Abdulateef Nahla Ahmad Bahgat, Ismail Manar Mohammad, Aljedani Hanadi
Laboratory and Blood Bank Department, KAMC, Makkah, Kingdom of Saudi Arabia E-mail :
Asian Pac J Cancer Prev. 2014;15(1):221-7. doi: 10.7314/apjcp.2014.15.1.221.
Aberrant phenotypes in acute leukemia have variable frequency and their prognostic and predictive relevance is controversial, despite several reports of clinical significance.
To determine the prevalence of aberrant antigen expression in acute leukemia, assess clinical relevance and demonstrate immunophenotype-karyotype correlations.
A total of 73 (40 AML and 33 ALL) newly diagnosed acute leukemia cases presenting to KAMC, Kingdom of Saudi Arabia, were included. Diagnosis was based on WHO criteria and FAB classification. Immunophenotyping by flow cytometry, conventional karyotyping and fluorescence in situ hybridization for gene rearrangements were performed.
Aberrant antigens were detected in 27/40 (67.5%) of AML and in 14/33 (42.4%) in ALL cases. There were statistically significant higher TLC in Ly+ AML than in Ly-AML (p=0.05) and significant higher blast count in ALL with aberrant antigens at presentation and day 14 (p=0.005, 0.046). There was no significant relation to clinical response, relapse free survival (RFS) or overall survival (p>0.05), but AML cases expressing ≥2 Ly antigens showed a lower median RFS than those expressing a single Ly antigen. In AML, CD 56 was expressed in 11/40. CD7 was expressed in 7/40, having a significant relation with an unfavorable cytogenetic pattern (p=0.046). CD4 was expressed in 5/40. CD19 was detected in 4/40 AML associated with M2 and t (8; 21). In ALL cases, CD33 was expressed in 7/33 and CD13 in 5/33. Regarding T Ag in B-ALL CD2 was expressed in 2 cases and CD56 in 3 cases.
Aberrant antigen expression may be associated with adverse clinical data at presentation. AML cases expressing ≥2 Ly antigens may have shorter median RFS. No specific cytogenetic pattern is associated with aberrant antigen expression but individual antigens may be related to particular cytogenetic patterns. Immunophenotype-karyotype correlations need larger studies for confirmation.
急性白血病中的异常表型频率各异，尽管有多项关于其临床意义的报道，但其预后和预测相关性仍存在争议。
确定急性白血病中异常抗原表达的发生率，评估其临床相关性，并证明免疫表型与核型的相关性。
纳入了沙特阿拉伯王国KAMC收治的73例新诊断的急性白血病病例（40例急性髓系白血病和33例急性淋巴细胞白血病）。诊断基于世界卫生组织（WHO）标准和FAB分类。通过流式细胞术进行免疫表型分析，进行常规核型分析以及基因重排的荧光原位杂交。
在40例急性髓系白血病中有27例（67.5%）检测到异常抗原，在33例急性淋巴细胞白血病中有14例（42.4%）检测到异常抗原。髓系阳性（Ly+）急性髓系白血病的白细胞计数（TLC）在统计学上显著高于髓系阴性（Ly-）急性髓系白血病（p=0.05），在初诊时和第14天，有异常抗原的急性淋巴细胞白血病的原始细胞计数显著更高（p=0.005，0.046）。与临床缓解、无复发生存期（RFS）或总生存期无显著相关性（p>0.05），但表达≥2种Ly抗原的急性髓系白血病病例的无复发生存期中位数低于表达单一Ly抗原的病例。在急性髓系白血病中，40例中有11例表达CD56。40例中有7例表达CD7，与不良细胞遗传学模式有显著相关性（p=0.046）。40例中有5例表达CD4。在40例与M2和t(8;21)相关的急性髓系白血病中检测到4例表达CD19。在急性淋巴细胞白血病病例中，33例中有7例表达CD33，33例中有5例表达CD13。关于B系急性淋巴细胞白血病中的T抗原，2例表达CD2，3例表达CD56。
异常抗原表达可能与初诊时的不良临床数据相关。表达≥2种Ly抗原的急性髓系白血病病例的无复发生存期中位数可能较短。没有特定的细胞遗传学模式与异常抗原表达相关，但个别抗原可能与特定的细胞遗传学模式有关。免疫表型与核型的相关性需要更大规模的研究来证实。
