Prognostic significance of CD20 expression in adults with de novo precursor B-lineage acute lymphoblastic leukemia

Deborah A. Thomas, Susan O'Brien, Jeffrey L. Jorgensen, Jorge Cortes, Stefan Faderl, Guillermo Garcia-Manero, Srdan Verstovsek, Charles Koller, Sherry Pierce, Yang Huh, William Wierda, Michael J. Keating, Hagop M. Kantarjian

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107 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)6330-6337
Number of pages8
JournalBlood
Volume113
Issue number25
DOIs
StatePublished - 2009

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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    Thomas, D. A., O'Brien, S., Jorgensen, J. L., Cortes, J., Faderl, S., Garcia-Manero, G., Verstovsek, S., Koller, C., Pierce, S., Huh, Y., Wierda, W., Keating, M. J., & Kantarjian, H. M. (2009). Prognostic significance of CD20 expression in adults with de novo precursor B-lineage acute lymphoblastic leukemia. Blood, 113(25), 6330-6337. https://doi.org/10.1182/blood-2008-04-151860