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 fr equently detectable in acute myeloid leukemia (AML). sl-selectin can i nhibit blast cell adhesion to vascular endothelium and may thereby inf luence the phenotype of AML. In this study, we have investigated the r elationship between sL-selectin levels and clinical presentation or di sease outcome in 100 patients with AML. Fifty-eight patients were foun d to have sl-selectin levels greater than or equal to 3.12 mu g/mL (3 greater than or equal to SD above the mean of healthy controls: ''incr eased''). Patients with extramedullary disease such as lymphadenopathi es, splenomegaly, hepatomegaly, and/or muco-cutaneous infiltration had significantly increased sl-selectin levels (P < .001). sl-selectin le vels were significantly heterogeneous in the French-American-British s ubtypes (P = .0003). Patients with ''normal'' sl-selectin levels had h igher probability of achieving complete remission (CR) than with ''inc reased'' levels: 81% versus 64%, respectively (P = .06). When adjustin g for clinically relevant covariates predictive for CR (sex, age, Auer rods), ''normal'' sl-selectin levels were significantly associated wi th CR (odds ratio, 3.08; 95% confidence interval [CI], 1.10 to 8.58; P = .03). Moreover, patients with ''increased'' sl-selectin levels (gre ater than or equal to 3.12 mu g/mL) had shorter event-free survival (E FS) (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 (mu g/mL. Multivariate statistical analysis (adjusted for age and presence of Au er rods) indicated that sl-selectin was an independent prognostic fact or for EFS (hazard ratio [HR], 1.96; 95% CI, 1.21 to 3.17, P = .006) a nd overall survival (HR, 1.80; 95% CI, 1.09 to 2.98; P = .02). Thus, p lasma sl-selectin may be a useful prognostic marker in the evaluation of AML at diagnosis. (C) 1998 by The American Society of Hematology.