Published online Dec 26, 2017. doi: 10.4252/wjsc.v9.i12.227
Peer-review started: February 13, 2017
First decision: May 10, 2017
Revised: October 17, 2017
Accepted: November 8, 2017
Article in press: November 8, 2017
Published online: December 26, 2017
To evaluate the importance of the CD34+CD38- cell population when compared to the CD34+CD38+/low and CD34+CD38+/high leukemic cell sub-populations and to determine its correlations with leukemia characteristics and known prognostic factors, as well as with response to therapy and survival.
Two hundred bone marrow samples were obtained at diagnosis from 200 consecutive patients with newly diagnosed acute myeloid leukemia (AML) were studied between September 2008 and December 2010 at our Institution (Hematology Department, Lyon, France). The CD34/CD38 cell profile was analyzed by multiparameter flowcytometry approach using 8C panels and FACS CANTO and Diva software (BD Bioscience).
We analyzed CD34 and CD38 expression in bone marrow samples of 200 AML patients at diagnosis, and investigated the prognostic value of the most immature CD34+CD38- population. Using a cut-off value of 1% of CD34+CD38- from total “bulk leukemic cells” we found that a high (> 1%) level of CD34+CD38- blasts at diagnosis was correlated with advanced age, adverse cytogenetics as well as with a lower rate of complete response after induction and shorter disease-free survival. In a multivariate analysis considering age, leukocytosis, the % of CD34+ blasts cells and the standardized cytogenetic and molecular risk subgroups, a percentage of CD34+CD38- leukemic cells > 1% was an independent predictor of DFS [HR = 2.8 (1.02-7.73), P = 0.04] and OS [HR = 2.65 (1.09-6.43), P = 0.03].
Taken together, these results show that a CD34/CD38 “backbone” for leukemic cell analysis by multicolour flowcytometry at diagnosis provides useful prognostic information.
Core tip: We analyzed the bone marrow samples of 200 acute myeloid leukemia (AML) patients at diagnosis by multicolour flow cytometry and investigated the prognostic value of the most immature CD34+CD38- population. We showed that a higher then > % level of CD34+CD38- blasts at diagnosis was an independent predictor of disease free survival (DFS) and overall survival in a multivariate analysis considering age, leukocytosis, the % of CD34+ blasts cells, cytogenetic and molecular risk subgroups. Despite heterogeneity and complexity of AML leukemia stem cells, we could still use CD34+CD38- quantification at diagnosis as useful complementary prognostic parameter for risk-stratification AML patients in future clinical trials.