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Orazi A, Cattoretti G, Sozzi G, Miozzo M, Polli N, Delia D, Viviani S, Negretti E, Della Porta G, Rilke F. Morphologic, Immunologic, and Cytogenetic Characteristics of Secondary Acute Unclassifiable Leukemia in Hodgkin's Disease. TUMORI JOURNAL 2018; 74:439-50. [PMID: 3188241 DOI: 10.1177/030089168807400411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blast cells from five cases of secondary unclassifiable leukemia following therapy for Hodgkin's disease were studied by cytochemical, immunological and cytogenetic analyses. Cytochemical and immunological reactivity were in accordance with poorly differentiated, myeloid blasts. The four cases in which karyotype analysis was performed showed specific chromosomal abnormalities. No evidence of multiple lineage involvement was found. Problems in classifying these cases of secondary ANLL were due to the high grade of undifferentiation of the blast cells. Their low cytochemical reactivity with markers of myeloid differentiation was similar to what may be observed in patients with acute undifferentiated leukemia or with chronic myeloid leukemia in blast crisis.
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Affiliation(s)
- A Orazi
- Divisione di Anatomia Patologica e Citologia, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italia
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4
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Huh YO, Smith TL, Collins P, Bueso-Ramos C, Albitar M, Kantarjian HM, Pierce SA, Freireich EJ. Terminal deoxynucleotidyl transferase expression in acute myelogenous leukemia and myelodysplasia as determined by flow cytometry. Leuk Lymphoma 2000; 37:319-31. [PMID: 10752983 DOI: 10.3109/10428190009089432] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The significance of terminal deoxynucleotidyl transferase (TdT) expression in acute myelogenous leukemia (AML) remains controversial. Therefore, we studied TdT expression by flow cytometry in 120 previously untreated patients with AML or myelodysplastic syndrome (MDS) to determine the distribution of TdT-positive blasts and the intensity of TdT expression and to seek clinically significant associations. TdT expression measured by flow cytometry (flow TdT%) was heterogeneous, ranging from 0.1% to 87% (median, 8.5%), and 74 patients (62%) had at least 5% TdT-positive blasts. TdT positivity was associated with the M0 or M1 subtype and with expression of CD34 and CD7. No significant correlation was found between TdT expression and type of cytogenetic abnormality or rearrangement of immunoglobulin or T-cell receptor genes. Remission lasted longer in patients with a flow TdT% < 5 than in patients with a flow TdT% > 5 (median, 95 weeks vs 55 weeks, p = 0.02); however, complete remission rates did not differ when patients were classified by initial flow TdT%. Survival was slightly better for patients with flow TdT% less than 5%. Among patients with a flow TdT% > 5%, those with a higher TdT intensity survived longer than those with a lower intensity. These data suggest that quantitative TdT measurement may contribute to prognostic estimate in AML patients.
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Affiliation(s)
- Y O Huh
- Department of Hematopathology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
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5
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Mahajan KN, Gangi-Peterson L, Sorscher DH, Wang J, Gathy KN, Mahajan NP, Reeves WH, Mitchell BS. Association of terminal deoxynucleotidyl transferase with Ku. Proc Natl Acad Sci U S A 1999; 96:13926-31. [PMID: 10570175 PMCID: PMC24167 DOI: 10.1073/pnas.96.24.13926] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Terminal deoxynucleotidyl transferase (TdT) catalyzes the addition of nucleotides at the junctions of rearranging Ig and T cell receptor gene segments, thereby generating antigen receptor diversity. Ku is a heterodimeric protein composed of 70- and 86-kDa subunits that binds DNA ends and is required for V(D)J recombination and DNA double-strand break (DSB) repair. We provide evidence for a direct interaction between TdT and Ku proteins. Studies with a baculovirus expression system show that TdT can interact specifically with each of the Ku subunits and with the heterodimer. The interaction between Ku and TdT is also observed in pre-T cells with endogenously expressed proteins. The protein-protein interaction is DNA independent and occurs at physiological salt concentrations. Deletion mutagenesis experiments reveal that the N-terminal region of TdT (131 amino acids) is essential for interaction with the Ku heterodimer. This region, although not important for TdT polymerization activity, contains a BRCA1 C-terminal domain that has been shown to mediate interactions of proteins involved in DNA repair. The induction of DSBs in Cos-7 cells transfected with a human TdT expression construct resulted in the appearance of discrete nuclear foci in which TdT and Ku colocalize. The physical association of TdT with Ku suggests a possible mechanism by which TdT is recruited to the sites of DSBs such as V(D)J recombination intermediates.
