Impact of CD56 Continuously Recognizable as Prognostic Value of Acute Promyelocytic Leukemia: Results of Multivariate Analyses in the Japan Adult Leukemia Study Group (JALSG)-APL204 Study and a Review of the Literature

Abstract

Background: After long-term analysis of the JALSG-APL204 study we recently reported that maintenance therapy with tamibarotene was more effective than all-trans retinoic acid (ATRA) by reducing relapse in APL patients. Here, the clinical significance of other important prognostic factors was evaluated with multivariate analyses. Patients and Methods: Newly diagnosed acute promyelocytic leukemia (APL) patients were registered with the study. Induction was composed of ATRA and chemotherapy. Patients who achieved molecular remission after consolidation were randomly assigned to maintenance with tamibarotene or ATRA. Results: Of the 344 eligible patients, 319 (93%) achieved complete remission (CR). After completing consolidation, 269 patients underwent maintenance random assignment—135 to ATRA, and 134 to tamibarotene. By multivariate analysis, overexpression of CD56 in blast was an independent unfavorable prognostic factor for relapse-free survival (RFS) (p = 0.006) together with more than 10.0 × 109/L WBC counts (p = 0.001) and the ATRA arm in maintenance (p = 0.028). Of all phenotypes, CD56 was related most clearly to an unfavorable prognosis. The CR rate, mortality rate during induction and overall survival of CD56+ APL were not significantly different compared with CD56− APL. CD56 is continuously an independent unfavorable prognostic factor for RFS in APL patients treated with ATRA and chemotherapy followed by ATRA or tamibarotene maintenance therapy.

The diagnostic power of CD117, CD13, CD56, CD64, and MPO in rapid screening acute promyelocytic leukemia

“…2 ), which was just mentioned as a low expression marker in the disease compared to other types of AML [ 11 , 13 , 14 , 16 – 20 ]. Clinically, patients without CD56 expression have a better prognosis compared to others when treated with the ATRA agent [ 27 – 32 ]. Based on this benefit of prognostics and the diagnostic power of the model (Fig.…”

Acute Promyelocytic Leukemia

“…However, these observations have not received approval to amend the standard therapy for APL. In an original article of this special issue on APL, the Japan Adult Leukemia Study Group (JALSG) analyzed the data of the 344 patients enrolled in the APL204 trial prospectively treated with ATRA combined with chemotherapy, followed by maintenance therapy using ATRA or tamibarotene, in order to identify important prognostic factors [ 6 ]. In multivariate analyses, overexpression of CD56 in blast appeared as an independent unfavorable prognostic factor for relapse-free survival.…”