CD5~+与CD5~-慢性淋巴细胞白血病临床特征的比较分析
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摘要
目的对比CD5~+与CD5~-慢性淋巴细胞白血病(CLL)患者在临床特点、免疫表型及其染色体等方面的差异,并探究其临床意义。方法回顾性分析2007-2017年10年间在新疆医科大学第一附属医院住院治疗的161例CD5~+与32例CD5~-CLL患者的病历资料,在临床特征、免疫表型、染色体核型等方面进行统计分析。结果 (1) CD5的阴性率为17%,CD5~-CLL患者较CD5~+CLL患者初诊时分期更高(P=0.03),更易累及脾脏(P=0.03),累及3组以上淋巴结数目更多(P=0.04)。(2) CD5~+CLL和CD5~-CLL的CD23表达差异有统计学意义(P=0.02);在染色体核型上,CD5~+CLL和CD5~-CLL的17p~-表达差异有统计学意义(P=0.02);CD5~+CLL和CD5~-CLL在13q~-、+12、11q~-、ZAP-70、CD38的表达差异无统计学意义(P>0.05)。结论 CD5~-CLL患者在初诊时往往分期更高、17p~-为高表达、脾肿大、累积淋巴结数目更多,显示出预后较差的特点,初诊时需早期行临床干预。
Objective To compare the clinical features, immunophenotypes and chromosomes between CD5~+ and CD5~- patients with chronic lymphoblastic leukemia(CLL), and to explore its clinical significance. Methods The clinical data of 161 cases of CD5~+ and 32 cases of CD5~-CLL hospitalized in the First Affiliated Hospital of Xinjiang Medical University from 2007 to 2017 were analyzed retrospectively. The clinical characteristics, immunophenotypes, chromosome karyotypes and so on were statistically analyzed. Results(1) The negative rate of CD5 was 17%. CD5~-CLL patients had higher staging(P=0.03) and spleen involvement(P=0.03) than those of CD5~+CLL patients. More than 3 groups lymph nodes were invaded in the CD~(5-)CLL group was more common, there were significant differences between two groups(P=0.04).(2) There was significant difference in CD23 expression between CD5~+CLL and CD5~-CLL(P=0.02), there was significant difference in 17 p~- expression in chromosome karyotype between CD5~+CLL and CD5~-CLL(P=0.02). There were no significant differences in expression of 13 q~-, +12, 11 q~-, ZAP-70 and CD38 between CD5~+CLL group and CD5~-CLL group(P>0.05). Conclusion CD5~-CLL patients tend to have higher stages, high expression of 17 q~-, splenomegaly and more accumulated lymph nodes at the beginning of diagnosis and have poor prognosis, so early clinical intervention should be carried out in the first diagnosis.
Objective To compare the clinical features, immunophenotypes and chromosomes between CD5~+ and CD5~- patients with chronic lymphoblastic leukemia(CLL), and to explore its clinical significance. Methods The clinical data of 161 cases of CD5~+ and 32 cases of CD5~-CLL hospitalized in the First Affiliated Hospital of Xinjiang Medical University from 2007 to 2017 were analyzed retrospectively. The clinical characteristics, immunophenotypes, chromosome karyotypes and so on were statistically analyzed. Results(1) The negative rate of CD5 was 17%. CD5~-CLL patients had higher staging(P=0.03) and spleen involvement(P=0.03) than those of CD5~+CLL patients. More than 3 groups lymph nodes were invaded in the CD~(5-)CLL group was more common, there were significant differences between two groups(P=0.04).(2) There was significant difference in CD23 expression between CD5~+CLL and CD5~-CLL(P=0.02), there was significant difference in 17 p~- expression in chromosome karyotype between CD5~+CLL and CD5~-CLL(P=0.02). There were no significant differences in expression of 13 q~-, +12, 11 q~-, ZAP-70 and CD38 between CD5~+CLL group and CD5~-CLL group(P>0.05). Conclusion CD5~-CLL patients tend to have higher stages, high expression of 17 q~-, splenomegaly and more accumulated lymph nodes at the beginning of diagnosis and have poor prognosis, so early clinical intervention should be carried out in the first diagnosis.
引文
[1] 中华医学会血液学分会白血病淋巴瘤学组,中国抗癌协会血液肿瘤专业委员会,中国慢性淋巴细胞白血病工作组.中国慢性淋巴细胞白血病/小淋巴细胞淋巴瘤的诊断与治疗指南(2018年版)[J].中华血液学杂志,2018,39(5):353-358.
[2] WUTTKE N J,MACARDLE P J,ZOLA H.Blood group antibodies are made by CD5+ and by CD5-B cells[J].Immunol Cell Biol,1997,75(5):478-483.
[3] 易莎,张小斌,陈燕.103例慢性淋巴细胞白血病患者免疫表型的研究[J].临床血液学杂志,2010,23(2):86-88.
[4] DEMIR C,KARA E,EKINCI ?,et al.Clinical and laboratory features of CD5- negative chronic lymphocytic leukemia[J].Med Sci Monit ,2017,23:2137-2142.
[5] CARTRON G,LINASSIER C,BREMOND J L,et al.CD5 negative B-cell chronic lymphocytic leukemia:clinical and biological features of 42 cases[J].Leuk Lymphoma,1998,31(1-2):209-216.
