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Expression of CD56 is an unfavorable prognostic factor for acute promyelocytic leukemia with higher initial white blood cell counts.

Ono T, Takeshita A, Kishimoto Y, Kiyoi H, Okada M, Yamauchi T, Emi N, Horikawa K, Matsuda M, Shinagawa K, Monma F, Ohtake S, Nakaseko C, Takahashi M, Kimura Y, Iwanaga M, Asou N, Naoe T, Japan Adult Leukemia Study Gro - Cancer Sci. (2014)

Bottom Line: Positive CD56 expression was found in 23 APL patients (9.6%).Expression of CD56 was significantly associated with lower platelet count (P = 0.04), severe disseminated intravascular coagulation (P = 0.04), and coexpression of CD2 (P = 0.03), CD7 (P = 0.04), CD34 (P < 0.01) and/or human leukocyte antigen-DR (P < 0.01).In conclusion, for APL with higher initial white blood cell counts, CD56 expression should be regarded as an unfavorable prognostic factor.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, School of Medicine, Hamamatsu University, Hamamatsu, Japan.

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Cumulative incidence of relapse (CIR) of patients with acute promylocytic leukemia (APL) according to CD56 expression. (a) CIR for all patients showed an inferior trend in the CD56+ APL group (39.1% vs 24.3% at 9 years, P = 0.08). (b) In patients whose white blood cell (WBC) count was ≥3.0 × 109/L, CIR for the CD56+ group was significantly higher compared to that for the CD56− APL group (53.8% vs 28.9%, P = 0.03).
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fig03: Cumulative incidence of relapse (CIR) of patients with acute promylocytic leukemia (APL) according to CD56 expression. (a) CIR for all patients showed an inferior trend in the CD56+ APL group (39.1% vs 24.3% at 9 years, P = 0.08). (b) In patients whose white blood cell (WBC) count was ≥3.0 × 109/L, CIR for the CD56+ group was significantly higher compared to that for the CD56− APL group (53.8% vs 28.9%, P = 0.03).

Mentions: Overall survival was not different between the two groups (73.9% vs 79.2%, P = 0.52, at 9 years; Fig.1a), whereas EFS and CIR tended to be inferior in CD56+ APL (47.8% vs 64.8%, P = 0.08, and 39.1% vs 24.3%, P = 0.08, at 9 years, respectively; Figs2a,3a). In patients with initial WBC counts ≥3.0 × 109/L, EFS and CIR for 11 CD56+APL patients were significantly inferior to those for 87 CD56− APL patients (30.8% vs 63.6%, P = 0.008, and 53.8% vs 28.9%, P = 0.03, at 9 years, respectively; Figs2b,3b). In patients with initial WBC counts <3.0 × 109/L, EFS and CIR were not different between the two groups (P = 0.99 and P = 0.98, at 9 years, respectively). The OS in patients with initial WBC counts ≥3.0 × 109/L was similar between the two groups (61.5% vs 78.8%, P = 0.13, at 9 years; Fig.1b). Although the number was small, EFS and CIR for five CD56+ APL patients among those with initial WBC counts of ≥10 × 109/L were inferior to those for 41 CD56− APL patients (20.0% vs 60.9%, P = 0.03, and 60.0% vs 30.7%, P = 0.09, at 9 years, respectively). Cumulative incidence of extramedullary relapse tended to be more frequent in patients with CD56+ APL whose initial WBC counts were ≥3.0 × 109/L (9.3% vs 1.1%, at 9 years, P = 0.07). We also analyzed the influence of CD56 expression on clinical outcomes according to Sanz's relapse risk score.7 Both CIR and EFS in patients with CD56+ APL were inferior in the high risk group (60.0% vs 31.4%, P = 0.09 and 20.0% vs 62.5%, P = 0.02, respectively), but not in low and intermediate risk groups (P = 0.17 and P = 0.55, respectively).


