CD20 is not a poor prognostic factor for childhood B-lineage acute lymphoblastic leukemia with high white blood cell count
ZHANG Lu-Yang, CHEN Xiao-Juan, WANG Shu-Chun, GUO Ye, YANG Wen-Yu, CHEN Yu-Mei, ZHANG Li, ZOU Yao, ZHU Xiao-Fan
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology&Blood Disease Hospital, Chinese Academy of Medical Sciences&Peking Union Medical College, Tianjin 300020, China
Abstract Objective To study the significance of CD20 combined with white blood cell (WBC) count at diagnosis in the prognosis assessment in children with B-lineage acute lymphoblastic leukemia (ALL). Methods A retrospective analysis was performed on the medical data of 821 B-ALL children who were treated with CCLG-ALL2008 regimen from April 2008 to April 2015. Their survival status was followed up. Results Among the 821 children, 547 (66.6%) were negative, while 274 (33.4%) were positive for CD20 expression. Among 694 children with WBC < 50×109/L (lower WBC count), the 5-year EFS rates were 65.9%±3.2% and 77.3%±2.0% for CD20 positive and negative patients respectively (P=0.001); the 5-year OS rates were 78.3%±2.9% and 87.5%±1.6% for CD20 positive and negative patients respectively (P=0.005); CD20 positive expression was an independent risk factor for EFS (HR=1.634, P=0.001) and OS (HR=1.761, P=0.005). Among 127 children with WBC > 50×109/L (higher WBC count), the 5-year EFS rates was 64.3%±7.7% and 53.7%±5.5% for CD20 positive and negative patients respectively (P=0.135); the 5-year OS rate was 81.4%±6.4% and 58.6%±5.6% for CD20 positive and negative patients respectively (P=0.022); CD20 positive expression was an independent protective factor for OS (HR=0.367, P=0.016). Conclusions In children with B-ALL who are treated with CCLG-ALL2008 regimen, those with CD20 positive expression in lower WBC count at diagnosis have a poor prognosis; however, those with CD20 positive expression in higher WBC count at diagnosis have a better long-time survival.
ZHANG Lu-Yang,CHEN Xiao-Juan,WANG Shu-Chun et al. CD20 is not a poor prognostic factor for childhood B-lineage acute lymphoblastic leukemia with high white blood cell count[J]. CJCP, 2020, 22(7): 728-733.
ZHANG Lu-Yang,CHEN Xiao-Juan,WANG Shu-Chun et al. CD20 is not a poor prognostic factor for childhood B-lineage acute lymphoblastic leukemia with high white blood cell count[J]. CJCP, 2020, 22(7): 728-733.
Chang H, Jiang A, Brandwein J. Prognostic relevance of CD20 in adult B-cell precursor acute lymphoblastic leukemia[J]. Haematologica, 2010, 95(6):1040-1042.
[3]
Isshiki Y, Ohwada C, Sakaida E, et al. CD20 positivity and white blood cell count predict treatment outcomes in Philadelphia chromosome-negative acute lymphoblastic leukemia patients ineligible for pediatric-inspired chemotherapy[J]. Jpn J Clin Oncol, 2017, 47(11):1047-1054.
[4]
Jeha S, Behm F, Pei D, et al. Prognostic significance of CD20 expression in childhood B-cell precursor acute lymphoblastic leukemia[J]. Blood, 2006, 108(10):3302-3304.
[5]
Maury S, Huguet F, Leguay T, et al. Adverse prognostic significance of CD20 expression in adults with Philadelphia chromosome-negative B-cell precursor acute lymphoblastic leukemia[J]. Haematologica, 2010, 95(2):324-328.
[6]
Thomas DA, O'Brien S, Jorgensen JL, et al. Prognostic significance of CD20 expression in adults with de novo precursor B-lineage acute lymphoblastic leukemia[J]. Blood, 2009, 113(25):6330-6337.
[7]
Yang S, Wang J, Zhao T, et al. CD20 expression sub-stratifies standard-risk patients with B cell precursor acute lymphoblastic leukemia[J]. Oncotarget, 2017, 8(62):105397-105406.
[8]
Borowitz MJ, Shuster J, Carroll AJ, et al. Prognostic significance of fluorescence intensity of surface marker expression in childhood B-precursor acute lymphoblastic leukemia. A Pediatric Oncology Group study[J]. Blood, 1997, 89(11):3960-3966.
[9]
Esteban RE, Christianne B, Alvaro A, et al. Prognostic effect of CD20 expression in adult B-cell acute lymphoblastic leukemia[J]. Clin Lymphoma Myeloma Leuk, 2018, 18(5):361-367.
[10]
Mannelli F, Gianfaldoni G, Intermesoli T, et al. CD20 expression has no prognostic role in Philadelphia-negative B-precursor acute lymphoblastic leukemia:new insights from the molecular study of minimal residual disease[J]. Haematologica, 2012, 97(4):568-571.
[11]
Solano-Genesta M, Tarín-Arzaga L, Velasco-Ruiz I, et al. CD20 expression in B-cell precursor acute lymphoblastic leukemia is common in Mexican patients and lacks a prognostic value[J]. Hematology, 2012, 17(2):66-70.
Kim DY, Park HS, Choi EJ, et al. Immunophenotypic markers in adult acute lymphoblastic leukemia:the prognostic significance of CD20 and TdT expression[J]. Blood Res, 2015, 50(4):227-234.
Kawabata KC, Ehata S, Komuro A, et al. TGF-β-induced apoptosis of B-cell lymphoma ramos cells through reduction of MS4A1/CD20[J]. Oncogene, 2013, 32(16):2096-2106.
Dworzak MN, Schumich A, Printz D, et al. CD20 up-regulation in pediatric B-cell precursor acute lymphoblastic leukemia during induction treatment:setting the stage for anti-CD20 directed immunotherapy[J]. Blood, 2008, 112(10):3982-3988.
[21]
Dworzak MN, Gaipa G, Schumich A, et al. Modulation of antigen expression in B-cell precursor acute lymphoblastic leukemia during induction therapy is partly transient:evidence for a drug-induced regulatory phenomenon. Results of the AIEOP-BFM-ALL-FLOW-MRD-Study Group[J]. Cytometry B Clin Cytom, 2010, 78(3):147-153.
