Prognostic significance of peanut agglutinin binding in childhood acute lymphoblastic leukemia.
We previously reported the favorable prognosis associated with positive peanut agglutinin (PNA) binding in childhood T cell acute lymphoblastic leukemia (ALL), and hypothesized that this may be related to glucocorticoid sensitivity (Veerman et al. Cancer Res 1985, 45: 1890). The purposes of this prospective study involving 202 children with newly diagnosed ALL were to determine the relationship between PNA binding and (1) immunophenotype; (2) in vitro resistance to prednisolone (PRD) and dexamethasone and other drugs; (3) clinical response to a systemic PRD monotherapy (plus one intrathecal injection with methotrexate); and (4) multidrug chemotherapy. PNA positivity was more frequent in T cell ALL (65% of 43 cases) than in pro-B (0% of seven cases), common (17% of 106 cases) and pre-B (16% of 45 cases) ALL (P < 0.001). PNA binding was not associated with in vitro resistance to PRD or dexamethasone. However, in 38 evaluable T cell ALL patients, nine of 13 PNA-negative cases were clinically poor responders to PRD, while all 25 PNA-positive cases were good responders to PRD clinically (P < 0.0001). The four clinically poor PRD responders with B cell precursor (BCP)-ALL were also PNA negative. Within T cell ALL, PNA-positive patients had a 3.4-fold (95% Cl, 1.1-10.4, P = 0.03) lower relative risk of any event, than PNA-negative patients. Within BCP-ALL, PNA binding was not of prognostic significance. In conclusion, PNA positivity, especially frequent in T cell ALL, is a marker for a subgroup of childhood ALL patients who are very likely to respond well to systemic PRD 'monotherapy'. In addition, PNA positivity is a favorable prognostic factor in T cell ALL.
Kaspers
G J
GJ
Department of Pediatrics, Free University Hospital, Amsterdam, The Netherlands.
Veerman
A J
AJ
Van Wering
E R
ER
Van Der Linden-Schrever
B E
BE
Van Zantwijk
C H
CH
Van Der Does-Van Den Berg
A
A
Pieters
R
R
D000293:Adolescent; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D010367:Arachis; D001853:Bone Marrow / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000627:therapeutic use; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D007223:Infant; D007278:Injections, Spinal; D037102:Lectins; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000097:blood / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use; D019887:Peanut Agglutinin; D037121:Plant Lectins; D011237:Predictive Value of Tests; D011239:Prednisolone / Q000627:therapeutic use*; D011336:Probability; D011379:Prognosis; D012307:Risk Factors; D014407:Tumor Cells, Cultured
D018931:Antineoplastic Agents, Hormonal; D037102:Lectins; D019887:Peanut Agglutinin; D037121:Plant Lectins; D003907:Dexamethasone; D011239:Prednisolone; D008727:Methotrexate