| Objective:To observe the expression of antigen in patients with acute myeloid leukemia and to explore the relationship between immunophenotyping and complete remission rate after 2 courses chemotherapy.Methods:A study was conducted in 86 patients were diagnosed as AML from September 2009 to September 2016 in the Department of Hematology,Affiliated Hospital of Yan’an University.The clinical data of FAB subtype and immunophenotyping were retrospectively analyzed.For non-M3 patients with MA [mitoxantrone + cytarabine],IDA [desmethoxy daunorubicin + cytarabine],DA [daunorubicin or pirarubicin + cytarabine],or HA [homoharringtonine + cytarabine] program chemotherapy,M3 type using arsenic trioxide or arsenic trioxide combined with all-trans retinoic acid chemotherapy.To analyze the relationship between the expression of single antigen,the high level of antigen expression,the expression of lymphoid antigen and the expression of common antigen and the remission rate of AML.The chi-square test was used to compare the counting data rate with p <0.05 as statistically significant.Results:(1)Among the 86 patients,47(54%)were male and 39 were female(46%),aged between 17 and 63 years,and the median age was 43 years.According to FAB classification diagnosis: 2 cases were diagnosed as M0 type,8 cases were diagnosed as M1 type,28 cases were diagnosed as M2 type,9 cases were diagnosed as M3 type,17 cases were diagnosed as M4 type,19 cases were diagnosed For the M5 type,3 cases were diagnosed with M6 type,the highest proportion of M2 type,32.6%.(2)The expression of myeloid antigens :CD33(90.7%),MPO(88.4%),CD13(87.2%),CD117(80.2%),CD64(66.3%),CD15(57.0%),CD123(54.7%),CD11b(53.5%),CD82(52.3%),CD14(10.5%).;Non-series-specific antigen expression: HLA-DR(59.30%)、CD34(45.4%)、CD38(70.9%)。;Lymphoid antigen expression: AML lymphoid antigen expression was 48.8%(42/86),wherein the highest expression of CD7,respectively CD7(16.3%),CD19(10.5%),CD20(7.0%),CD10(4.7%),CD5(3.5%),CD79a(2.3%).(3)CD13,CD33,MPO and CD117 in all subtypes of AML were shown to be highly expressed.CD14 expression in M5 was higher 5/19(26.3%)and CD14 was not expressed in M3 type.CD64 is highly expressed in M2,M3,M4,M5,M6.The expression rates of CD11 b in M5 and M4 were 73.7% and 70.6%,respectively,followed by 50% in M1 and 46.4% in M2.CD15 was expressed in M4(82.4%),M5(78.9%),M2(64.3%),and not expressed in M0 and M1.CD13,CD33 and CD117 were highly expressed in M3 patients,while HLA-DR and CD14 were not expressed or rarely expressed in M3.CD34 was expressed in non-M3 subtypes,such as M0(50%),M1(62.5%)M2(50%),M4(47.1%),M5(52.6%),but rarely expressed in M3(11.1%)。CD38 was expressed in M1,M2,M3,M4 and M5,the average expression rate was 75.3%,and no expression of CD38 was found in M0 and M6.Experssion of CD5 in M2 and M4 was low(3.5%)and was not expressed in other subtypes.The overall expression rate of CD7 in AML was 16.3%,mainly expressed in M2,M4,M5 and M6,and expression of CD7 was not found in M0,M1 and M3.CD19,CD20,CD10 and CD79 a were expressed in AML in different degrees,10.5%,4.7%,3.5% and 2.3%,respectively.Non-series specific antigen CD34,HLA-DR mainly in poorly differentiated AML expression,such as M0,M1 and so on.(4)The group of 86 patients with AML received two courses of induction of remission therapy,after chemotherapy,of which 55 people achieved complete remission(CR),the overall CR rate of 63.9%.The CR rate(35.9%)in CD34 positive group was lower than that in CD34 negative group(59.6%),which was statistically significant(p = 0.029).The CR rate(35.7%)in CD7 positive group was lower than that in CD7 negative group(69.4%),which was statistically significant(p = 0.016).The CR rate(92.3%)in CD19 positive expression group was higher than that in CD19 negative expression group(58.1%),the difference was statistically significant(p = 0.046).The positive rate of CR and negative CR in other antigen groups were different,but not statistically significant.The CR rate(13.3%)in the high expression group of CD34 was lower than that in the non-high level expression group(50.0%),which was statistically significant(P = 0.020).The CR rate(35.7%)in the high expression level of CD13 was significantly lower than that in the non-high level expression group(75.0%),which was statistically significant(P = 0.002).The CR rate(10.0%)in the high expression level of CD7 was lower than that in non-high-level expression group(100%),which was statistically significant(P = 0.011).The CR rate(30%)of the CD34 、 CD7 antigen group was significantly lower than that of the non-co-expression group(68.4%),and the difference was statistically significant。The CR rate(42.4%)of AML CR34 、 CD82 co-expression group was lower than that of non-co-expression group(75.9%),the difference was statistically significant(P = 0.001)。 Conclusions:1.Immunophenotyping is a good complement to cell morphology,molecular genetics and cytogenetics,and combined with each other is more helpful in the diagnosis of acute myeloid leukemia.2.When immunophenotyping is used to diagnose AML,it is not necessary to look at the expression of an antigen alone,but rather to evaluate the overall expression of each series and different stages of antigen,and to combine the leukemia antigen integration system to make more accurate judgment.CD13,CD33,CD117 and MPO simultaneous expression contribute to the diagnosis of AML.3.The influence of the expression of lymphatic antigens in AML on prognosis can not be generalized,and it needs to be analyzed synthetically with the clinical manifestations,age factors,molecular genetics and cytogenetics of patients.CD7 expression was considered to be a poor prognostic factor in AML,whereas CD19 expression was positive as a good prognostic factor for AML.4.In comparison with the expression of monoclonal antigens in AML,co-expression of multiple antigens is more valuable in the diagnosis and prognosis of AML.CD34 /CD7,CD34 /CD82 coexpression can be used as one of the poor prognostic factors of AML. |
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