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[Immunophenotyping characteristics of biphenotypic acute leukemia and analysis of curative effect]
Jing-Jing Zhang1, Nan Zhang, Xin-Fu Zhang
1Department of Medical Laboratorial Examination, Xinxiang, 453003, Henan Province, China.
Insights
Biphenotypic acute leukemia (BAL) exhibits distinct immunophenotypes, with Myeloid/B-acute lymphoblastic leukemia (My/B-ALL) being most common. Flow cytometry is crucial for diagnosing BAL, and poor prognosis is linked to low cell differentiation.
Area of Science:
- Hematology
- Immunology
- Oncology
Context:
- Biphenotypic acute leukemia (BAL) presents diagnostic challenges due to co-expression of myeloid and lymphoid markers.
- Accurate immunophenotyping is essential for classifying BAL subtypes and guiding treatment strategies.
Purpose:
- To investigate the immunophenotypic characteristics of BAL using four-color direct immunofluorescence staining and flow cytometry.
- To analyze the curative efficacy and prognostic factors associated with different BAL subtypes.
Summary:
- The study analyzed 45 BAL cases, identifying Myeloid/B-acute lymphoblastic leukemia (My/B-ALL) as the most frequent subtype (23 cases), followed by Myeloid/T-acute lymphoblastic leukemia (My/T-ALL) (18 cases).
- Co-expression of cytoplasmic CD79a (cCD79a) and cytoplasmic myeloperoxidase (cMPO) was common in My/B-ALL, while co-expression of cytoplasmic CD3 (cCD3) and cMPO characterized My/T-ALL.
- CD34 expression was associated with lower complete remission rates in My/B-ALL.
- Cytoplasmic CD3 (cCD3), cytoplasmic CD79a (cCD79a), and cytoplasmic myeloperoxidase (cMPO) are valuable diagnostic markers for BAL.
- Four-color direct immunofluorescence staining via flow cytometry demonstrated high specificity for BAL diagnosis.
Impact:
- This research highlights the importance of detailed immunophenotyping for accurate BAL diagnosis and subclassification.
- Identifying prognostic indicators like CD34 expression and cell differentiation can help predict patient outcomes.
- The findings support the use of flow cytometry as a definitive diagnostic tool for BAL, improving patient management and therapeutic strategies.
Abstract:
This study was aimed to investigate the immunophenotyping characteristics of biphenotypic acute leukemia (BAL) and to analyze its curative efficacy. The four-color direct immunofluorescence staining and CD45/SSC gating analysis of flow cytometry were used to detect the cells of bone marrow and peripheral blood of 45 doubtful cases of BAL, and the immunophenotyping was performed according to the European Group for the Immunological Classification of Leukemia (EGIL) score criterion. The results showed that among 45 doubtful cases of BAL, the co-expression of cCD79a and cMPO was observed in 23 cases of My/B-ALL, with highest level of CD19 expression, followed by CD10; the co-expression of cCD3 and cMPO was observed in 18 cases of My/T-ALL, with highest level of CD7 expression, followed by CD5; the co-expression of cCD3 and cCD79a was found in 4 cases of T/B. Out of 45 cases of BAL, 30 cases showed cTdT expression, 25 cases showed CD34 expression, 31 cases showed CD117 expression. The results also indicated that the expression rate of CD33 was higher than that of CD13 in antigen expression of My/B-ALL and My/T-ALL patients. The complete remission (CR) rate of My/B-ALL with My/T-ALL CD34(+) was lower than that of My/B-ALL with CD34(-), the CR rate of My/B-ALL with CD34(+) was lower than that of My/T-ALL with CD34(-). It is concluded that the co-expression of My/B-ALL antigen has been found to be most common, then followed by My/T-All. cCD3, cCD79a, cMPO have important value for diagnosing and identifying of BAL. The flow cytometry with four-color direct immunofluorescence staining is most specific method for diagnosis of BAL. The clinical prognosis of BAL with low cell differentiation is poor.
