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Expression of CD 4 is correlated with an unfavorable prognosis in wild‐type NPM 1, FLT 3‐ ITD ‐negative cytogenetically normal adult acute myeloid leukemia
Author(s) -
Guo R. J.,
Atenafu E. G.,
Schimmer A. D.,
Minden M. D.,
Chang H.
Publication year - 2017
Publication title -
international journal of laboratory hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.705
H-Index - 55
eISSN - 1751-553X
pISSN - 1751-5521
DOI - 10.1111/ijlh.12649
Subject(s) - npm1 , medicine , cd34 , oncology , population , hematopoietic stem cell transplantation , clinical significance , myeloid leukemia , gastroenterology , karyotype , stem cell , immunology , biology , transplantation , gene , genetics , environmental health , chromosome
Summary Introduction In the cytogenetically normal population of AML ( CN ‐ AML ), FLT 3‐ ITD ‐positive and wild‐type NPM 1 is correlated with a worse outcome, and FLT 3‐ ITD ‐negative with NPM 1‐mut is correlated with a better outcome. This leaves a large subpopulation of CN ‐ AML patients without NPM 1 or FLT 3‐ ITD mutations with heterogeneous outcomes with overall survivals (OS) ranging from several weeks to years. Therefore, new prognostic markers are needed to better risk stratify this subset of patients. Methods The retrospective study included 60 de novo adult AML patients diagnosed at our institution with normal karyotype, no FLT 3‐ ITD or NPM 1 mutations, and who did not receive allogeneic hematopoietic stem cell transplantations. We investigated the prognostic significance of immunophenotypic markers and clinical laboratory features in this double‐negative population. Results Older age (>60) and CD 4 expression (14%) were significantly correlated with shorter event‐free survival ( EFS ) ( P < 0.001, P = 0.016, respectively). Expression of CD 56 (12%), as well as lack of CD 34 expression (19% of the cases), was also associated with a worse EFS ( P = 0.048, P = 0.028, respectively). On multivariable analysis, CD 4 expression and old age (>60) were identified as independent predictors for worse EFS ( P = 0.016; P = 0.001, respectively) and OS ( P = 0.048; P = 0.028, respectively). Conclusions Our results indicate that CD 4 expression and older age are adverse prognostic factors in wild‐type NPM 1, FLT 3‐ ITD ‐negative CN ‐ AML .