Predictive significance of the cut-off value of CD20 expression in patients with B-cell lymphoma
Predictive significance of the cut-off value of CD20 expression in patients with B-cell lymphoma
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DOI：
10.3892/or_00000961
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发表时间：
2010-10-01
期刊：
影响因子：
4.2
通讯作者：
Novakovic, Barbara Jezersek
中科院分区：
文献类型：
--
作者：
Horvat, Mateja;Prevodnik, Veronika Kloboves;Novakovic, Barbara Jezersek
将抗CD20单克隆抗体利妥昔单抗引入B细胞淋巴瘤患者的治疗中，提高了总体缓解率、缓解持续时间和这些患者的总体生存率。然而，只有少数研究解决了更高的 CD20 表达是否与更好的治疗结果平行的问题。本研究的目的是评估 B 细胞淋巴瘤患者中 CD20 表达水平与总生存期 (OS)、无病生存期 (DFS) 以及总缓解率 (ORR) 之间的关系。该研究的最终目的是确定 CD20 表达的截止值以及利妥昔单抗治疗更好结果的预测意义。 2003 年至 2007 年间接受利妥昔单抗和化疗治疗的 114 名不同组织学类型的 B 细胞淋巴瘤患者参与了该研究。所有患者在治疗开始前均进行了 CD20 表达评估。 CD20表达水平通过定量流式细胞仪测量确定，而OS和DES通过Kaplan-Meier生存曲线评估。 CD20 表达的截止值预测 B 细胞淋巴瘤患者对利妥昔单抗有更好的反应，其确定为 25,000 个分子的等效可溶性荧光染料 (MESF)。我们的数据显示，利妥昔单抗治疗后获得完全缓解的患者的 CD20 抗原表达显着高于利妥昔单抗治疗后疾病才稳定的患者（p=0.018）。 CD20抗原表达高于截止值的患者和CD20抗原表达低于截止值的患者之间的反应持续时间没有观察到显着差异[风险比（HR），0.5667：95%CI，0.124至3.18，p=0.57]。尽管我们已经证明，CD20 表达水平高于利妥昔单抗治疗临界值的患者的 OS 明显更长[风险比 (HR)，0.4573； 95%CI，0.1364 至 0.9461。 p=0.0383] 高于 CD20 表达水平低于截止值的患者。在我们的研究人群中，17.5% 的 CD20 表达水平低于截止值。 CD20表达水平低于临界值的患者比例最高（80%）属于慢性淋巴细胞白血病（CLL）患者组，而滤泡性淋巴瘤（FL）患者组中观察到最低比例（6.7%）。这些数据表明，较高水平的 CD20 表达与利妥昔单抗治疗患者 OS 的改善相关。在我们的系列中，CD20 表达的截止限值表明具有更好结果的预测意义，该截止限值设置为 25.000 MESF。在做出有关利妥昔单抗治疗的决定时，应考虑该临界值。然而，这些结果需要对更大的患者群体进行进一步的研究。
The introduction of the anti-CD20 monoclonal antibody, rituximab, into the treatment of patients with B-cell lymphomas has improved the overall response rate, as well as the response duration and the overall survival of these patients. However, only a few studies have addressed the question of whether higher CD20 expression parallels with better treatment outcomes. The aim of this study was to assess the relationship between the level of CD20 expression and overall survival (OS), disease-free survival (DFS) along with the overall response rate (ORR) in B-cell lymphoma patients. The ultimate objective of the study was to determine the cut-off value of CD20 expression together with the predictive significance of better outcome of rituximab treatment. One hundred and fourteen patients with different histological types of B-cell lymphomas treated with rituximab and chemotherapy between 2003 and 2007 were enrolled in the study. All patients had CD20 expression assessed prior to the beginning of treatment. The level of CD20 expression was determined by quantitative flow cytometric measurements, while the OS and DES were evaluated by means of Kaplan-Meier survival curves. The cut-off value of CD20 expression, which predicts a better response to rituximab in patients with B-cell lymphomas, was determined at 25.000 molecules of equivalent soluble fluorochrome (MESF). Our data show that patients who achieved complete response after rituximab therapy had a significantly higher expression of the CD20 antigen (p=0.018) than those whose disease only stabilized after rituximab therapy. No significant difference was observed in the response duration between the patients with CD20 antigen expressed above the cut-off value and those expressing CD20 antigen below the cut-off value [hazard ratio (HR), 0.5667: 95%CI, 0.124 to 3.18, p=0.57]. Even though we have proved that patients with a CD20 expression level above the cut-off value treated with rituximab had a significantly longer OS [hazard ratio (HR), 0.4573; 95%CI, 0.1364 to 0.9461. p=0.0383] than patients with a CD20 expression level below the cut-off value. Among our study population, 17.5% had a CD20 expression level below the cut-off value. The highest percentage (80%) of the patients with a CD20 expression level below the cut-off value belonged to the group of chronic lymphocytic leukemia (CLL) patients, while the lowest (6.7%) was observed in the follicular lymphoma (FL) patient group. These data indicate that a higher level of CD20 expression correlates with an improved OS in patients treated with rituximab. The cut-off limit of CD20 expression suggested to have the predictive significance of better outcome was in our series set at 25.000 MESF. This cut-off value should be considered when the decision regarding treatment with rituximab is taken. However, these results warrant further studies on larger groups of patients.