Journal of Clinical Oncology, Vol 16, 3768-3773, Copyright © 1998 by American Society of Clinical Oncology

ARTICLES

Reappraisal of the clinical and biologic significance of myeloid- associated antigen expression in childhood acute lymphoblastic leukemia

CH Pui, JE Rubnitz, ML Hancock, JR Downing, SC Raimondi, GK Rivera, JT Sandlund, RC Ribeiro, DR Head, MV Relling, WE Evans and FG Behm
Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA. ching-hon.pui@stjude.org

PURPOSE: To reassess the clinical and biologic significance of myeloid- associated antigen expression in childhood acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS: We prospectively studied 334 newly diagnosed cases of this disease, using a comprehensive panel of antibodies that represented five myeloid cluster groups (CD13, CD14, CD15, CD33, and CD65). Blast cells were tested for ETV6 and MLL rearrangement using Southern blot analysis. RESULTS: CD13 was expressed in 13.7% of cases, CD14 in 1%, CD15 in 6.6%, CD33 in 16%, and CD65 in 9.7%. Approximately one third of cases (31.4%) expressed one or more of these antigens (B-cell precursor, 31.9%; T-cell, 28.8%), while 10.5% expressed two or more (B-cell precursor, 11.3%; T-cell, 6.1%). Among the B-cell precursor leukemias, myeloid-associated antigen expression was significantly associated with a lack of hyperdiploidy and rearrangements of ETV6 or MLL gene. Most of the cases with MLL rearrangements (82%) expressed CD65, CD15, and CD33, either alone or in combination, whereas 48% of those with a rearranged ETV6 gene expressed CD13, CD33, or both. Myeloid-associated antigen expression did not correlate with event-free survival, whether the analysis was based on any of the five antigens in our panel or on the three more commonly tested antigens (CD13, CD33, and CD65). Importantly, this finding was not affected by exclusion of patients with ETV6 or MLL gene rearrangements. CONCLUSION: Even though blast cell expression of myeloid-associated antigen expression shows significant associations with specific genetic abnormalities, it lacks prognostic value in childhood ALL.

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