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Affiliation(s)
- K N Mahajan
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA
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6
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Abstract
The French-American-British (FAB) classification of acute leukemias is based on the light microscopic detection of myeloperoxidase (MPO) activity in blast cells. Cells with MPO activity in > 3% of cells are classified as acute myeloid leukemia (AML) and usually express myeloid cell surface antigens. We describe a case of acute leukemia in which the blast cells have lymphoid morphology, ultrastructure, immunophenotype, and molecular rearrangements, but express significant amounts of MPO. We discuss the incidence, features, and outcome of MPO-positive acute lymphoblastic leukemia (ALL).
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Affiliation(s)
- S Wright
- Division of Laboratory Medicine, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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7
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Schmidt CA, Przybylski G, Seeger K, Siegert W. TCR delta gene rearrangements in acute myeloid leukemia with T-lymphoid antigen expression. Leuk Lymphoma 1995; 20:45-9. [PMID: 8750622 DOI: 10.3109/10428199509054752] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In this review we present our data concerning T-cell receptor (TCR) delta gene rearrangements in acute myeloid leukemia with coexpression of T-lymphoid features (CD2/CD4/CD7; Ly+ AML). We found a correlation between TCR delta gene rearrangements and coexpression of these T-lymphoid features. Ten of 66 Ly+ AML and only one of 44 AML cases without this coexpression exhibited TCR delta gene rearrangements (p = .028). In contrast, no correlation was observed between terminal deoxynucleotidyl transferase (TdT) expression and the occurrence of TCR delta gene rearrangements in AML. Rearrangements were found in two of 25 AML with and seven of 71 AML cases without TdT expression. Interestingly, nucleotide sequencing of junctional sites revealed up to 36 N-nucleotides in cases without or with only weak TdT expression indicating downregulation of TdT expression after the TCR rearrangement took place. Complete V delta 1J delta 1 and incomplete D delta 2J delta 1 gene rearrangements were observed most frequently in Ly+ AML. These recombination patterns were similar to patterns observed in acute T-lymphoblastic leukemia with coexpression of myeloid features (My+ T-ALL) suggesting transformation of a common myeloid/T-lymphoid progenitor cell in these cases.
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Affiliation(s)
- C A Schmidt
- Abt. Hämatologie und Onkologie, Freie Universität Berlin, Germany
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Wang JC, Beauregard P, Soamboonsrup P, Neame PB. Monoclonal antibodies in the management of acute leukemia. Am J Hematol 1995; 50:188-99. [PMID: 7485080 DOI: 10.1002/ajh.2830500307] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This report reviews the diagnostic significance of immune markers, their relationship to patient outcome, and the therapeutic uses of monoclonal antibodies (MoAbs) in acute leukemia. Immunophenotyping allows for rapid and reproducible diagnosis in the majority of cases of acute leukemia. It is of particular importance in recognizing the major immunologic subclasses of acute lymphoblastic leukemia (ALL), and in identifying subtypes of acute myeloblastic leukemia (AML) which cannot be differentiated by morphology and cytochemistry alone, such as FAB M0 or M7. Immune marker analysis has been used to detect minimal residual disease in patients' bone marrow and CSF after treatment. However, the presence of leukemia-associated phenotypes on small numbers of normal cells may reduce the sensitivity of detection in some cases. The prognostic value of immune markers in AML is limited. In ALL, the prognostic significance of the different immunophenotypic subtypes has been lessened by modern treatment protocols. The relationship of mixed-lineage or biphenotypic antigen expression to patient outcome in both AML and ALL is unclear. Therapeutic applications of MoAbs in acute leukemia include immunologic techniques for purging malignant cells from autografts prior to transplantation, T-lymphocyte depletion from allografts as a strategy to reduce graft-versus-host disease, and the use of flow cytometry to monitor the timing and extent of leukapheresis in peripheral stem cell transplantation. MoAbs have also enabled the recent development of transplantation protocols using positively-selected CD34+ stem cells.
