Prognostic significance of surface marker analysis in childhood non-hodgkin's lymphoproliferative malignancies

Abstract

Blast cell surface markers for T- and B-lymphocyte characteristics were studied at diagnosis in 73 children with non-Hodgkin's lymphoproliferative malignancies. Three distinctive groups of patients were identified on the basis of the analysis of blast cells for surface immunoglobulin (SIg), sheep erythrocyte (sE) rosette formation, and complement receptors. The seven group I patients had monoclonal IgM on their blast cells, morphologic features of Burkitt's lymphoma, abdominal masses, and very short survival. The 13 group II patients had receptors for sE, complement, or both on their blast cells, mediastinal or nodal masses, and short survival. The distinction between leukemia and lymphoma based on the presence of bone marrow involvement at diagnosis is not prognostically useful in this group of patients. The blast cells of group II patients could not be morphologically distinguished from those of the group III patients. The 53 group III patients had SIg, sE, and complement negative blast cells and could be further subdivided on the basis of white blood cell count. The nine group III_A patients (> 100.0 × 10⁹/liter) had in general short survival, while most of the 44 group III_B patients (< 100.0 × 10⁹/liter) have remained in complete remission. Positive surface markers, mass lesions, male sex, and age of diagnosis < 2 years or ≧ 10 years appear to be interrelated factors indicating poor prognosis. Elevated white blood cell count is a prognostic indicator independent of surface marker analysis or presence of mass lesions.