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Blood, Vol. 96 No. 3 (August 1), 2000:
pp. 870-877
The immunophenotype of 177 adults with acute myeloid leukemia:
proposal of a prognostic score
Ollivier Legrand,
Jean-Yves Perrot,
Marion Baudard,
Annie Cordier,
Régine Lautier,
Ghislaine Simonin,
Robert Zittoun,
Nicole Casadevall, and
Jean-Pierre Marie
From the Formation de Recherche Claude Bernard,
Institute National de la Santé et de la Recherche Médicale
(INSERM), Université Paris 6, and the Services
d'Hématologie Biologique et Clinique, Hôpital
Hôtel-Dieu, Paris, France. J.-Y.P. belongs to the European Group
for the Immunological Classification of Leukaemias (EGIL).
In acute myeloid leukemia (AML) patients, a variety of clinical and
biologic parameters, including phenotype, have been examined for
potential value in predicting treatment response and survival. The
European Group for the Immunological Classification of Leukaemias (EGIL) has proposed that AML be defined immunologically by the expression of 2 or more of the following myeloid markers:
myeloperoxidase, CD13, CD33, CDw65, and CD117. With
regard to this classification, the prognostic significance of 21 antigens taken separately and with immunophenotypic subgroups were
evaluated and compared with other clinical and biological variables in
177 adult AML patients. None of the antigens tested were associated
with treatment outcome. In contrast, patients with blasts disclosing a
full expression of panmyeloid phenotype (defined by the expression of
all 5 myeloid markers) had a higher complete remission rate
(P < .0001) and differed significantly in disease-free
survival (P = .02) and overall survival
(P = .008) than patients whose cells expressed fewer than 5 of these markers. In multivariate analysis, only age, panmyeloid
phenotype, performance status, and permeability glycoprotein activity
influence treatment outcome. Cytogenetics was significant in univariate
analysis but not in multivariate analysis, most likely because of the
redundancy with panmyeloid phenotype and a higher sensitivity of
immunophenotyping. Patients whose cells exhibit the panmyeloid
phenotype appear to define a relatively homogeneous biological subset
of AML. The 4 independent prognostic factors were used to create a
prognostic score, defined by the number of factors present. This score
permitted a stratification of patients with AML, thereby allowing for
the consideration of innovative therapies to improve outcome in the
poorer outcome groups.
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