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Comprehensive Protocol to Sample and Process Bone Marrow for Measuring Measurable Residual Disease and Leukemic Stem Cells in Acute Myeloid Leukemia
Published on: March 5, 2018
CD7, CD4 and myeloid antigen-positive acute lymphoblastic leukemia
1Department of Internal Medicine, Yamada Red Cross Hospital, Misono, Japan.
Insights
This study details a rare case of acute lymphoblastic leukemia (ALL) with unusual cell markers. Findings suggest potential myeloid differentiation capacity in T-cell precursors, offering new insights into leukemia.
Area of Science:
- Hematology
- Oncology
- Cell Biology
Background:
- Acute lymphoblastic leukemia (ALL) is a heterogeneous hematologic malignancy.
- Understanding unique cellular characteristics is crucial for diagnosis and treatment.
- FAB-L2 subtype presents specific morphological and immunophenotypic features.
Observation:
- A case of ALL (FAB-L2) exhibited unique cellular properties.
- Leukemic cells were negative for most cytochemical stains, except acid phosphatase.
- Immunophenotyping revealed a distinct CD profile: CD7+, CD4+, CD8-, CD2+, CD3-, CD13+, CD25+, CD33+, and CD34+.
Findings:
- Genetic analysis showed germline configurations for immunoglobulin heavy chain and T-cell receptor genes.
- The patient's karyotype displayed complex abnormalities involving chromosomes 5 and 7.
- Leukemic cells responded robustly to IL-3, GM-CSF, and G-CSF, with partial granulocytic differentiation.
- High and low affinity receptors for GM-CSF were confirmed.
Implications:
- The findings suggest that CD7+CD4+CD8-CD3- T-cell precursors may retain myeloid differentiation potential.
- This challenges traditional lineage commitment models in leukemia.
- Further research could explore therapeutic strategies targeting this aberrant differentiation pathway.
Abstract:
We report a case of acute lymphoblastic leukemia (ALL, FAB-L2) with unique cellular characteristics. Leukemic cells were negative for various cytochemical stainings except acid phosphatase. Immunophenotypic studies revealed CD7+, CD4+, CD8-, CD2+, CD3-, CD13+, CD25+, CD33+ and CD34+. The immunoglobulin heavy chain and T-cell receptor beta, gamma and delta chain genes were germline configurations. This patient had a karyotype of complex abnormalities involving Nos. 5 and 7. Leukemic cells showed a prominent response to interleukin-3, granulocyte macrophage colony stimulating factor (GM-CSF) and G-CSF with partial granulocytic differentiation in a colony assay. A binding assay confirmed the presence of both high and low affinity receptors for GM-CSF. These findings suggest that CD7+CD4+CD8-CD3- putative T-cell precursors may retain the capacity to differentiate to myeloid lineage.
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