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目的:分析急性髓系白血病(AML)跨系抗原表达的临床特征及其预后意义,以便对此类患者进行预后分层,为建立个体化的治疗提供指导。方法:用流式细胞术对227例初发AML患者(M3除外)进行免疫分型,以CD7~-CD56~-CD19~-的AML为对照,比较CD7~+组、CD56~+组、CD19~+组及对照组间的临床特征、治疗反应和生存情况。结果:CD56~+AML、CD7~+AML和CD19~+AML检出率分别为15.9%、25.1%和11.0%。3个组的发病年龄,原始细胞比例,白细胞计数,血红蛋白含量,血小板计数,MDS继发的AML分布与对照组无统计学差异。CD56~+AML首次化疗后完全缓解(CR)率和累积CR率均低于对照组(20.0%vs 58.1%,P=0.0099;73.3%vs 87.5%,P=0.04),取得CR的中位时间长于对照组(118 d vs 46 d,P=0.04),无进展生存期(PFS)和总体生存期(OS)低于对照组(245 d vs 580 d,P=0.037;494 dvs 809 d,P=0.04)。CD19~+AML首次化疗后CR率、累积CR率均高于对照组(75.0%vs 58.1%,P=0.46;100%vs 87.5%,P=0.02),取得CR的中位时间明显少于对照组(28 d vs 46 d,P=0.02),PFS及OS较对照组有延长趋势(P=0.13;P=0.07),至末次随访中位PFS及OS尚未达到。CD7~+AML首次化疗后CR率、累积CR率、取得CR中位时间与对照组比较均未取得统计学差异(53.1%vs 58.1%,P=0.67;87.1%vs 87.5%,P=0.44;50 d vs 46 d,P=0.44),PFS和OS与对照组比也无差异。结论:CD56~+AML患者治疗反应差,诱导缓解后易复发,总体生存期短,应在治疗之初选择更强的化疗方案或联合多种治疗手段,并缩短该类患者的MRD检测周期,以期早期发现残留白血病细胞并早期干预。CD19~+AML患者治疗反应好,不易复发,总体生存期长,对此类患者应避免过度治疗。异常表达CD7抗原不是AML预后不良因素。
OBJECTIVE: To analyze the clinical features and prognostic significance of the expression of the transmembrane antigens of acute myeloid leukemia (AML) so as to provide prognostic stratification for these patients and provide guidance for establishing individualized therapy. Methods: A total of 227 patients with newly diagnosed AML (except M3) were immunophenotyped by flow cytometry. CD7 ~ + CD56 ~ -CD19 ~ - AML was used as control. CD7 ~ +, CD56 ~ ~ + Group and control group clinical features, treatment response and survival. Results: The detection rates of CD56 ~ + AML, CD7 ~ + AML and CD19 ~ + AML were 15.9%, 25.1% and 11.0% respectively. There was no significant difference in the age of onset, blast percentage, white blood cell count, hemoglobin, platelet count, and the distribution of AML secondary to MDS in the three groups. The rates of complete remission (CR) and cumulative CR were lower in patients with CD56 ~ + AML after the first chemotherapy (20.0% vs 58.1%, P = 0.0099; 73.3% vs 87.5%, P = 0.04) (P <0.05), and overall survival (OS) were lower than those in the control group (118 d vs 46 d, P = 0.04) = 0.04). The CR rate and cumulative CR rate of the patients with CD19 ~ + AML after initial chemotherapy were significantly higher than those of the control group (75.0% vs 58.1%, P = 0.46; 100% vs 87.5%, P = 0.02) (P = 0.13; P = 0.07). However, the median PFS and OS had not reached the final follow-up. No significant difference was found in CR rate, cumulative CR rate and median CR between the two groups (53.1% vs 58.1%, P = 0.67; 87.1% vs 87.5%, P = 0.44; 50 d vs 46 d, P = 0.44). There was no difference in PFS and OS between the two groups. Conclusion: Patients with CD56 ~ + AML have poor response to therapy, relapse after induction of remission, and short overall survival. Patients with CD56 ~ + AML should be treated with stronger chemotherapy or combined with multiple treatments at the beginning of treatment and to shorten the period of MRD detection. In order to early detection of residual leukemia cells and early intervention. Patients with CD19 ~ + AML response is good, not easy to relapse, the overall survival period, for such patients should avoid over-treatment. Abnormal expression of CD7 antigen is not a poor prognostic factor for AML.