| BackgroundAcute leukemia(AL) is the most common malignant tumor in blood system which is an dangerous illness with acute onset, rapid progress and high mortality rate.Acute myeloid leukemia(AML), as one of the main subtypes of AL, is a highly heterogeneous and malignant clonal disease which is originated from hematopoietic stem cells. Myeloid cells are blocked in different stages in the process of differentiation under the influence of a variety of pathogenic factors, result in different subtypes of AML with varied clinical features and prognosis. Currently,clinical diagnosis and classification of AML mainly depend on FAB and the MICM scheme based on WHO, including the morphology, immuneophenotyping,cytogenetics, molecular biology of the blasts. With the application of monoclonal antibody and Flow Cytometry(FCM), immunological phenotyping of leukemia has served as an important lab examination, which not only has important significance in the diagnosis, provides important basis for risk stratification and prognosis of AML,but also has certain guiding effect to therapy. There are many reports indicated that acute myeloid leukemia associated with the expression of some Lymphatic antigens,such as deoxynucleotidyl transferase(TdT), CD9, CD7 and so on. The abnormalexpression of TdT and CD7 in AML are often associated with poor prognosis. The expression of CD25 in AML is a poor prognostic factor applying to the risk stratification of AML. There were a few reports about the expression of CD25 in AML in this country. Therefore further research is needed. Two hundred eighty-three cases of de novo AML in the First Affiliated Hospital of Zhengzhou University from September 2014 to December 2015 were retrospectively analyzed for the clinical characterizations and therapeutic responses of AML with the expression of CD25.ObjectiveTo analyze the expression of CD25 in AML blasts and to explore the clinical characterizations and treatment responses of CD25~+AML patients. The prognostic value of CD25 in AML were evaluated.Materials and methodsThe clinical and laboratory data of 283 de novo AML(excluded APL) patients,who were diagnosed in the First Affiliated Hospital of Zhengzhou University from September 2014 to December 2015, were collected and retrospectively analyzed. The diagnosis of all the patients were based on FAB and WHO criteria, including morphology,histochemical staining, immuneophenotyping, cytogenetic and molecular characterizations of blasts. Flow Cytometry was applied to detect the expression of CD25 on leukemia cells. According to the expression of CD25, cases were divided into CD25~+AML group and CD25-AML group. The clinical characterizations and treatment responses between the two groups based on CD25 expression in AML were retrospectively analyzed. Patients were followed up to December 31, 2015, or to the date of death or last follow-up.Results1. The expression of CD25 in AML: Fourty-four out off 283 cases(15.55%) of AML expressed CD25 antigen. The incidence(28.05%) of CD25 antigen expressed in acute mononuclear leukemia(M5) was higher than other subtypes of leukemia. The difference is statistically significant(P<0.05).2. The clinical characteristics of CD25~+AML: There were no statistically significant differences in age, HGB and PLT count between CD25~+AML and CD25-AML(P>0.05). Compared with CD25-AML patients, CD25~+AML patients were more common in women than in man, with higher WBC counts at diagnosis and higher percentage of blasts in peripheral blood and bone marrow(P<0.05).3. The immunophenotypes of CD25~+AML: Thirty antigens were used in the immunophenotye of AML. Compared with CD25-AML patients, the positive cell numbers of CD11 b, CD36, CD4, CD22 and CD123 were higher in CD25~+AML,while CD38 and CD56 were lower CD25~+AML(P<0.05). No statistically significances were observed on other antigens between the two groups(P>0.05).4. The treatment responses of CD25~+AML: Compared with CD25-AML patients,CD25~+AML patients had lower CR rate: the first CR rate were 49.00% and 23.08%respectively(c2=6.021, P=0.014) and the second CR rate were 75.93% and 44.44%respectively(c2=7.493, P=0.006). CD25~+AML patients had shorter OS than CD25-AML patients(c2=24.554, P=0.000).5. The relationship of CD25 expression and Chromosome karyotype: Most of CD25~+AML patients carried normal karyotype(65.71%). No significant differences in the OS of CD25~+AML were found between patients with unfavorable karyotype and with intermediate karyotype(c2=3.194, P=0.071).6. The relationship of CD25 expression and FLT3-ITD mutation: The patients in CD25~+AML had significantly higher chance to carry FLT3-ITD mutation than CD25-AML patients(60% vs 9.15%;c2=44.948,P=0.000). The OS in CD25~+AML patients with FLT3-ITD mutation was significantly shorter than that in CD25-AML patients with FLT3-ITD mutation(c2=4.078,P=0.043).Conclusion1. CD25~+AML patients tend to be AML-M5 subtypes with normal chromosome karyotype. CD25~+AML patients are more common in women than in man, with higher WBC counts and higher percentage of blasts in peripheral blood and bone marrow at diagnosis.2. CD25 expression in AML is an adverse prognostic factor independent of the chromosome karyotype,with low complete remission ratio and short survival time.3. CD25~+AML patients have a higher chance to carry FLT3-ITD mutation. With CD25 expression, FLT3-ITD~+AML patients have a poorer prognosis. |
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