positivity). At
6 years postdiagnosis, the EFS estimates for the three CD2 expression
groups (low positivity to high positivity) were 52.8%, 65.5%, and 71.9%,
respectively. CD2 expression remained a significant predictor of EFS after
adjustment for the effects of other covariates by multivariate regression,
with a RER of 1.47 for CD2- negative patients (P = .04). Analysis of
T-lineage ALL patients shows a significant separation in EFS after
adjustment for the National Cancer Institute (NCI) age and white blood cell
(WBC) criteria for standard and high-risk ALL (P = .002, RER = 1.67). The
determination of CD2 expression on leukemic cells helped identify patients
with the better and poorer prognoses in both of these risk group subsets.
For standard risk T-lineage ALL, CD2-negative patients had a worse outcome
(P = .0007, RER = 2.92) with an estimated 5-year EFS of 55.9% as compared
with 78.3% for the CD2-positive patients. Thus, CD2 negativity in standard
risk T-lineage ALL identified a group of patients who had a worse outcome
than high-risk T-lineage ALL patients who were CD2 positive. The percentage
of CD2 antigen positive leukemic cells from T- lineage ALL patients is a
powerful predictor of EFS after chemotherapy. This prognostic relationship
is the first instance in which a biological marker in T-lineage ALL has
been unequivocally linked to treatment outcome.
Volume 88,
Issue 11,
pp. 4288-4295,
12/01/1996
Copyright © 1996 by The American Society of Hematology
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