Korean J Hematol 2002; 37(2):
Published online June 30, 2002
© The Korean Society of Hematology
급성골수성백혈병에서 염색체변이 및 면역표현형의 임상적 의의
권혁찬
동아대학교 의과대학 내과학교실
Clinical Significance of the Chromosomal Abnormalities and Immunophenotype in Acute Myeloid Leukemia
Background : Acute myeloid leukemia (AML) is a hematologic malignant disease characterized by an uncontrolled proliferation of myeloid cells in marrow and arrest in their maturation. Immunophenotyping is a widely used method to diagnose and classify leukemia, and cytogenetic studies can help providing the clues of disease progression and monitoring remission status after chemotherapy.
Methods : From August 1997 to July 2000, 68 patients with AML were treated with ara-C and idarubicin for remission induction, then followed by consolidation therapy. A panel of monoclonal antibodies (CD5, CD7, CD10, CD19, CD22, CD14, CD13, CD33, HLA-DR) were used to characterize immunologic phenotypes by flow cytometry. Chromosomal abnormalities by high resolution banding technique were evaluated. Patients were divided into three groups (favorable : A, intermediate : B, unfavorable :
C).
Results : The incidence of chromosomal abnormalities was 57% (39/68), and the proportion of patients per groups were 21% (14/68) for group A, 57% (39/68) for group B, and 22% (15/68) for group C. The median follow- up duration of the 68 evaluable patients was 12.7 months. The complete remission (CR) rate was 63.2% (43/68). The CR rate in group A, B, and C were 92.9% (13/14), 66.7% (26/39) and 26.7% (4/15), respectively (P=0.005). The AML patients who expressed CD19 (P=0.048) or did not express CD14 (P=0.013) had better CR than other groups. The median leukemia free survival duration of group A and B were 39.5 months and 11.9 months, respectively, and the leukemia free survival duration of group C has not been reached at median value
(P=0.038). The median overall survival duration was 12.3 months, the survival duration of group A has not been reached at median value, and the median survival duration of group B and C were 12.0 months and 1.5 months, respectively (P=0.001). The AML patients without CD7 (P=0.029), without CD14 (P=0.023), or with CD19 (P=0.047) showed a better survival than other groups. In multivariate analysis, karyotype proved to be a significant prognostic factor (P=0.018).
Conclusion : This study demonstrated that karyotype was an important prognostic factor in AML patients. Among surface marker expressions, CD7, CD14, CD19 may be used as a prognostic factor. Further study will be needed to confirm the role of immunophenotyping in AML.
Keywords Chromosomal abnormality; Immunophenotype; Acute myeloid leukemia;
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Korean J Hematol 2002; 37(2): 89-96
Published online June 30, 2002
Copyright © The Korean Society of Hematology.
급성골수성백혈병에서 염색체변이 및 면역표현형의 임상적 의의
권혁찬
동아대학교 의과대학 내과학교실
Clinical Significance of the Chromosomal Abnormalities and Immunophenotype in Acute Myeloid Leukemia
Hyuk Chan Kwon
Department of Internal Medicine, College of Medicine, Dong, A University, Busan, Korea
Abstract
Background : Acute myeloid leukemia (AML) is a hematologic malignant disease characterized by an uncontrolled proliferation of myeloid cells in marrow and arrest in their maturation. Immunophenotyping is a widely used method to diagnose and classify leukemia, and cytogenetic studies can help providing the clues of disease progression and monitoring remission status after chemotherapy.
Methods : From August 1997 to July 2000, 68 patients with AML were treated with ara-C and idarubicin for remission induction, then followed by consolidation therapy. A panel of monoclonal antibodies (CD5, CD7, CD10, CD19, CD22, CD14, CD13, CD33, HLA-DR) were used to characterize immunologic phenotypes by flow cytometry. Chromosomal abnormalities by high resolution banding technique were evaluated. Patients were divided into three groups (favorable : A, intermediate : B, unfavorable :
C).
Results : The incidence of chromosomal abnormalities was 57% (39/68), and the proportion of patients per groups were 21% (14/68) for group A, 57% (39/68) for group B, and 22% (15/68) for group C. The median follow- up duration of the 68 evaluable patients was 12.7 months. The complete remission (CR) rate was 63.2% (43/68). The CR rate in group A, B, and C were 92.9% (13/14), 66.7% (26/39) and 26.7% (4/15), respectively (P=0.005). The AML patients who expressed CD19 (P=0.048) or did not express CD14 (P=0.013) had better CR than other groups. The median leukemia free survival duration of group A and B were 39.5 months and 11.9 months, respectively, and the leukemia free survival duration of group C has not been reached at median value
(P=0.038). The median overall survival duration was 12.3 months, the survival duration of group A has not been reached at median value, and the median survival duration of group B and C were 12.0 months and 1.5 months, respectively (P=0.001). The AML patients without CD7 (P=0.029), without CD14 (P=0.023), or with CD19 (P=0.047) showed a better survival than other groups. In multivariate analysis, karyotype proved to be a significant prognostic factor (P=0.018).
Conclusion : This study demonstrated that karyotype was an important prognostic factor in AML patients. Among surface marker expressions, CD7, CD14, CD19 may be used as a prognostic factor. Further study will be needed to confirm the role of immunophenotyping in AML.
Keywords: Chromosomal abnormality, Immunophenotype, Acute myeloid leukemia,
