CLINICAL IMPORTANCE OF MYELOID ANTIGEN EXPRESSION IN ADULT ACUTE LYMPHOBLASTIC-LEUKEMIA
CLINICAL IMPORTANCE OF MYELOID ANTIGEN EXPRESSION IN ADULT ACUTE LYMPHOBLASTIC-LEUKEMIA
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DOI：
10.1056/nejm198704303161802
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发表时间：
1987-04-30
影响因子：
158.5
通讯作者：
BLOOMFIELD, CD
中科院分区：
文献类型：
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作者：
SOBOL, RE;MICK, R;BLOOMFIELD, CD
为了确定免疫表型在成人急性淋巴细胞白血病 (ALL) 中的临床重要性，我们前瞻性研究了 76 名患有这种疾病的患者。治疗前，测试淋巴母细胞与 B 细胞、T 细胞和髓样 (My) 抗原的单克隆抗体的反应性。出乎意料的是，在 25 名患者 (33%) 中发现了骨髓抗原（MCS-2 或 MY9），通常与 B 细胞或 T 细胞抗原结合在一起。在 My+ 患者中，15 名（60%）表达 B 细胞抗原 (B+ T- My+)；所有 6 名测试者都重新排列了免疫球蛋白基因。 5 名患者 (20%) 表达 T 细胞抗原 (B- T+ My2)，1 名 My+ 患者同时表达 B 细胞和 T 细胞抗原。 4 名患者（16%）仅表达骨髓抗原（B-T-My+）；三名接受测试的人具有种系免疫球蛋白和 T 细胞受体基因配置。尽管在临床特征上没有发现显着差异，但 My+ 患者的完全缓解率低于 My- 患者（35% vs. 76%，P < 0.01）。在表达 T 细胞抗原的 My+ 和 My- 患者之间没有观察到反应或存活率存在差异。然而，在表达 B 细胞抗原的患者中，My+ 患者的完全缓解率较低（29% vs. 71%，P = 0.02），且生存期较短（P = 0.03；中位数为 8.1% vs. > 26 个月）。这些发现表明，髓系抗原的表达可识别出成人 ALL 患者的高危人群，应针对这些患者研究替代治疗形式。
To determine the clinical importance of immunophenotypes in adult acute lymphoblastic leukemia (ALL), we prospectively studied 76 patients with this condition. Before treatment, lymphoblasts were tested for reactivity with monoclonal antibodies to B-cell, T-cell, and myeloid (My) antigens. Unexpectedly, myeloid antigens (MCS-2 or MY9) were identified in 25 patients (33 percent) usually in conjunction with B-cell or T-cell antigens. Among My+ patients, 15 (60 percent) expressed B-cell antigens (B+ T- My+); all 6 tested had rearranged immunoglobulin genes. Five patients (20 percent) expressed T-cell antigens (B- T+ My2), and one My+ patient expressed both B-cell and T-cell antigens. Only myeloid antigens (B- T- My+) were expressed in four patients (16 percent); three who were tested had germ-line immunoglobulin and T-cell-receptor gene configurations. Although no significant differences in presenting clinical features were found, My+ patients had fewer complete remissions than My- patients (35 vs. 76 percent, P < 0.01). No differences in response or survival were observed between My+ and My- patients expressing T-cell antigens. However, among those expressing B-cell antigens, My+ patients had fewer complete remissions (29 vs. 71 percent, P = 0.02) and shorter survival (P = 0.03; median, 8.1 vs. > 26 months). These findings indicate that expression of myeloid antigen identifies a high-risk group of patients with adult ALL for whom alternative forms of treatment should be investigated.