Laboratoire d'Hématologie, Réseau des Laboratoires Hospitaliers Universitaires de Bruxelles (LHUB-ULB), Bruxelles, Belgique.
Int J Lab Hematol. 2018 Dec;40(6):734-739. doi: 10.1111/ijlh.12912. Epub 2018 Aug 16.
The discrimination of leukemia lymphoblasts (LB) in diagnosis and follow-up of B-cell progenitor acute lymphoblastic leukemia (BCP-ALL) by multiparameter flow cytometry (MFC) may be difficult due to the presence of hematogones (HG). The aim of this study was to compare lymphoblasts of BCP-ALL and HG for the expression of the most discriminating antigens.
A total of 82 bone marrow samples (39 BCP-ALL and 43 patients with HG) were analyzed using MFC. Mean fluorescence intensity (MFI) was measured for ten markers commonly used in hematology laboratories: CD45, CD19, CD10, CD34, CD38, CD20, CD22, CD58, CD81, and CD123. Statistical comparison of the MFI between LB and HG was performed. The presence on LB of aberrant expression of myeloid and/or T-cell markers was also investigated.
Qualitative pattern expression of antigens showed overexpression on LB of CD58, CD22, CD34, CD10 and underexpression of CD81, CD45, CD38 when compared to HG. Expression of CD123 was positive in 34% of BCP-ALL LB and always absent on HG. Aberrant antigen expression (myeloid and/or T-cell marker) including CD123 was observed in 58% of BCP-ALL patients. The use of a MFI antigen ratio of the most discriminating markers (CD81/CD58) (analysis of variance, P < 0.005) increased the distinction of LB versus HG with a high specificity and sensitivity as demonstrated by the use of ROC curve analysis (AUC of CD81/CD58: 0.995).
We demonstrate in this study that routine use of the MFI antigen ratio (CD81/CD58) in addition to the MFC evaluation using WHO classical criteria appears to be an efficient approach to discriminate LB from HG.
在 B 细胞前体细胞急性淋巴细胞白血病（BCP-ALL）的诊断和随访中，通过多参数流式细胞术（MFC）对白血病淋巴母细胞（LB）进行区分可能较为困难，因为存在造血细胞（HG）。本研究旨在比较 BCP-ALL 和 HG 的淋巴母细胞在最具鉴别性抗原上的表达。
共分析了 82 例骨髓样本（39 例 BCP-ALL 和 43 例 HG 患者），采用 MFC 检测。常用的十个标记物的平均荧光强度（MFI）：CD45、CD19、CD10、CD34、CD38、CD20、CD22、CD58、CD81 和 CD123。对 LB 和 HG 之间的 MFI 进行了统计学比较。还研究了 LB 上是否存在异常表达髓系和/或 T 细胞标记物。
抗原的定性模式表达显示，与 HG 相比，LB 上 CD58、CD22、CD34、CD10 过度表达，CD81、CD45、CD38 表达减少。BCP-ALL LB 中 34%表达 CD123，而 HG 中 CD123 始终为阴性。在 58%的 BCP-ALL 患者中观察到异常抗原表达（髓系和/或 T 细胞标记物），包括 CD123。使用最具鉴别性标记物的 MFI 抗原比值（CD81/CD58）（方差分析，P < 0.005）增加了 LB 与 HG 的区分度，ROC 曲线分析显示具有高特异性和敏感性（CD81/CD58 的 AUC：0.995）。
本研究表明，在常规使用多参数流式细胞术（MFC）评估的基础上，结合 WHO 经典标准，额外使用 MFI 抗原比值（CD81/CD58）似乎是一种有效区分 LB 与 HG 的方法。
