目的 分析CD20在成人急性B淋巴细胞白血病(B-ALL)患者中的表达及CD20阳性B-ALL患者的临床特点和预后.方法 回顾性分析郑州大学附属肿瘤医院血液科2007年5月至2011年7月收治的168例初治成人B-ALL患者,其中CD20阳性58例,阴性110例.对比分析两组患者的临床特点和生存情况.结果 CD20阳性与阴性组在性别、年龄分布及贫血、血小板减少、肝脾或淋巴结肿大、髓外浸润、Ph染色体阳性、髓系抗原表达、早期死亡、高危患者比例方面差异均无统计学意义(P值均> 0.05),CD20阳性组患者初诊时中位白细胞计数(19.2×10^9/L)和高白细胞计数患者比例(37.9%)明显高于CD20阴性组(6.93×10^9/L和20.9%),差异有统计学意义(P值均<0.05);两组诱导缓解治疗4周完全缓解率分别为78.6%和76.9%,差异无统计学意义(P>0.05),3年累积复发率分别为59.3%和42.5%,差异有统计学意义(P<0.05).多因素分析显示CD20 阳性是影响患者总生存(P=0.004)和疾病无进展生存(P=0.001)的独立预后不良因素 结论 CD20阳性表达与成人B-ALL患者外周血白细胞计数相关,且CD20阳性者预后不良.
Objective To explore the clinical and survival significance of CD20 positive adult patients with B-lineage acute lymphoblastic leukemia (B-ALL).Methods The clinical features and survival of 168 adult patients with B-ALL diagnosed and treated in our department from May 2007 to July 201 1 were analyzed retrospectively,58 expressed CD20 and 110 not.Results The sex,distribution of age,anemia,thrombocytopenia,infiltration of liver,spleen and lymph nodes,the expression of myeloid lineage marker,incidence of Ph chromosome,complete remission within 4 weeks showed no significant differences in CD20 positive and negative groups (P 〉 0.05); median white blood cell count at diagnosis and the rate of patients with high white blood cell count in CD20 positive group were 19.2 ×10^9/L and 37.9% respectively,which were significantly higher than those of 6.93 ×10^9/L and 20.9% in CD20 negative group (P 〈 0.05); cumulative incidence of relapse between two groups showed significant difference (P 〈 0.05); multivariable analysis for overall survival and progress-free survival identified CD20 positivity as independent predictor.Conclusion The expression of CD20 in adult patients with B-ALL appeared to be associated with high white blood cell count and poor prognosis.