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[Phenotypic changes in refractory and relapse acute lymphoblastic leukemias].

E Gómez1, J F San Miguel, M González

  • 1Servicio de Hematología, Hospital Clínico, Salamanca.

Sangre
|June 1, 1991
PubMed
Summary

Phenotypic changes in acute lymphoblastic leukemia (ALL) are common during relapse, often involving immature or activation markers. However, these shifts rarely alter the initial diagnosis, suggesting a persistent original cell clone in primary resistant cases.

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Area of Science:

  • Hematology
  • Immunology
  • Oncology

Background:

  • Acute lymphoblastic leukemia (ALL) is a heterogeneous hematologic malignancy.
  • Understanding phenotypic evolution in ALL is crucial for prognosis and treatment.
  • Relapse and primary resistance present distinct challenges in ALL management.

Purpose of the Study:

  • To investigate the incidence and characteristics of antigenic changes in relapsed and primary resistant ALL.
  • To compare the immunophenotype at diagnosis with that during relapse or primary resistance.
  • To determine if phenotypic shifts impact diagnostic classification or prognosis.

Main Methods:

  • Sequential immunophenotypic analysis of 18 ALL cases (15 relapsed, 3 primary resistant).
  • Utilized a panel of 20 monoclonal antibodies against lymphoid and myeloid antigens.

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  • Compared antigen expression profiles at diagnosis versus relapse/resistance.

    • Main Results:

    • Major phenotypic changes (e.g., CD13, CD33 acquisition) observed in 7% of relapsed ALL.
    • Minor changes (antigen gain/loss, expression level alteration) found in 47% of relapsed ALL.
    • No phenotypic changes detected in primary resistant ALL, suggesting clone persistence.

    Conclusions:

    • Antigenic changes are frequent in relapsing ALL, often indicating immature or activated blast cells.
    • These changes typically do not alter the fundamental phenotypic diagnosis of ALL.
    • Primary resistant ALL may represent a stable, unaltered clone, contrasting with relapsed cases.