全反式维甲酸治疗前和早期急性早幼粒细胞白血病的诊断免疫表型。
Diagnostic immunophenotype of acute promyelocytic leukemia before and early during therapy with all-trans retinoic acid.
机构信息
From the Departments of Hematopathology and Laboratory Medicine and
From the Departments of Hematopathology and Laboratory Medicine and.
出版信息
Am J Clin Pathol. 2014 Oct;142(4):546-52. doi: 10.1309/AJCPPOKEHBP53ZHV.
OBJECTIVES
To study the immunophenotypic changes of acute promyelocytic leukemia (APL) in patients who recently received all-trans retinoic acid (ATRA) and to assess the diagnostic utility of flow cytometry in this setting.
METHODS
Flow cytometry was performed on 29 newly diagnosed APLs and 93 other acute myeloid leukemias, including 25 HLA-DR- or CD34- cases. Clinical notes from referring institutions were reviewed to assess for recent ATRA administration.
RESULTS
Recent ATRA therapy was documented in 17 (59%) of 29 patients with APL. The main features of untreated APL were preserved with ATRA therapy, including CD34- (83% vs 82%), HLA-DR- (83% vs 100%), and CD117+ (100% vs 77%). CD11b and CD11c were negative in all untreated APLs but positive in 76% and 88% of ATRA-treated APLs, respectively. Optimal diagnostic criteria for untreated APL (CD34- or HLA-DR- and CD11b- and CD11c-) showed 100% sensitivity and 98% specificity but were not useful after ATRA administration. The best interpretative approach to ATRA-treated APL (CD34- or HLA-DR-) showed 100% sensitivity but limited specificity (73%).
CONCLUSIONS
Information about recent ATRA administration is critical for adequate interpretation of the flow cytometric findings in patients with suspected APL.
目的
研究近期接受全反式维甲酸（ATRA）治疗的急性早幼粒细胞白血病（APL）患者的免疫表型变化，并评估流式细胞术在这种情况下的诊断效用。
方法
对 29 例新诊断的 APL 和 93 例其他急性髓系白血病（包括 25 例 HLA-DR-或 CD34-病例）进行流式细胞术分析。回顾转诊机构的临床记录，以评估近期是否接受 ATRA 治疗。
结果
17 例（59%）APL 患者有近期 ATRA 治疗史。在 ATRA 治疗后，未治疗的 APL 的主要特征得以保留，包括 CD34-（83%比 82%）、HLA-DR-（83%比 100%）和 CD117+（100%比 77%）。所有未经治疗的 APL 均为 CD11b 和 CD11c 阴性，但分别有 76%和 88%的 ATRA 治疗的 APL 为阳性。未经治疗的 APL 的最佳诊断标准（CD34-或 HLA-DR-且 CD11b-和 CD11c-）具有 100%的敏感性和 98%的特异性，但在 ATRA 治疗后并不适用。最佳解释方法是将 ATRA 治疗的 APL（CD34-或 HLA-DR-）视为阳性，该方法具有 100%的敏感性，但特异性有限（73%）。
结论
在疑似 APL 患者中，近期 ATRA 治疗的信息对于充分解释流式细胞术结果至关重要。
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