Stasi R, Del Poeta G, Venditti A, Bruno A, Suppo G, Aronica G, Di Carlo G, Papa G
Department of Hematology, University of Rome Tor Vergata, S. Eugenio Hospital, Rome, Italy.
Hematol Pathol. 1995;9(2):79-94.
This study assesses the value of immunologic and ultrastructural methods in disclosing the lineage commitment of cells from acute leukemias (ALs). Two hundred and fifty-one ALs were characterized morphologically, cytochemically, and immunologically. Myeloperoxidase (MPO) positivity in > 3% of blasts was regarded as evidence of the myeloid origin of leukemic cells, cytoplasmic CD22 (cCD22) expression was taken as an indication for B-lineage acute lymphoblastic leukemia (ALL), and CD3+ (membrane or cytoplasmic) cases were classified as T-ALL. Diagnosis of minimally differentiated acute myeloid leukemia (AML-M0) was made when blast cells had undifferentiated features by light microscopy, reacted with at least one of the antibodies to myeloid-specific antigens (CD13, CD33, MPO), and lacked CD19, cCD22, and c/mCD3. Megakaryoblastic differentiation was demonstrated by the expression of CD41 and/or CD61. Following these criteria, 209 cases were classified as acute myeloid leukemia (AML) and 39 as ALL. Expression of lymphoid antigens was detected in 45% of AML cases and 30% of ALLs showed myeloid antigens. One case was regarded as a true biphenotypic leukemia because of the combined expression of MPO and CD33 for the myeloid lineage, and cCD3, CD2, and CD5 for the T-cell lineage. Two cases lacked signs of myeloid or lymphoid differentiation and were studied by electron microscopy methods. One displayed platelet peroxidase (PPO) activity and was classified as a megakaryoblastic variant, one other reacted with anti-CD33 and was considered AML-M0. We conclude that light microscopy and standard immunologic methods can accurately demonstrate the lineage orientation in greater than 99% of ALs. Integration with ultrastructural analysis can define the cell nature of virtually all cases of AL.
本研究评估免疫和超微结构方法在揭示急性白血病（AL）细胞系别归属方面的价值。对251例急性白血病进行了形态学、细胞化学和免疫学特征分析。原始细胞中髓过氧化物酶（MPO）阳性率>3%被视为白血病细胞髓系起源的证据，细胞质CD22（cCD22）表达被视为B系急性淋巴细胞白血病（ALL）的指征，CD3+（膜或细胞质）病例被归类为T-ALL。当原始细胞在光学显微镜下具有未分化特征，与至少一种髓系特异性抗原（CD13、CD33、MPO）抗体反应，且缺乏CD19、cCD22和c/mCD3时，诊断为微分化急性髓系白血病（AML-M0）。巨核细胞分化通过CD41和/或CD61的表达来证实。按照这些标准，209例被归类为急性髓系白血病（AML），39例为ALL。45%的AML病例检测到淋巴系抗原表达，30%的ALL病例显示髓系抗原。1例因同时表达髓系谱系的MPO和CD33以及T细胞谱系的cCD3、CD2和CD5，被视为真正的双表型白血病。2例缺乏髓系或淋巴系分化迹象，采用电子显微镜方法进行研究。1例显示血小板过氧化物酶（PPO）活性，被归类为巨核细胞变异型，另1例与抗CD33反应，被认为是AML-M0。我们得出结论，光学显微镜和标准免疫方法能够准确地在超过99%的急性白血病中显示细胞系别方向。与超微结构分析相结合可以明确几乎所有急性白血病病例的细胞性质。
