| Background:Acute myelogenous leukemia(AML)is a malignant clonal disease of hematopoietic stem and progenitor cells,and its biological characteristics are highly heterogeneous.Cytogenetics and molecular biology markers at the first diagnosis are currently the main stratification factors for the prognosis of AML,but these stratification factors are not detectable in all patients.Therefore,it is necessary to explore the relationship between immunophenotype and AML treatment efficacy or prognosis.It was reported that CD123,CD56,and CD7 are related to poor efficacy and prognosis of AML.But some studies did not support these results.Therefore,the relationship between CD123,CD56 or CD7 and efficacy and prognosis still keep controversial.Moreover,the clinical application value of these immunophenotypes combined in AML patients have not been reported.This study aims to clarify the clinical significance of CD123,CD56 and CD7 and their combination in AML patients,and to provide help for the assessment of AML efficacy and prognosis.Objects and methods:1.Medical data:140 newly diagnosed AML(M0-M7)patients were admitted from the department of hematology,the First Affiliated Hospital of Gannan Medical College from January 2019 to March 2020,including 87 male patients and 53 female patients.There were 11 children(1-14 years old),112 adolescents and adult patients<60 years(15-59 years old),17 elderly patients(60-77 years old),with an average age of 41 years(1 to 77 years).All cases are routinely performed complete blood count,blood chemistries,bone marrow cytologic examination,banding technique for chromosome karyotype analysis,chest computed tomography(CT),abdominal color doppler ultrasound,electrocardiogram,and etc..The standard of stratification and risk of cytogenetics/molecular genetics refers to<Chinese Guidelines for Diagnosis and Treatment of Adult Acute Myelogenous Leukemia(Non-acute Promyelocytic Leukemia)>(2017 Edition)and<Chinese Guidelines for Diagnosis and Treatment of Acute Promyelocytic Leukemia>(2018 Edition),and the therapeutic efficacy assessment refers to<Zhang Zhinan Standards for Diagnosis and Treatment of Blood Diseases>(Third Edition).2.Research method:The expression levels of CD123,CD56,and CD7 on the surface of their bone marrow leukemia cells were detected by flow cytometry within140 newly diagnosed AML patients.the antigen expression rate≥20%is defined as positive expression.All the patients received 1 course of inducing therapy.According to the expression rates of CD123、CD56 and CD7,all 140 patients were divided into 7 groups:CD123 positive and negative group,CD56 positive and negative group,CD7 positive and negative group,CD123/CD56 double positive group and non-double positive group(including CD123+/CD56-,CD123-/CD56+and CD123/CD56-),CD123/CD7 double positive group and non-double positive group(including CD123+/CD7-,CD123-/CD7+and CD123/CD7-),CD56/CD7double positive group and non-double positive group(including CD56+/CD7-,CD56-/CD7+and CD56/CD7-),CD123/CD56/CD7 triple positive group and non-triple positive group(including CD123+/CD56+/CD7-,CD123+/CD56-/CD7-,CD123-/CD56+/CD7-,CD123-/CD56+/CD7+,CD123-/CD56-/CD7+,CD123+/CD56-/CD7+and CD123/CD56/CD7-).The sexes,age,white blood cell count,karyotype,complete remission rate after the first course of chemotherapy,and minimal residual disease(MRD)after complete remission within these 7 groups were compared and analyzed.3.Statistical analysis:SPSS 21.0 statistical software for statistical analysis were used.If the measurement data conforms to the normal distribution,the mean±standard deviation is used to describe,the comparison between the two groups is performed by the t test;if it conforms to the non-normal distribution,the median±interquartile range is used to describe,and the Wilcoxon rank sum test is used for the between groups Compare.Theχ~2test or Fisher’s exact probability method was used to compare the count data between the two groups.P<0.05 indicates that the difference is statistically significant.result:1.Among 140 newly treated AML patients,101 cases were CD123 positive,with a positive rate of 72.14%,39 cases were CD56 positive,with a positive rate of27.86%,and 17 cases were CD7 positive,with a positive rate of 12.14%.There was no significant difference in age and gender contribution between the positive group and the negative group(all P>0.05).The expressions of CD123,CD56 and CD7were not related to each other(all P>0.05).CD123,CD56,CD7 and their combination are all expressed at the highest rate in AML-M2 subtypes.2.The comparison of white blood cell count,karyotype risk stratification,the complete remission rate of the first course induced treatment were statistically significant(both P<0.05)within CD7 positive group and negative group,CD123/CD7 double positive group and non-double positive group(including CD123+/CD7-,CD123-/CD7+and CD123-/CD7-)patients.;the comparison of the white blood cell count at the first diagnosis between CD123 positive group and the negative group had statistical significance(P<0.05),but in the chromosome nucleus risk.There was no statistical significance in the comparison of the complete remission rate between study group and the first course inducing treatment(all P>0.05);There were not statistically significant(all P>0.05)compared the white blood cell count,karyotype prognostic risk classification at the first diagnosis,and the complete remission rate of the first course of treatment among CD56 positive group versus negative group,CD123/CD56 double positive group versus non-double positive group(including CD123+/CD56-,CD123-/CD56+and CD123-/CD56-).The cases of CD56/CD7 in the double-positive group and the CD123/CD56/CD7triple-positive group were not been analyzed due to too small case number(1patient each).In these 7 groups,the comparison of MRD after the first course of treatment in each group of positive and non-positive patients was not statistically significant(all P>0.05).3.The expression rate of CD7 positive and negative groups in the elderly was not statistically significant(P>0.05);but the comparison between the two groups of patients in the range of WBC≥20×10~9/L and WBC≥100×10~9/L,There was statistical significance between the two groups(all P<0.05).conclusion:1.CD123 is an effective marker for AML detection.CD56 and CD7 are common crossline expression antigens of AML.CD123,CD56 and CD7 are the confirmed leukemia-associated immunophenotypes of AML patients.In AML patients,the expression and gender contribution of CD123,CD56 and CD7 have no correlation with each other regardless of age,and there is no difference in expression between the CD7 positive group and the CD7 negative group in elderly patients.2.CD7-positive newly diagnosed AML patients have a higher white blood cell count,a worse karyotype,and a lower complete remission rate in the first course of treatment,regardless of CD56 or CD123 co-expression.CD7 positive expression in AML has independent poor prognostic value.3.CD123/CD7+,CD56/CD7+and CD123/CD56/CD7+positive expression group patients have higher tumor burden,worse recent chemotherapy effect,and poor prognosis,which seems to be related to CD7 expression.The white blood cell count of patients with CD123+expression at first diagnosis is higher,which is not associated with the patient’s short-term curative effect and prognosis.CD56+,CD123/CD56+expression has no correlation with the patient’s white blood cell count at first diagnosis,short-term curative effect and prognosis.significance:This study analyzes CD123,CD56,CD7 and their mutual combination for comparative study and added chromosome karyotype indicators for analysis.The results illustrated that CD7 act as an independent indicator related to poor prognosis.The resultss of this study is of great significance to the prognostic stratification of AML patients,the formulation of treatment plans,the selection and combination of antibodies in the detection of minimal residual disease,and the development of targeted drugs. |
