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Prognostic value of immunophenotyping in acute myeloid leukemia. Australian
Leukaemia Study Group
K Bradstock, J Matthews, E Benson, F Page and J Bishop
Department of Haematology, Westmead Hospital, New South Wales, Australia.
The diagnostic and prognostic value of immunophenotyping with 18 murine
monoclonal antibodies (MoAbs) to a variety of leukocyte differentiation
antigens was assessed in 168 adults aged 15 to 60 years with acute myeloid
leukemia (AML). Patients were entered on the multicentre Australian
Leukaemia Study Group M4 protocol, and were randomized to receive either
standard or high-dose Ara-C together with daunorubicin and etoposide as
induction chemotherapy, followed by standard consolidation and maintenance
therapy. Diagnostic bone marrow aspirate (152 cases) or peripheral blood
samples (16) were analyzed by indirect immunofluorescence and flow
cytometry. MoAbs used were directed at myeloid (CD11b, CD13, CD14, CD15,
CD33, CD41), lymphoid (CD2, CD3, CD7, CD9, CD10, CD19), or stem cell
(HLA-DR, CD34, c-kit receptor) antigens, as well as the leukocyte integrins
CD18 and CD49e, and the transferrin receptor CD71. Of the myeloid markers,
CD13 and CD33 were the most useful diagnostically (71% and 79% of cases
positive, respectively), with CD11b, CD14, and CD15 less commonly positive.
A minority of cases expressed lymphoid antigens, either T cell (CD2 16%,
CD3 7%, CD7 28%) or B cell (CD10 2%, CD19 7%). CD34 was detected on 42% and
c-kit receptor on 48%. When patients were analyzed for response to
treatment, CD2, CD9, and CD14 were significantly associated with complete
remission rate: cases expressing these antigens had a poorer response than
negative cases. In univariate analysis, CD11b+ cases had shorter periods of
remission (relative risk of relapse, 2.33; P = .003) and shorter survival
(relative death rate, 1.91; P = .006). In multivariate analysis, adjusting
for other prognostic factors, CD9 and CD11b were significantly predictive
of shorter survival. No other marker had a significant predictive effect.
We conclude that myeloid MoAbs are useful in confirming the diagnosis of
AML, but their prognostic value may be limited to CD11b. Lymphoid antigen
expression is a consistent phenomenon in a minority of cases of AML, but
appears to have little clinical significance.
Volume 84,
Issue 4,
pp. 1220-1225,
08/15/1994
Copyright © 1994 by The American Society of Hematology
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