Higher Level of Peripheral Blood CD34 Positive Cells Presented with Unfavorable Prognosis in Intermediate-Low Risk Acute
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ORIGINAL ARTICLE
Higher Level of Peripheral Blood CD34 Positive Cells Presented with Unfavorable Prognosis in Intermediate-Low Risk Acute Promyelocytic Leukemia Cuiling Zhang1 • Haibo Dong1 • Yipeng Lin1 • Peipei Xu1 • Rongfu Zhou1 Hui Zeng1,2
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Received: 28 July 2019 / Accepted: 15 November 2019 Ó Indian Society of Hematology and Blood Transfusion 2019
Abstract Our previous work has demonstrated that some acute promyelocytic leukemia (APL) patients had significantly elevated circulating CD34? cell count (C 10 9 106/L), and these patients with higher CD34? cell level usually presented with high-risk disease (WBC [ 10,000/lL). The aim of this study was to investigate whether circulating CD34? cell count is a prognostic marker in intermediate-low risk APL patients. In this study, 76 intermediate-low risk APL patients and 56 age-adjusted healthy volunteers were evaluated. Enumeration of CD34? cells was investigated before the treatment. A cut-off value of 10 9 106/L CD34? cells could just distinguish APL patients with adverse prognostic factors from others and may have the power to predict shorter progression-free survival (PFS) and poor prognosis. Higher count of CD34? cells was usually associated with nonclassical chromosomal translocation, PML/RARa gene complex fusion, APL history, chemotherapy-related APL, disease progression, second tumor, extramedullary infiltration, FLT3-ITD positive mutation, atypical morphology, BM promyelocyte CD56/CD34 positive expression, myelofibrosis, PCR-positive PML/RARa gene fusion but FISH-negative, marrow necrosis and shorter PFS. Our results suggest that the level of CD34? cells can be further the stratification of disease Cuiling Zhang and Haibo Dong are co-first author. & Hui Zeng [email protected] 1
Department of Hematology, Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing 210093, People’s Republic of China
2
Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, People’s Republic of China
risk, a higher CD34? cell count may be indicative of inferior survival and serve as an adverse biomarker for intermediate-low risk APL. Keywords Circulating CD34? cell count Peripheral blood Acute promyelocytic leukemia Prognostic factor Progression-free survival Abbreviations APL Acute promyelocytic leukemia PFS Progression-free survival OS Overall survival ATRA All-transretinoic acid CR Complete remission
Introduction Acute promyelocytic leukemia (APL) is a subtype of myeloid leukemia which is characterized by leukemic cells blocked at the promyelocytic stage of granulocytic differentiation and is associated with the presence of balanced t(15;17) and PML/RARa fusion transcripts [1]. CD34 antigen is transmembrane glycophosphoprotein expressed on early hematopoietic cells [2]. In steady state, there is little exchange of hematopoietic stem cells from the marrow through the blood and into the marrow under basal conditions, while many factors can facilitate bone marrow CD34? cells influx into peri
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