Blood.
2009 Jun 18;113(25):6330-7. Epub 2008 Aug 14.
Prognostic
significance of CD20 expression in adults with de
novo precursor B-lineage acute lymphoblastic
leukemia.
Thomas DA, O'Brien S, Jorgensen JL, Cortes J, Faderl
S, Garcia-Manero G, Verstovsek S, Koller C, Pierce
S, Huh Y, Wierda W, Keating MJ, Kantarjian HM.
Department of Leukemia, University of Texas M. D.
Anderson Cancer Center, Houston, 77030, USA.
debthomas@mdanderson.org
Immunophenotypic classification of acute
lymphoblastic leukemia (ALL) has well-recognized
prognostic implications. The significance of
CD20 expression has been evaluated in childhood
precursor B-lineage ALL with conflicting
results. We retrospectively analyzed the
influence of CD20 expression on outcome in 253
adults with de novo precursor B-lineage ALL
treated with either conventional (VAD/CVAD) or
intensive (hyper-CVAD) frontline chemotherapy
regimens in the pre-rituximab era. Overall, CD20
positivity of at least 20% was associated with
lower 3-year rates of complete remission
duration (CRD; 20% vs 55%, P < .001) and overall
survival (OS; 27% vs 40%, p = .03). In the CD20
negative subset, the 3-year rates for CRD (58%
vs 42%, p = .04) and OS (60% vs 28%, P < .001)
were superior for hyper-CVAD compared with VAD/CVAD;
rates were particularly favorable for the CD20
negative younger age group (68% and 85%,
respectively). In contrast, 3-year CRD and OS
rates were uniformly poor for the CD20-positive
group regardless of therapy (27% or less).
Multivariate analysis for event-free survival
identified older age, leukocyte count higher
than 30 x 10(9)/L, presence of Philadelphia
chromosome, high systemic risk classification,
and CD20 positivity as independent predictors of
worse outcome. In conclusion, CD20 expression in
de novo adult precursor B-lineage ALL appears to
be associated with a poor prognosis.
Incorporation of monoclonal antibodies directed
against CD20 into frontline chemotherapy
regimens warrants investigation.
PMID: 18703706 [PubMed - indexed for
MEDLINE]