| Background Acute myeloid leukemia(AML)is a highly heterogeneous malignant clonal disease of myeloid hematopoietic stem cells,which is the most common type of adult leukemia.With the emergence of new fluorescently labeled antibodies in recent years,The sensitivity of flow cytometry to detect AML cell surface or intracytoplasmic antigens has been greatly improved,which can accurately detect specific or abnormal antigens on AML cell surfaces.Leukemia cells usually only express their own series of antigens,However,some of the original cells of leukemia patients can express both myeloid and lymphoid antigens.It is reported that 13%-60% of AML expresses lymphoid antigen.Lymphoid antigens may have hints in clinical features and prognosis of AML,of which CD7,CD56,and CD19 are common.Therefore,on the basis of previous studies,this study attempts to explore whether acute myeloid leukemia with lymphoid antigen expression has unique clinical characteristics and prognosis.Objective Try to explore whether Ly+AML has unique clinical characteristics and prognosis,which may help guide the selection of clinical treatment options and prognosis evaluation.Method Using flow cytometry to analyze the immune phenotype of AML leukemia cells.According to the 1998 Leukemia Immunotyping of European Group(EGIL1998)and the2008 World Health Organization(WHO2008)classification criteria,we reviewed 101 newly diagnosed AML patients in our hospital from May 2013 to May 2019(Excluding acute promyelocytic leukemia,M3).Take these newly diagnosed AML patients withlymphoid antigen expression as Ly+AML group,and then further divided into CD7+AML group,CD19+AML group and CD56+AML group according to the immunophenotype results.Analyze and compare the clinical characteristics,blood routine,and Bone marrow blast ratio between Ly+AML group and Ly-AML.Compare the efficacy and prognosis of CD7+AML group,CD19+AML group,and CD56+AML group with Ly-AML.Follow up and observe differences in survival curves.Result 1)Antigen expression characteristics: Myeloid antigens CD33,CD13,CD117,cMPO,CD64 and non-specific antigens HLA-DR,CD34 have high expression rates,CD7 and CD56(both 29 cases,28.7%)are the most common T-line antigens,CD19 is the most common B-line antigen(13 cases,12.9%).CD7 and CD34 antigens were co-expressed in27 cases,and CD7 and HLA-DR antigens were co-expressed in 27 cases.CD7 antigen was positively correlated with CD34 and HLA-DR antigen expression(r = 0.263,P <0.01;r =0.210,P <0.05).2)Distribution of lymphoid antigens in FAB typing: 52 of 101 AML patients expressed lymphoid system antigen,the most common of which is CD7,CD56,and CD19.Observe the distribution of three antigens in FAB typing,CD7+AML was 29 cases,M0 1case,M1 2 cases,M2 11 cases,M4 0 cases,M5 15 cases,M6 0 cases;CD56+AML accounted for 29 cases,M0 1 case,M1 1 case,M2 15 cases,M4 0 cases,M5 12 cases,M60 cases;CD19+AML 13 cases,M0 1 case,M1 0 cases,M2 7 cases,M4 0 cases,M5 5cases,M6 0 cases.The three antigens were mainly distributed in M2 and M5 subtypes.3)Comparison of clinical features and test results: There was no difference between the Ly+AML group and the Ly-AML group in fever,bleeding,hepatosplenomegaly and extramedullary infiltration(P>0.05);Compared with Ly-AML group,the Ly+AML group had a higher white blood cell count and bone marrow blasts at the time of initial diagnosis,but a lower platelet count.The difference was statistically significant(P<0.05).There wasno statistical difference between the two groups in the hemoglobin at the initial diagnosis(P>0.05).4)Clinical efficacy and prognosis analysis: 56 of 101 patients obtained CR after 1course of induction chemotherapy.The 1-course CR rate was 55.4%.After multiple courses of chemotherapy,79 cases obtained CR,the total CR rate was 78.2%.Using Fisher's exact test,Compare the 1-course CR rate and total CR rate of CD7+AML group,CD19+AML group,CD56+AML group with Ly-AML,The 1-course CR rate and total CR rate of CD56+AML group were lower than Ly-AML;compared with Ly-AML,there was no statistical difference between the CD7+AML group and CD19+AML group in the1-course CR rate and total CR rate(P>0.05);according to the follow-up results of all patients,The progression-free survival(PFS)of the CD56+AML group was shorter than the Ly-AML group(P<0.05).compared with Ly-AML,there was no statistical difference in the PFS of CD7+AML and CD19+AML groups(P> 0.05).Conclusion 1)Ly+AML patients have diversity and heterogeneity.Compared with the Ly-AML group,the white blood cell count and Bone marrow blast ratio are high at the initial diagnosis,but the platelet count is low;2)CD56+AML patients have low sensitivity to conventional chemotherapy and poor prognosis.CD56 may be a poor factor in the prognosis of AML patients.CD7 and CD19 antigens do not affect the prognosis of AML patients. |
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