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Updated: Aug 8, 2026
Flow Cytometry to Estimate Leukemia Stem Cells in Primary Acute Myeloid Leukemia and in Patient-derived-xenografts, at Diagnosis and Follow Up
Published on: March 26, 2018
[CD7 (+) stem cell leukemia presenting different phenotypes in lymph node and bone marrow]
1Third Department of Internal Medicine, Faculty of Medicine, Kyushu University.
Insights
This study tracks a patient initially diagnosed with lymphoblastic lymphoma who later relapsed with myeloblasts. Genetic analysis revealed both cell types originated from the same clone, suggesting a stem cell origin for this leukemia.
Area of Science:
- Hematology
- Oncology
- Molecular Biology
Background:
- Lymphoblastic lymphoma is a type of non-Hodgkin lymphoma.
- Treatment protocols like MACOP-B are used for lymphoma.
- Relapse in lymphoma can present with different cell phenotypes.
Observation:
- A 27-year-old male initially diagnosed with lymphoblastic lymphoma showed complete remission after MACOP-B therapy.
- The patient relapsed with cervical lymphadenopathy and bone marrow myeloblasts.
- Initial lymphoblasts and relapsed myeloblasts shared common genetic abnormalities (11p-, T-cell receptor gene rearrangement).
Findings:
- Cytogenetic and genetic studies confirmed a single clone origin for both lymphoblastic lymphoma and subsequent myeloblasts.
- Despite originating from the same clone, the relapsed blasts exhibited distinct phenotypes (peroxidase-positive myeloblasts in bone marrow vs. peroxidase-negative in lymph nodes).
Implications:
- This case suggests a pluripotent stem cell origin for the observed leukemia.
- The findings support the hypothesis that leukemia can arise from a stem cell and differentiate along multiple lineages.
- Understanding clonal evolution is crucial for diagnosing and treating relapsed hematologic malignancies.
Abstract:
A 27-year-old male with systemic lymphadenopathy was diagnosed as lymphoblastic-type lymphoma by inguinal lymph node biopsy in September, 1990. Bone marrow at the initial diagnosis contained 55.4% lymphoblasts with a phenotype of peroxidase (-), CD7 (+), CD4 (-), CD8 (-). Lymphadenopathy and lymphoblasts in bone marrow disappeared after MACOP-B therapy. In December, 1990, however, the patient again noticed swelling of cervical lymph nodes. At this time, the bone marrow contained 36.4% myeloblasts with a peroxidase (+), CD7 (+), CD13 (+), CD33 (+) phenotype. Cytogenetic and genetic study revealed that the lymphoblasts at the initial diagnosis and the myeloblasts at relapse shared an common abnormal karyotype, 11p-, and the same rearranged band of T-cell receptor delta, gamma, beta genes, suggesting that these two blasts originated from the same clone. The blasts obtained from the cervical lymph node at relapse were still negative for peroxidase, in contrast to the blasts from bone marrow. These findings suggest that this leukemia originated from a stem cell and differentiated along multilineage pathways.
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