| Objective:CD27 is expressed in several of B-cell chronic lymphocytic proliferative diseases(B-CLPD).To evaluate the expression of CD27 in chronic lymphocytic leukemia(CLL)and other B-CLPD as well as the value of CD27 in the prognosis of CLL.Methods:We analyzed the expression of CD27,clinical features and prognosis in 110 cases of CLL patients retrospectively.And the expression of CD27 in 36 cases of other B-CLPD were also made,including MCL,SMZL and WM/LPL.All patients were diagnosed based on the criteria of WHO 2008 Guidelines,and the data of cell morphology,flow immunophenotype,cytogenetics and molecular biology were collected.By using multi-parameter flow cytometry,the mean fluorescence intensity(MFI)of CD 19 positive cells was calculated.The MFI of CD27 expression was calculated on the basis of CD19 positive.X-tile software was used to determine the best cutoff for predicting the clinical outcome.Survival curves were constructed by the Kaplan-Meier method and log-rank test was utilized for comparison.Results:A total of 110 CLL and 36 other B-CLPD patients were included in this study,including MCL(n=19),SMZL(n=5)and WM/LPL(n=12).However,the MFI was variable.The median MFI of CD27 on CLL cells was 102.0(rang,15.5-422.0).In MCL,SMZL and WM/LPL,the median MFI of CD27 was 98.9(rang,34.9-330.0),82.8(rang,43.4-193.0),39.5(rang,4.7-181.0)respectively.CD27 MFI did not show significant statistical differences between CLL and MCL,MCL and SMZL.In addition,the MFI of CD27 significantly different from that of CLL(median 102.0,P<0.0001),MCL(median 98.9,P<0.0096)and SMZL(median 82.8,P=0.0485).Further analysis revealed that CD27 expression in CLL was heterogeneous(MFI range from 15.5 to 422.0),suggesting that there may be have a potential prognostic value.The time from diagnosis to first treatment(TTT)(rang form 1.0 months to 88.0 months)was defined.And the median TTT was 10.4 months,the median OS was 15.0 months.X-tile identified CD27 MFI 100 as the best cutoff,which was therefore to divide CLL cases into two groups of high and low expression.The number of two groups was respectively 57 and 53 cases(51.82%and 48.18%).Patients with high CD27 MFI(?100)had a significantly shorter time-to-treatment(TTT)than those with low CD27 MFI(<100)(P=0.0147),with no significant statistical relationship with OS(P>0.05).The MFI of CD27 and the prognosis of CLL were analyzed by univariate analysis.The results showed that CD27 MFI had no significant statistical relationship with disease stage(Binet and Rai stage),cytogenetic index(+12,del(11q22),del(17p13))(P>0.05).However,patients with high MFI of CD27 expression(?100)were enriched in unmutated immunoglobulin heavy-chain variable(IGHV)status(p<0.001).It indicated that the prognostic significance of CD27 expression might be in part due to its association with IGHV status.Conclusion:This study confirmed heterogeneous expression of CD27 in B-CLPD.CD27 may have a potential differential diagnosis value,by the expression of CD27 in LPL/WM is significantly lower than other B-CLPD.More importantly,because of high CD27 expression associated with IGHV unmutated status and rapid disease progression,CD27 MFI may be regarded as a novel prognostic and survival factor in CLL. |
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