The Immunophenotypic Characteristics Of Leukemic Cells With Adult Acute B-cell Lymphoblastic Leukemia And Its Clinical Significance

Objective: A retrospective analysis of the relationship with clinicalfeatures, immunophenotype, therapeutic effect and prognosis in183cases ofnewly diagnosed adult acute B-cell lymphoblastic leukemia（B-ALL）admittedby the Department of Hematology in our hospital from June.2003to June.2013.Method: A retrospective analysis of183cases of newly diagnosed adultB-ALL patients admitted by the Department of Hematology in our hospitalfrom June.2003to June.2013. All the patients had finished theimmunophenotypic detection and completed the inductive treatment. Used theFACSCanto II flow cytometry (USA BD) to detect immunophenotype, thedetection of B-lymphocyte monoclonal antibodies were: CD10, CD19, CD20,CD22; T-lymphocyte monoclonal antibodies were: CD3, CD5, CD7; myeloidmonoclonal antibodies were: CD13, CD14, CD15, CD33, CD117, MPO;monoclonal antibodies of hematopoietic stem/progenitor cells were: CD34,HLA-DR, The surface antigen of leukemia cells was judged as positive whenits positive rate was higner than20%. Myeloid antigen positive-ALL(My+ALL): at least one of the myeloid antigens reached the positive standard,but not up to the diagnostic standard of AML. All the patients were treatedwith the analogous program of VCDP:VCR/VDS+CTX+DNR/IDA+Dex/Pre±L-asp. Since the beginning of therapy,patients who acquired complete remission within4weeks were diagnosed asCR, others were diagnosed as NR. The time of overall survival (OS) wasdefined as the time from diagnosis to death or last follow-up date (2013.12.1).The time of event-free survival (EFS) was defined as the time from diagnosisto the time of the first event or last follow-up date (2013.12.1), assessment of the events included the following:1. Did not acquire CR in4weeks afterinductive treatment;2. relapse;3. death. The survival time and survival stateof lost visitors were calculated with that of the last follow-up date. Thediagnostic criteria of ALL, CR, relapse were refered to《Standard of diagnosisand curative effect of hematologic diseases》. Used the SPSS17.0software tofinish the statistical analysis of data.Results：1Analysis on the overall situation:①Among the183cases of B-ALL,there were113male patients and70female patients (male: female=1.6:1).The median age was30years (14-69years). The CR rate of183cases ofB-ALL was81.42%(149/183). The median OS time was10months (1-81months), OS rate for2yeras was19.00%, the median EFS time was8months(1-76months), EFS rate for2yeras was14.00%.70patients were relapsedafter CR during the period of follow-up (46.98%).②The expression oflymphatic antigens of B-ALL: The expressed rate of CD19was100%.Followed by cCD79a (83.06%), CD10(65.57%), CD22(39.34%), andCD20(27.87%).③A mong the183cases of B-ALL,43patients withexpression of myeloid antigens (23.50%). The expressed rate of CD13andCD33were10.93%and8.20%. There was no expression of CD117and MPO.④T heexpression of the early series-antigens: the expressed rate of CD34andHLA-DR were:73.22%and61.20%.⑤Among the183cases of B-ALLpatients,131cases finished the detection of BCR/ABL fusion gene. Therewere37positive cases,94cases of patients with negative.⑥Karyotypicanalysis was performed in24patients. There were14patients with normalkaryotype (58.33%) and complex karyotype in7cases (29.17%).3patientshad no division. Because of the small number of patients, this study had notconducted the statistical analysis.2The relationship between My and the clinical features, therapeuticeffect and OS, EFS of B-ALL:①There were43cases with My positiveamong183cases of B-ALL, the CR rate of My+ALL was67.44%which waslower than that of the My-ALL (85.71%), the OS rate and EFS rate for2 years of My+patients were8.00%and6.00%lower than that of My-patients(21.50%and17.40%)(P<0.05). The relapsing rate of two groups had nodifference.②The peripheral white blood cell(WBC) count in My+ALL washigher than that in My-ALL(WBC), hemoglobin (Hb) and platelet count (PLT)were lower than that of My-patients (P <0.05). There was no differencebetween age, positive rate of BCR/ABL fusion gene in the two groups ofpatients.3The relationship between CD10, CD34and the clinical features,therapeutic effect and OS, EFS of B-ALL:①There were120cases with CD10positive in183cases of B-ALL, The CR rate, OS rate and EFS rate for2yearsof CD10+ALL were85.83%,25.10%,18.90%which were higher than thatof CD10-ALL (73.02%,7.80%,6.10%), while the relapsing rate (41.75%)is lower than that in CD10-ALL (58.70%), the expressed rate of My (18.33%)was lower than that of CD10-ALL (33.33%)(P <0.05). There were nodifference between CD10+and CD10-ALL with age, WBC, Hb, PLT, thepositive rate of BCR/ABL fusion gene (P>0.05).②T here were nosignificantdifference with the age, WBC, PLT, Hb, and the positive rate of BCR/ABLfusion gene and CR rate, relapsing rate, OS rate and EFS rate for2yearsbetween CD34+ALL and CD34-ALL (P>0.05).③The CR rate, OS rate andEFS rate for2years of38cases of CD10+CD34-ALL were94.74%,34.60%,30.70%, which were higher than that in CD10+CD34+ALL (81.71%,17.90%,13.10%)(P <0.05). The relapsing rate between the two groups had nodifference. There were no significant difference of CR rate, relapsing rate, OSrate and EFS rate for2years between CD10-CD34+and CD10-CD34-ALL (P>0.05).4The relationship between CD20and the clinical features, therapeuticeffect and OS, EFS of B-ALL:①T here were51cases with CD20positive in183cases of B-ALL. There was no significant difference with age, WBC, Hb,PLT, positive rate of BCR/ABL fusion gene, CR rate, relapsing rate, OS rateand EFS rate for2year between CD20+and CD20-ALL (P>0.05).②Therewere no significant difference of CR rate, relapsing rate, OS rate and EFS rate for2year between CD20+CD34+andCD20-CD34-ALL (P>0.05).5The COX analysis of the immunophenotype of B-ALL showed that:CD10+had a positive relationship with the OS and EFS of adult B-ALL. My+had a negative relationship with the OS and EFS of adult B-ALL. Nosignificant association was found in other antigens.Conclusion:1CD19was the symbolic antigen of the B-ALL.2CD13and CD33were the common myeloid antigens of B-ALL.3My+was the indicator of poor prognosis for B-ALL. CD10+was theindicator of favorable prognosis of B-ALL.4The positive rate of My in CD10+B-ALL was lower than that inCD10-B-ALL.5CD10and CD34both positive was a poor prognostic indicator.