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[Cellular immunophenotypes in 97 adults with acute leukemia]
J Piedras1, X López-Karpovitch, M R Cárdenas
1Departamento de Hematología-Oncología, Laboratorio de Biología Celular, Instituto Nacional de la Nutrición Salvador Zubirán, Vasco de Quiroga, México, D.F.
Insights
Flow cytometry effectively diagnosed acute leukemia (AL) and identified acute mixed-lineage leukemia (AMLL). This immunophenotypic analysis confirmed the diverse nature of AL, aiding classification in challenging cases.
Area of Science:
- Hematology
- Immunology
- Flow Cytometry
- Leukemia Diagnosis
Context:
- Acute leukemia (AL) diagnosis often relies on cytomorphology and cytochemistry.
- Immunophenotyping by flow cytometry offers a more detailed analysis of cell surface antigens.
- Distinguishing between acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML), especially mixed-lineage types, is critical for treatment.
Purpose:
- To analyze hematopoietic cell surface antigen reactivity in de novo acute leukemia (AL) using flow cytometry.
- To identify acute mixed-lineage leukemias (AMLL) based on established immunophenotypic criteria.
- To compare flow cytometry findings with cytomorphologic and cytochemical data for diagnostic accuracy.
Summary:
- Flow cytometry classified 12 previously unclassified AL cases.
- Immunophenotyping identified 54 ALL and 43 AML cases.
- AMLL was identified in 9% of ALL and 12% of AML cases, with CD34 expression in 90% of AMLL patients.
Impact:
- Flow cytometry provides crucial diagnostic information, especially in cytomorphologically ambiguous cases.
- The study confirms the heterogeneity of acute leukemia and the utility of immunophenotyping in defining subtypes.
- Accurate identification of AMLL through flow cytometry aids in precise diagnosis and potentially tailored therapeutic strategies.
Objective:
To analyze hematopoietic cell surface antigen reactivity in acute leukemia (AL) by flow cytometry and identify acute mixed-lineage leukemias (AMLL) employing the most widely accepted criteria.
Material And Methods:
Ninety seven patients with de novo AL were studied. Cell surface antigens were investigated with monoclonal antibodies directed to: B lymphoid (CD10, CD19, CD20, CD21, CD22); T lymphoid (CD2, CD3, CD5, CD7); and myeloid (CD13, CD14, CD15, CD33, CD41) cell lineages. Maturation cell-associated antigens (CD34, HLA-DR and TdT) were also studied.
Results:
Twelve patients unclassified by cytomorphology could be classified by immunophenotype. Using cytomorphologic, cytochemical and immunophenotypic data, 54 cases corresponded to acute lymphoblastic leukemia (ALL) and 43 were acute myeloblastic leukemia (AML). In All there were 63% B lineage, 15% T, 7% T/B, 6% undifferentiated and 9% mixed-lineage (coexpression of two or more myeloid-associated antigens). In AML, myeloid immunophenotype was observed in 86% undifferentiated in 2%, and mixed-lineage in 12% (coexpression of two or more lymphoid-associated antigens). In addition, 26% of ALL cases and 12% of AML cases expressed a single myeloid and lymphoid antigen respectively. The most common aberrant antigens in ALL and AML were CD13 and CD7 respectively. The highest frequency of CD34 antigen expression (90%) was detected in patients with AMLL.
Conclusions:
Flow cytometric immunophenotypic analysis allowed to: a) establish diagnosis in cytomorphologically unclassified cases; b) identify AMLL with a frequency similar to that reported in other series; and c) confirm the heterogeneity of AL.
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