Seegmiller Adam C, Kroft Steven H, Karandikar Nitin J, McKenna Robert W
Department of Pathology, University of Texas Southwestern Medical Center at Dallas, USA.
Am J Clin Pathol. 2009 Dec;132(6):940-9. doi: 10.1309/AJCP8G5RMTWUEMUU.
Morphologic distinction of leukemic lymphoblasts in B acute lymphoblastic leukemia (B-ALL) from their nonneoplastic counterparts in bone marrow (hematogones) can be difficult. Thus, the presence of aberrant antigen expression detectable by flow cytometry may be critical for diagnosis of B-ALL and detection of minimal residual disease. The current study examined the immunophenotype of B-lineage leukemic lymphoblasts in 200 consecutive, unique, pretreatment patient specimens. We found that all cases of B-ALL exhibited multiple immunophenotypic aberrancies by which they can be distinguished from hematogones. The most frequent aberrancies were uniform or a spectrum of expression of terminal deoxynucleotidyl transferase and CD34, underexpression of CD45, overexpression of CD10, underexpression of CD38, and underexpression of CD20. Asynchronous coexpression of CD34 and CD20 was also frequently observed. Of the 200 cases, 86.5% expressed myeloid-associated antigens, and 19.0% expressed 3 or more. Of 200 cases, 9.0% aberrantly expressed T cell-associated antigens. There were significant differences in antigen-expression patterns between adult and pediatric B-ALL. Specific aberrancies correlate with recurrent cytogenetic abnormalities in B-ALL.
区分B急性淋巴细胞白血病（B-ALL）中的白血病性淋巴母细胞与其骨髓中的非肿瘤对应物（造血细胞）的形态学差异可能具有挑战性。因此，通过流式细胞术检测到的异常抗原表达可能对B-ALL的诊断和微小残留病的检测至关重要。本研究检测了200例连续、独特的预处理患者标本中B系白血病性淋巴母细胞的免疫表型。我们发现，所有B-ALL病例均表现出多种免疫表型异常，据此可将它们与造血细胞区分开来。最常见的异常包括末端脱氧核苷酸转移酶和CD34的均匀表达或表达谱、CD45的低表达、CD10的高表达、CD38的低表达以及CD20的低表达。还经常观察到CD34和CD20的异步共表达。在这200例病例中，86.5%表达髓系相关抗原，19.0%表达3种或更多。在200例病例中，9.0%异常表达T细胞相关抗原。成人和儿童B-ALL的抗原表达模式存在显著差异。特定的异常与B-ALL中复发性细胞遗传学异常相关。