[6] 许芳,程澍,翁香琴,等.112例CD5阳性与15例CD5阴性慢性淋巴细胞白血病的比较分析[J].中华血液学杂志,2008,29(2):134-135.
[7] CRESPO M,BOSCH F,VILLAMOR N,et al.ZAP-70 expression as a surrogate for immunoglobulin-variable-region mutations in chronic lymphocytic leukemia[J].N Engl J Med,2003,348(18):1764-1775.
[8] DURIG J,NUCKEL H,CREMER M,et al.ZAP-70 expression is a prognostic factor in chronic lymphocytic leukemia[J].Leukemia,2003,17(12):2426.
[9] 张之南,郝玉书,千建祥,等.血液病学[M].第2版.北京:人民卫生出版社,2011:749-751.
[10] SALOMON-NGUYEN F,VALENSI F,MERLE-BERAL H,et al.A scoring system for the classification of CD5-B CLL versus CD5+ B CLL and B PLL[J].Leuk Lymphoma,1995,16(5-6):445-450.
[11] EFSTATHIOU S,TSIOULOS D,ZADCHAROS I,et al.The prognostic role of CD5 negativity in B-cell chronic lymphocytic leukaemia:a case-control study[J].Haematologia,2002,32(3):209.
[12] HUANG J C,FINN W G,GOOLSBY C L,et al.CD5- small B-cell leukemias are rarely classifiable as chronic lymphocytic leukemia[J].Am J Clin Pathol,1999,111(1):123-130.
[13] OSCIER D G,MATUTES E,COPPLESTONE A,et al.Atypical lymphocyte morphology:an adverse prognostic factor for disease progression in stage A CLL independent of trisomy 12[J].Br J Haematol,2015,98(4):934-939.
[14] HALLEK M,CHESON B D,CATOVSKY D,et al.Guidelines for diagnosis,indications for treatment,response assessment and supportive management of chronic lymphocytic leukemia[J].Blood,2018,131(25):2745-2760.
[15] 刘伟,申徐良,史文芝,等.45例CLL染色体核型及免疫表型与预后关系探讨[J].中国卫生检验杂志,2010,20(12):3384-3386.
[2] WUTTKE N J,MACARDLE P J,ZOLA H.Blood group antibodies are made by CD5+ and by CD5-B cells[J].Immunol Cell Biol,1997,75(5):478-483.
[3] 易莎,张小斌,陈燕.103例慢性淋巴细胞白血病患者免疫表型的研究[J].临床血液学杂志,2010,23(2):86-88.
[4] DEMIR C,KARA E,EKINCI ?,et al.Clinical and laboratory features of CD5- negative chronic lymphocytic leukemia[J].Med Sci Monit ,2017,23:2137-2142.
[5] CARTRON G,LINASSIER C,BREMOND J L,et al.CD5 negative B-cell chronic lymphocytic leukemia:clinical and biological features of 42 cases[J].Leuk Lymphoma,1998,31(1-2):209-216.
[6] 许芳,程澍,翁香琴,等.112例CD5阳性与15例CD5阴性慢性淋巴细胞白血病的比较分析[J].中华血液学杂志,2008,29(2):134-135.
[7] CRESPO M,BOSCH F,VILLAMOR N,et al.ZAP-70 expression as a surrogate for immunoglobulin-variable-region mutations in chronic lymphocytic leukemia[J].N Engl J Med,2003,348(18):1764-1775.
[8] DURIG J,NUCKEL H,CREMER M,et al.ZAP-70 expression is a prognostic factor in chronic lymphocytic leukemia[J].Leukemia,2003,17(12):2426.
[9] 张之南,郝玉书,千建祥,等.血液病学[M].第2版.北京:人民卫生出版社,2011:749-751.
[10] SALOMON-NGUYEN F,VALENSI F,MERLE-BERAL H,et al.A scoring system for the classification of CD5-B CLL versus CD5+ B CLL and B PLL[J].Leuk Lymphoma,1995,16(5-6):445-450.
[11] EFSTATHIOU S,TSIOULOS D,ZADCHAROS I,et al.The prognostic role of CD5 negativity in B-cell chronic lymphocytic leukaemia:a case-control study[J].Haematologia,2002,32(3):209.
[12] HUANG J C,FINN W G,GOOLSBY C L,et al.CD5- small B-cell leukemias are rarely classifiable as chronic lymphocytic leukemia[J].Am J Clin Pathol,1999,111(1):123-130.
[13] OSCIER D G,MATUTES E,COPPLESTONE A,et al.Atypical lymphocyte morphology:an adverse prognostic factor for disease progression in stage A CLL independent of trisomy 12[J].Br J Haematol,2015,98(4):934-939.
[14] HALLEK M,CHESON B D,CATOVSKY D,et al.Guidelines for diagnosis,indications for treatment,response assessment and supportive management of chronic lymphocytic leukemia[J].Blood,2018,131(25):2745-2760.
[15] 刘伟,申徐良,史文芝,等.45例CLL染色体核型及免疫表型与预后关系探讨[J].中国卫生检验杂志,2010,20(12):3384-3386.