Prognostic Value of CD95, Active Caspase-3, and Bcl-2 Expression in Adult Patients with De Novo Acute Lymphoblastic Leukemia

Background: Acute lymphoblastic leukemia is an aggressive malignant disease with high mortality rates in adults. Aim of the study: The expression levels of CD95, active caspase-3, and Bcl-2 were determined in 111 patients with de novo acute lymphoblastic leukemia (ALL) and correlated with overall survival (OS) and disease-free survival (DFS). Methods: The immunophenotyped ok leukemia and the expression of CD95, active caspase-3, and Bcl-2, were determined by flow cytometry. Apoptotic variables were correlated by Spearman test, and survival by Kaplan-Meier method. Log-rank test was used to compare survival curves. Results: From a total of 111 patients, 56 cases were B-ALL, 16 T-ALL, 16 B-ALL/CD33⁺, and 23 ambiguous lineage-AL (AmbLin-AL). The median expression of CD95 (61.5%) and active-caspase-3 (19.4%) was higher in T-ALL (p <0.05), whereas Bcl-2 was lower in T-ALL (p <0.038). There was a highly significant correlation in B-ALL, B-ALL/CD33⁺ and AmbLin-AL between CD95 and Bcl-2, CD95-Active caspase-3, and Bcl-2-Active caspase-3; while in T-ALL, there was only a correlation between CD95-Active caspase-3, and Bcl-2-Active caspase-3. OS and DFS were better for T-ALL than the other groups, especially in patients having higher values of CD95 and active caspase 3, and lower values of Bcl-2. The worse survival rates were observed in patients with B-ALL/CD33⁺, and AmbLin-AL. Conclusions: The prognosis of ALL in adults is influenced by the expression levels of Bcl-2, active-caspase-3, and CD95.