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Heterogeneity in acute undifferentiated leukemia.

A LeMaistre1, C C Childs, C Hirsch-Ginsberg

  • 1Division of Laboratory Medicine, University of Texas M. D. Anderson Cancer Center, Houston.

Hematologic Pathology
|January 1, 1988
PubMed
Summary

Acute undifferentiated leukemia (AUL) can be challenging to classify. Ultrastructural myeloperoxidase (UMPO) testing identified myeloid lineage in some AUL cases, suggesting myeloid commitment may occur without standard MPO positivity.

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Area of Science:

  • Hematology
  • Oncology
  • Cell Biology

Background:

  • Acute undifferentiated leukemia (AUL) presents diagnostic challenges when cell lineage is unclear.
  • Accurate leukemia classification is crucial for appropriate treatment selection and patient outcomes.

Purpose of the Study:

  • To investigate the utility of immunophenotyping and ultrastructural cytochemistry in characterizing AUL cases.
  • To explore potential alternative pathways for myeloid lineage commitment in leukemia.

Main Methods:

  • Studied 256 adults with newly diagnosed acute leukemia, identifying 12 (4.6%) with AUL.
  • Utilized immunophenotyping, ultrastructural myeloperoxidase (UMPO), and ultrastructural platelet peroxidase assays.
  • Performed gene rearrangement studies (JH, Tcr beta) on selected cases.

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Main Results:

  • Ultrastructural myeloperoxidase (UMPO) positivity reclassified 5 of 12 AUL cases as acute myeloblastic leukemia (AML).
  • Three UMPO-negative cases exhibited a myeloid immunophenotype, with one showing germline configuration for JH and Tcr beta genes.
  • Treatment outcomes were poor with standard acute lymphoblastic leukemia (ALL) chemotherapy, while AML regimens yielded limited complete remission (CR).

Conclusions:

  • Ultrastructural myeloperoxidase (UMPO) can detect myeloid lineage in a subset of AUL cases.
  • Myeloid lineage commitment may occur in the absence of myeloid peroxidase (MPO) cytochemical positivity, as suggested by immunophenotype and gene studies.
  • These findings highlight the complexity of leukemia lineage determination and the need for advanced diagnostic techniques.