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Published on: March 5, 2018
Paraffin section immunophenotyping of acute leukemias in bone marrow specimens
1Division of Pathology, City of Hope National Medical Center, Duarte, California 91010, USA.
Insights
Immunohistochemistry on paraffin sections aids in determining acute leukemia lineage. This method accurately identifies most acute myeloid leukemia and acute lymphoblastic leukemia cases, improving diagnostic capabilities for these blood cancers.
Area of Science:
- Hematology
- Oncology
- Immunopathology
Background:
- Traditional immunohistochemical evaluation of acute leukemia in paraffin sections was limited by the inability to detect many lineage-specific antigens.
- Advances in immunohistochemical techniques and antibody development have overcome previous limitations in antigen detection.
Purpose of the Study:
- To assess the diagnostic value of immunohistochemistry on paraffin-embedded tissues for determining the lineage of acute leukemias.
- To evaluate a specific panel of antibodies for their efficacy in differentiating acute myeloid leukemia (AML) from acute lymphoblastic leukemia (ALL).
Main Methods:
- Studied 77 previously immunophenotyped acute leukemia specimens.
- Utilized a panel of antibodies including CD3, CD20, CD34, CD43, CD68, CD79a, HLA-DR, myeloperoxidase (MPX), and terminal deoxynucleotidyl transferase (TdT).
- Included cases of AML, precursor B-cell ALL, T-cell ALL, and mixed precursor B/myeloid leukemias.
Main Results:
- The immunohistochemical panel correctly identified the lineage in 96% of AML and ALL cases.
- Evidence of mixed lineage was identified in 60% of mixed lineage leukemia cases.
- Antibodies against CD3, CD79a, myeloperoxidase (MPX), and terminal deoxynucleotidyl transferase (TdT) were most effective, though MPX and TdT lacked complete specificity.
Conclusions:
- Paraffin section immunohistochemistry is a valuable tool for lineage determination in acute leukemia.
- This technique can assist in diagnosing challenging cases, including those with mixed lineage features.
- The study supports the integration of immunohistochemistry into the diagnostic workup of acute leukemias.
Abstract:
The immunohistochemical evaluation of acute leukemia specimens has been limited in the past due of the inability to detect many lineage-related antigens in paraffin sections. With the improvement in immunohistochemical methods as well as the introduction of new antibodies, these limitations are now reduced. To evaluate the diagnostic utility of paraffin section immunohistochemistry in the lineage determination of acute leukemias, 77 previously immunophenotyped acute leukemias were studied with a panel of antibodies that included antibodies directed against CD3, CD20, CD34, CD43, CD68, CD79a, HLA-DR, myeloperoxidase (MPX), and terminal deoxynucleotidyl transferase (TdT). The cases included 48 acute myeloid leukemias, 18 precursor B-cell acute lymphoblastic leukemias, 6 T-cell acute lymphoblastic leukemias, and 5 mixed precursor B/myeloid leukemias. This immunohistochemical panel correctly identified the lineage of 96% of both acute myeloid leukemias and acute lymphoblastic leukemias and identified evidence of mixed lineage in 60% of mixed lineage leukemias. Antibodies directed against CD3, CD79a, MPX, and TdT were found to be the most useful, although the latter three alone were not entirely lineage specific. These findings suggest a role for paraffin section immunohistochemistry in the lineage determination of some cases of acute leukemia.
