Significance of enzyme markers as a part of multiple marker analysis in leukemia research.

The multidisciplinary approach of leukemia phenotyping, called multiple marker analysis, led to changes in the classification systems of normal hematopoiesis and leukemic cells, and introduced the use of a biological and functional definition of leukemia, rather than merely morphological-cytochemical descriptions. Two major conclusions can be drawn from the findings of multiple marker analysis: 1) differentiation of leukemia is not abnormal but blocked ("maturation arrest"), and leukemic cells retain normal maturation-linked markers; and 2) no leukemia specific marker could be detected so far. Although leukemic cells show general qualitative features in common with normal cells, some quantitative characteristics of these similar attributes are peculiar to leukemic blasts. Qualitative and quantitative enzymological characteristics help to identify the cell lineage involved and to determine the developmental point at which maturation arrest occurs. The expression of isoenzymes is often linked to the presumptive sequence of developmental stages. Subsets within ALL subtypes showed pronounced modifications in their isoenzyme patterns associated with increasing maturity. Thus, enzyme markers can provide refined definitions of subgroups by biochemical criteria. Based on recent observations using the enzyme markers TdT, adenosine deaminase, 5'-nucleotidase, purine nucleoside phosphorylase, acid phosphatase, and hexosaminidase, a scheme of enzymological expression in the various commonly accepted subtypes of acute lymphoid leukemia and acute nonlymphoid leukemia is presented. Enzyme marker analysis represents a useful tool as an adjunctive method in multiple marker analysis for assessing diagnosis, prognosis, and the evolutionary and pathogenetic mechanisms underlying the spectrum of leukemia subtypes. Furthermore, enzyme marker analysis may provide further insight into certain aspects of the pathobiology of leukemia which might not be elucidated by other methods.(ABSTRACT TRUNCATED AT 250 WORDS)