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The expression of the pluripotent stem cell antigen CD34 was evaluated at diagnosis in forty-five adult patients with de novo ALL. Comparison of clinical and hematological features between CD34 positive (24/45) and CD34 negative (21/45) patients showed that the former were of older age, had more pronounced lymphoid organ involvement and higher serum LDH levels. Immunophenotypic analysis of marrow blast cells revealed a significant predominance of the 'null' phenotype in the CD34 positive group, together with a strong expression of the VLA-4 and VLA-5 integrins (fibronectin receptors). CD34 positive ALL were also more frequently associated with either aberrant myeloid-related antigens (CD13, CD33) or the P-gp/MDR-1 phenotype. Only 11 out of 24 (45%) CD34 positive patients achieved complete remission after induction chemotherapy, compared to 20/21 (95%) CD34 negative cases. Furthermore, survival was significantly shorter in the CD34 positive group (6.6 mo. vs 13.5 mo.). These results suggest that in ALL, as in AML, CD34 positivity may predict a poor prognosis.
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