CD38在M2型急性髓系白血病预后分层中的意义

摘要

Objective To investigate the expression level of CD38 in the M2 subtype of acute myeloid leukemia and its effect on the prognosis of patients.Methods From January 2012 to December 2015,in PLA General Hospital,47 patients with primary M2 subtype of acute myeloid leukemia were collected.The expression level of CD38 on leukemic cells was detected by flow cytometry.The clinical data and laboratorial characteristics and the survival status were compared between these patients,and the prognostic significance of CD38 was analyzed retrospectively with the combination of the most common genetic aberration of t (8;21) translocation in this type of leukemia.Results The rate of CD38+ patients was 100％ in the M2 subtype of patients with t (8;21) translocation,which was higher than the 73.9％ of CD38+ patients in non-t (8;21) patients (P =0.02).The remission rate after the induction therapy in the CD38-patients with non-t (8;21) was lower than those in the CD38+ patients with or without t (8;21) translocation (50.0％,88.2％,95.8％,P =0.03).The survival analysis showed that the 3-year EFS rate of these three cohorts was 16.7％,38.1％ and 58.7％,respectively,the differences were not statistically significant (P ＞ 0.05),while the 5-year OS rate of the CD38-patients was much lower than those in the CD38+ patients with or without t (8;21) translocation (16.7％,44.0％,47.2％,P =0.03).Conclusion CD38 expression has a positive correlation with t (8;21) in the M2 subtype of acute myeloid leukemia,and the downregulation of CD38 expression is one of the hallmarks of poor prognosis in this subtype,which is expected to guide the prognostic stratification and personalized therapy of the patients.%目的 分析CD38在M2型急性髓系白血病患者中的表达及其对患者预后的影响.方法 收集2012年1月～2015年12月解放军总医院诊治的原发性M2型急性髓系白血病患者47例,使用流式细胞术检测骨髓样本中白血病细胞CD38的表达,回顾性分析患者的临床和实验室检查特点以及生存状况,并结合M2型白血病中最常见的遗传学特征t(8;21)易位对此类疾病进行预后分层研究.结果 伴有t(8;21)易位的M2型急性髓系白血病患者中,CD38+比例为100％,高于非t(8;21)易位患者的73.9％(P=0.02).CD38-的非t(8;21)易位患者的诱导缓解率低于CD38+的非t(8;21)易位患者和CD38+的伴有t(8;21)易位的患者(50.0％、88.2％、95.8％,P=0.03).在生存分析方面,三者的3年无事件生存率分别为16.7％、38.1％和58.7％,虽然差异无统计学意义(P＞0.05),但是前者的5年总生存率远远低于后两者(16.7％、44.0％、47.2％,P=0.03).结论 在M2型急性髓系白血病中,CD38+与t(8;21)易位具有正相关性,CD38表达减弱是M2型急性髓系白血病预后不良的标志之一,并有望指导患者的预后分层和个体化治疗.