Reading C L, Estey E H, Huh Y O, Claxton D F, Sanchez G, Terstappen L W, O'Brien M C, Baron S, Deisseroth A B
Department of Hematology, M.D. Anderson Cancer Center, Houston, TX 77030.
Blood. 1993 Jun 1;81(11):3083-90.
Immunophenotypes for 272 patients with acute myelogenous leukemia (AML) were analyzed using a panel of 22 antibodies. Numerical evidence for unusual coexpressions (present in normal marrow at < or = 0.1%) of surface markers on > or = 10% of the blast cells was found in 85% of all cases. Asynchronous expression of myeloid differentiation antigens occurred in 70% of the cases. Unusual coexpression of T-lymphoid, B-lymphoid, or natural killer (NK) markers with myeloid markers occurred in 38%, 13%, and 21%, respectively, of all AML cases. Two- and three-color analyses confirmed coexpression in 15 of 15 cases, and indicated that these percentages are an underestimate, because coexpression can be demonstrated in cases without numerical overlap. These data indicate that the unusual coexpression of normal differentiation antigens is a common occurrence in AML. Markers in 12 of 13 patients were similar between presentation and relapse, and in two patients, unusual phenotypes detected at first relapse were shown at second relapse, indicating these immunophenotypes are stable in the majority of AML patients. Significant correlations were found between t(8;21) cytogenetics and coexpression of CD19 with CD15 or CD34, t(9;22) and coexpression of CD19 and CD34, and t(15;17) and coexpression of CD2 and myeloid antigens. Multiparameter fluorescence analysis allows detection of unusual phenotypes when the blast counts are < 5% (classical remission). Analysis of 16 patients in remission indicated the presence of presentation phenotypes in 0.2% to 7.9% of the lymphocyte + blast light scatter region, representing 0.03% to 1.4% of the total nucleated marrow cells. Of the 16 patients with > or = 4 months follow-up after detection of these cells, 6 of 6 patients with > or = 0.2% unusual presentation phenotypic marrow cells have relapsed, while 9 of 10 patients with < 0.2% remain in remission. The detection of cells with the unusual presentation phenotype may reflect residual AML cells, and their increase may predict relapse.
使用一组22种抗体对272例急性髓系白血病（AML）患者的免疫表型进行了分析。在所有病例的85%中发现了原始细胞表面标志物异常共表达（在正常骨髓中发生率≤0.1%）的数值证据，且原始细胞≥10%。70%的病例出现了髓系分化抗原的异步表达。在所有AML病例中，T淋巴细胞、B淋巴细胞或自然杀伤（NK）标志物与髓系标志物异常共表达的发生率分别为38%、13%和21%。双色和三色分析在15例病例中的15例中证实了共表达，并表明这些百分比被低估了，因为在没有数值重叠的病例中也可证实共表达。这些数据表明，正常分化抗原的异常共表达在AML中很常见。13例患者中有12例患者初诊和复发时的标志物相似，2例患者在首次复发时检测到的异常表型在第二次复发时再次出现，表明这些免疫表型在大多数AML患者中是稳定的。发现t(8;21)细胞遗传学与CD19和CD15或CD34共表达、t(9;22)与CD19和CD34共表达以及t(15;17)与CD2和髓系抗原共表达之间存在显著相关性。当原始细胞计数<5%（经典缓解）时，多参数荧光分析可检测到异常表型。对16例缓解期患者的分析表明，在淋巴细胞+原始细胞光散射区域中，初诊表型的细胞占0.2%至7.9%，占骨髓有核细胞总数的0.03%至1.4%。在检测到这些细胞后进行了≥4个月随访的16例患者中，异常初诊表型骨髓细胞≥0.2%的6例患者中有6例复发，而异常初诊表型骨髓细胞<0.2%的10例患者中有9例仍处于缓解期。检测到具有异常初诊表型的细胞可能反映残留的AML细胞，其增加可能预示复发。
