Relationship between cleaved L-selectin levels and the outcome of acute myeloid leukemia.
High plasma levels of the shed form of L-selectin (sL-selectin) are frequently detectable in acute myeloid leukemia (AML). sL-selectin can inhibit blast cell adhesion to vascular endothelium and may thereby influence the phenotype of AML. In this study, we have investigated the relationship between sL-selectin levels and clinical presentation or disease outcome in 100 patients with AML. Fifty-eight patients were found to have sL-selectin levels >/=3.12 microgram/mL (>/=3 SD above the mean of healthy controls: "increased"). Patients with extramedullary disease such as lymphadenopathies, splenomegaly, hepatomegaly, and/or muco-cutaneous infiltration had significantly increased sL-selectin levels (P < .001). sL-selectin levels were significantly heterogeneous in the French-American-British subtypes (P = .0003). Patients with "normal" sL-selectin levels had higher probability of achieving complete remission (CR) than with "increased" levels: 81% versus 64%, respectively (P = .06). When adjusting for clinically relevant covariates predictive for CR (sex, age, Auer rods), "normal" sL-selectin levels were significantly associated with CR (odds ratio, 3.08; 95% confidence interval [CI], 1.10 to 8.58; P = .03). Moreover, patients with "increased" sL-selectin levels (>/=3.12 microgram/mL) had shorter event-free survival (EFS) (median 7.3 v 12 months, P = .008) and overall survival (median 1 v 2.05 years, P = .03) than patients with sL-selectin <3.12 microgram/mL. Multivariate statistical analysis (adjusted for age and presence of Auer rods) indicated that sL-selectin was an independent prognostic factor for EFS (hazard ratio [HR], 1.96; 95% CI, 1.21 to 3.17, P = .006) and overall survival (HR, 1.80; 95% CI, 1.09 to 2.98; P = .02). Thus, plasma sL-selectin may be a useful prognostic marker in the evaluation of AML at diagnosis.
Extermann
M
M
Division of Hematology, Centre Hospitalier Universitaire Vaudois, Lausanne; SIAK Coordinating Center, Bern; Swiss Red Cross Blood Center, Kantonsspital, St Gallen; Institute of Medical Oncology, Inselspital and University of Bern, Switzerland.
Bacchi
M
M
Monai
N
N
Fopp
M
M
Fey
M
M
Tichelli
A
A
Schapira
M
M
Spertini
O
O
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D002479:Inclusion Bodies; D019041:L-Selectin / Q000097:blood* / Q000737:chemistry; D007951:Leukemia, Myeloid / Q000097:blood* / Q000401:mortality / Q000473:pathology; D017254:Leukemic Infiltration; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000097:blood* / Q000737:chemistry; D014411:Neoplastic Stem Cells / Q000737:chemistry / Q000648:ultrastructure; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011499:Protein Processing, Post-Translational; D016019:Survival Analysis
D009363:Neoplasm Proteins; D019041:L-Selectin