Expression of CD56 is an unfavorable prognostic factor for acute promyelocytic leukemia with higher initial white blood cell counts.

Ono T, Takeshita A, Kishimoto Y, Kiyoi H, Okada M, Yamauchi T, Emi N, Horikawa K, Matsuda M, Shinagawa K, Monma F, Ohtake S, Nakaseko C, Takahashi M, Kimura Y, Iwanaga M, Asou N, Naoe T, Japan Adult Leukemia Study Gro - Cancer Sci. (2014)

Cumulative incidence of relapse (CIR) of patients with acute promylocytic leukemia (APL) according to CD56 expression. (a) CIR for all patients showed an inferior trend in the CD56+ APL group (39.1% vs 24.3% at 9 years, P = 0.08). (b) In patients whose white blood cell (WBC) count was ≥3.0 × 109/L, CIR for the CD56+ group was significantly higher compared to that for the CD56− APL group (53.8% vs 28.9%, P = 0.03).
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fig03: Cumulative incidence of relapse (CIR) of patients with acute promylocytic leukemia (APL) according to CD56 expression. (a) CIR for all patients showed an inferior trend in the CD56+ APL group (39.1% vs 24.3% at 9 years, P = 0.08). (b) In patients whose white blood cell (WBC) count was ≥3.0 × 109/L, CIR for the CD56+ group was significantly higher compared to that for the CD56− APL group (53.8% vs 28.9%, P = 0.03).
Mentions: Overall survival was not different between the two groups (73.9% vs 79.2%, P = 0.52, at 9 years; Fig.1a), whereas EFS and CIR tended to be inferior in CD56+ APL (47.8% vs 64.8%, P = 0.08, and 39.1% vs 24.3%, P = 0.08, at 9 years, respectively; Figs2a,3a). In patients with initial WBC counts ≥3.0 × 109/L, EFS and CIR for 11 CD56+APL patients were significantly inferior to those for 87 CD56− APL patients (30.8% vs 63.6%, P = 0.008, and 53.8% vs 28.9%, P = 0.03, at 9 years, respectively; Figs2b,3b). In patients with initial WBC counts <3.0 × 109/L, EFS and CIR were not different between the two groups (P = 0.99 and P = 0.98, at 9 years, respectively). The OS in patients with initial WBC counts ≥3.0 × 109/L was similar between the two groups (61.5% vs 78.8%, P = 0.13, at 9 years; Fig.1b). Although the number was small, EFS and CIR for five CD56+ APL patients among those with initial WBC counts of ≥10 × 109/L were inferior to those for 41 CD56− APL patients (20.0% vs 60.9%, P = 0.03, and 60.0% vs 30.7%, P = 0.09, at 9 years, respectively). Cumulative incidence of extramedullary relapse tended to be more frequent in patients with CD56+ APL whose initial WBC counts were ≥3.0 × 109/L (9.3% vs 1.1%, at 9 years, P = 0.07). We also analyzed the influence of CD56 expression on clinical outcomes according to Sanz's relapse risk score.7 Both CIR and EFS in patients with CD56+ APL were inferior in the high risk group (60.0% vs 31.4%, P = 0.09 and 20.0% vs 62.5%, P = 0.02, respectively), but not in low and intermediate risk groups (P = 0.17 and P = 0.55, respectively).

Bottom Line: Positive CD56 expression was found in 23 APL patients (9.6%).Expression of CD56 was significantly associated with lower platelet count (P = 0.04), severe disseminated intravascular coagulation (P = 0.04), and coexpression of CD2 (P = 0.03), CD7 (P = 0.04), CD34 (P < 0.01) and/or human leukocyte antigen-DR (P < 0.01).In conclusion, for APL with higher initial white blood cell counts, CD56 expression should be regarded as an unfavorable prognostic factor.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, School of Medicine, Hamamatsu University, Hamamatsu, Japan.

Show MeSH
Related in: MedlinePlus