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Clinical features and treatment outcome of children with biphenotypic CD2+
CD19+ acute lymphoblastic leukemia: a Children's Cancer Group study
FM Uckun, P Gaynon, H Sather, D Arthur, M Trigg, D Tubergen, J Nachman, P Steinherz, MG Sensel and GR Reaman
Biotherapy Institute, University of Minnesota, Roseville 55113, USA.
Leukemic cells from a subset of children with acute lymphoblastic leukemia
(ALL) express lymphoid antigens of both T lineage and B lineage, but the
clinical significance of this immunophenotype is unknown. We now report the
first comprehensive comparison of treatment outcomes among a large cohort
of children with CD2+ CD19+ biphenotypic ALL (N = 77), B-lineage ALL (BL)
(N = 1,631), or T-lineage ALL (TL) (N = 347) ALL who were treated on
risk-adjusted Children's Cancer Group (CCG) protocols. CD2+ CD19+ patients
were more similar to BL than TL patients with respect to presenting
features and antigen expression. The percentages of patients achieving
successful induction therapy outcome were 98.7%, 97.8%, and 97.3% for CD2+
CD19+, BL, and TL patients, respectively. Univariate comparisons of 4-year
event-free survival (83.7%, 72.8%, 75.2% for CD2+ CD19+, BL, and TL
patients, respectively) achieved borderline significance (CD2+ CD19+ B, P =
.08; CD2+ CD19+ v T, P = .07). Relative hazard rate (RHR) estimates for BL
and TL compared with CD2+ CD19+ were 1.79 and 1.90, respectively, implying
a better outcome for biphenotypic patients. However, multivariate adjusted
RHRs for BL and TL compared with CD2+ CD19+ were 1.43 (P = .29) and 1.16 (P
= .76), respectively, suggesting a significant reduction in risk for BL or
TL patients once adjustment was made for the more favorable characteristics
of the CD2+ CD19+ group. Thus, pediatric ALL patients treated on
contemporary CCG protocols who present with CD2+ CD19+ biphenotypic
leukemia generally have good treatment outcomes, due in part to their
favorable presenting features.
Volume 89,
Issue 7,
pp. 2488-2493,
04/01/1997
Copyright © 1997 by The American Society of Hematology
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