CD34阳性与CD34阴性成人急性T淋巴细胞白血病临床分析

发布时间：2018-08-07 18:55

【摘要】：背景及目的急性T淋巴细胞白血病(acute T-lymphoblastic leukemia,T-ALL)是一种生物学特征异质性很大的疾病,多见于儿童和青少年,也见于成人,发病率约占成人ALL的25%[1]。研究表明,CD34在除AML-M3以外的AML中高表达,其表达程度与预后相关[2、3],而CD34在ALL中的研究相对较少。T-ALL的免疫表型与临床特点的研究以及免疫表型与预后关系的研究目前主要以T淋巴系常见的抗原如CD2、CD3、CD5、CD7等居多,而对于非特异性抗原CD34,国内外的研究重点在于该抗原在造血干细胞移植中的作用,对其与预后的关系报道鲜少。T-ALL发病率较低,预后差,CD34抗原在T-ALL中的表达不高,目前人们对其生物学、免疫学等了解不足,不能通过识别可靠的预后因素调整治疗方案。本研究分析CD34阳性及阴性成人急性T淋巴细胞白血病患者的临床表现及预后,探讨CD34表达对成人T-ALL预后的价值。方法回顾性分析郑州大学第一附属医院血液科2012年1月至2015年7月收治的57例初治成人T-ALL患者,根据CD34的表达情况,分为CD34阳性组与CD34阴性组,并对两组的临床特点、实验室检查、中枢神经系统白血病的发生率、化疗后的4周完全缓解率及预后生存进行比较。分析CD34的表达是否影响造血干细胞移植。结果57例初治成人T-ALL患者中,CD34阳性组13例(22.8%),CD34阴性组44例(77.2%)。CD34阳性组与CD34阴性组在性别、年龄、肝脾大、淋巴结肿大、血小板减少、白细胞增高、染色体异常、4周完全缓解率(CR)率、中枢神经系统白血病(CNSL)方面,差异均无统计学意义(均P0.05);CD34的表达与纵隔肿物无相关性(P0.05)。初诊时CD34阳性组血红蛋白(Hb)90g/L、伴髓系抗原表达者的比例高于阴性组,差异均有统计学意义(χ2=4.571,P=0.033;χ2=6.787,P=0.009)。治疗过程中,43.2%的患者疾病复发,但与CD34的表达无相关性(P0.05)。15例选择造血干细胞移植(HSCT),42例未选择HSCT,在未选择HSCT的患者中,CD34阳性组中位生存期为5个月,CD34阴性组为17个月,两者差异有统计学意义(χ2=4.220,P=0.040)。结论1.成人T-ALL中CD34的表达与初诊时年龄、性别、肝脾肿大、淋巴结肿大、高白细胞、血小板减少、染色体异常及中枢神经系统白血病的发生率无明确相关性。2.CD34的表达与纵隔肿物、疾病复发无明确相关性。3.CD34阳性组更易出现中、重度贫血,且与髓系抗原表达有关。4..CD34阳性组T-ALL患者的完全缓解率低于CD34阴性组,但差异无统计学意义,可能与例数较少有关。5.未行造血干细胞移植患者中CD34阳性组中位生存期短于CD34阴性组,提示CD34的表达可能是T-ALL的预后不良因素之一。6.行造血干细胞移植的患者生存率高于未行造血干细胞移植的T-ALL患者,说明造血干细胞移植仍然是急性白血病患者改善预后的重要治疗手段。
[Abstract]:Background and objective Acute T lymphocyte leukemia (acute T-lymphoblastic leukemia-T all) is a disease with high biological heterogeneity. It is more common in children and adolescents, but also in adults, the incidence of which is about 25% of adult ALL. The results showed that CD34 was highly expressed in AML with the exception of AML-M3. The expression of T-ALL was related to the prognosis of ALL. The immunophenotype and clinical characteristics of T-ALL and the relationship between immunophenotype and prognosis were mainly studied by T lymphoid antigens such as CD2T, CD3, CD5, CD5, CD7, and so on. However, for non-specific antigen CD34, the emphasis at home and abroad is on the role of CD34 in hematopoietic stem cell transplantation. The relationship between CD34 and prognosis is reported to be low incidence of CD34, and poor prognosis of CD34 antigen in the expression of CD34 in T-ALL. At present, people do not know enough about its biology, immunology and so on, and can't adjust the treatment plan by identifying reliable prognostic factors. This study analyzed the clinical manifestation and prognosis of CD34 positive and negative adult acute T lymphocyte leukemia patients, and discussed the value of CD34 expression in the prognosis of adult T-ALL. Methods from January 2012 to July 2015, 57 newly diagnosed adult T-ALL patients were analyzed retrospectively. According to the expression of CD34, they were divided into CD34 positive group and CD34 negative group, and the clinical characteristics of the two groups were analyzed. Laboratory examination, the incidence of central nervous system leukemia, the complete remission rate of 4 weeks after chemotherapy and the survival of prognosis were compared. To analyze whether the expression of CD34 affects hematopoietic stem cell transplantation. Results among 57 newly treated adult T-ALL patients, 13 (22.8%) were positive for CD34, 44 (77.2%) were negative for CD34, and 44 (77.2%) were positive for CD34. The complete remission rate of (CR) in sex, age, hepatosplenomegaly, lymphadenopathy, thrombocytopenia, leukocytosis and chromosome abnormality in 4 weeks was found in the positive group and CD34 negative group. In (CNSL) of central nervous system leukemia, there was no significant difference (P0.05) between the expression of CD34 and mediastinal mass (P0.05). The proportion of hemoglobin (Hb) 90 g / L and myeloid antigen expression in the CD34 positive group was higher than that in the negative group at first diagnosis, and the difference was statistically significant (蠂 2 4. 571 P 0. 033; 蠂 2 + 6. 787 P 0. 009). In the course of treatment, 43.2% of the patients had relapsed disease, but there was no correlation between the expression of CD34 and the expression of CD34 (P0.05). The median survival time of CD34 positive group was 5 months and that of CD34 negative group was 17 months. 15 cases of (HSCT) were selected for hematopoietic stem cell transplantation and 42 cases did not choose HSCT.The median survival time of CD34 positive group was 5 months and that of CD34 negative group was 17 months. The difference between the two groups was statistically significant (蠂 2 = 4.220 P < 0.040). Conclusion 1. The expression of CD34 in adult T-ALL was not correlated with age, sex, hepatosplenomegaly, lymphadenopathy, high white blood cell, thrombocytopenia, chromosome abnormality and the incidence of central nervous system leukemia. The complete remission rate of T-ALL patients with positive myeloid antigen expression was lower than that of CD34 negative group, but the difference was not statistically significant, and it might be related to the number of cases. 5. 3. The positive group of disease recurrence was more prone to moderate and severe anemia, and the complete remission rate of T-ALL patients with positive myeloid antigen expression was lower than that of CD34 negative group, but the difference was not statistically significant, and might be related to the number of cases. The median survival time of CD34 positive group was shorter than that of CD34 negative group in patients without hematopoietic stem cell transplantation, suggesting that the expression of CD34 might be one of the poor prognostic factors of T-ALL. The survival rate of patients undergoing hematopoietic stem cell transplantation was higher than that of T-ALL patients without hematopoietic stem cell transplantation, which indicated that hematopoietic stem cell transplantation was still an important therapy for improving the prognosis of patients with acute leukemia.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.71

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