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Affiliation(s)
- J C Wang
- Department of Laboratory Medicine, Hamilton Civic Hospitals, Ontario, Canada
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Venditti A, Del Poeta G, Stasi R, Masi M, Bruno A, Buccisano F, Cox C, Coppetelli U, Aronica G, Simone MD. Minimally differentiated acute myeloid leukaemia (AML-M0): cytochemical, immunophenotypic and cytogenetic analysis of 19 cases. Br J Haematol 1994; 88:784-93. [PMID: 7819103 DOI: 10.1111/j.1365-2141.1994.tb05118.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We describe our experience in the identification of 19 cases of AML-M0 categorized among 200 consecutive AML cases. Leukaemic cells from our cases were morphologically marked by agranular basophilic cytoplasm, finely dispersed chromatin and prominent nucleoli. In two cases heavily vacuolated and monocytoid-shaped blasts were also observed. Cytochemistry (MPO, SBB, alpha ANAE, alpha NBE, NASDCAE, AP, PAS) was negative in 14 cases, five cases expressing a very faint cytoplasmic positivity for alpha NBE (not exceeding 30% of the blasts) and alpha ANAE (not exceeding 41%) which was sodium fluoride resistant. In these five cases other monocytic markers (e.g. CD14) were not in favour of myelomonocytic differentiation. All the cases were anti-MPO positive at frequency > 10%. Phenotypic analysis also revealed myeloid features with all the patients having at least one myeloid antigen (CD13, CD33, CD15), Tdt was expressed in nine cases and CD7 in six cases. All cases but one were positive for CD34. Cytogenetic analysis, performed in 16 cases, showed no adequate growth in two cases and no consistent abnormality in four; among the remaining 10 cases no consistent abnormality was observed, the most common finding was trisomy 8 (two cases) and 4 (two cases) and aberrations of chromosomes 2, 3, 5, 7, 9, 12 and 21. No cases of (t9;22), Ph chromosome were observed. Interestingly three out of five patients with faint alpha NBE/alpha ANAE positivity relapsed as typical M4 (one case) or M5a (two cases).
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Affiliation(s)
- A Venditti
- Cattedra di Ematologia, Ospedale S. Eugenio, Università di Roma Tor Vergata, Italy
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Casasnovas RO, Solary E, Campos L, Maynadie M, Favre M, Bremend JL, Garand R, Béné MC, Faure G. Prognostic relevance of surface markers in adult de novo acute myeloblastic leukemias: a prospective study of the Groupe d'Etude Immunologique des Leucémies (G.E.I.L.). Leuk Lymphoma 1994; 13 Suppl 1:7-10. [PMID: 8075584 DOI: 10.3109/10428199409052665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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11
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Neame PB, Soamboonsrup P, Quigley JG, Pewarchuck W. The use of monoclonal antibodies and immune markers in the diagnosis, prognosis, and therapy of acute leukemia. Transfus Med Rev 1994; 8:59-75. [PMID: 8136608 DOI: 10.1016/s0887-7963(94)70098-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- P B Neame
- Department of Laboratory Medicine, Hamilton Civic Hospitals, Ontario, Canada
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12
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Abstract
Immunophenotyping with monoclonal antibodies to leucocyte differentiation antigens has an established diagnostic role in the laboratory investigation of acute leukemia. In the vast majority of cases, a hemopoietic lineage can be confidently assigned; namely, acute myeloid leukemia (AML), or the precursor-B and precursor-T variants of acute lymphoblastic leukemia (ALL). The areas of greatest practical importance are in morphologically difficult or undifferentiated cases, and in distinguishing between the major variants of precursor-B and T-ALL. Cases with aberrant patterns of marker expression (acute mixed lineage leukemia, lineage infidelity) are frequently encountered in both ALL and AML, and can lead to diagnostic confusion. However, correlation with morphology and other clinicopathologic features, and careful consideration of the weight of phenotyping evidence almost always allows the correct lineage to be identified. The prognostic value of phenotypic information in acute leukemia is generally limited. Recognition of the major variants of ALL is still of clinical importance, but the significance of myeloid antigen positivity in ALL is controversial, and may not have prognostic value. Patterns of myeloid antigen expression in AML have limited prognostic significance, while the relationship between lymphoid antigen expression and treatment response in AML remains highly controversial. Careful evaluation of the predictive power of immunophenotype in large controlled clinical trials in acute leukemia is still required.
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Affiliation(s)
- K F Bradstock
- Haematology Department, Institute of Clinical Pathology and Medical Research, Westmead Hospital, New South Wales
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13
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Orfao A, Vidriales B, Gonzalez M, Lopez-Berges MC, del Cañizo MC, San Miguel JF. Diagnostic and prognostic importance of immunophenotyping in adults with acute myeloid leukemia. Recent Results Cancer Res 1993; 131:369-79. [PMID: 8210655 DOI: 10.1007/978-3-642-84895-7_33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- A Orfao
- Department of Cytometry, University Hospital of Salamanca, Spain
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14
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Sperling C, Seibt-Jung H, Gassmann W, Komischke B, Sauerland C, Hiddemann W, Löffler H, Büchner T, Thiel E, Ludwig WD. Immunophenotype of acute myeloid leukemia: correlation with morphological characteristics and therapy response. Recent Results Cancer Res 1993; 131:381-92. [PMID: 8210656 DOI: 10.1007/978-3-642-84895-7_34] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- C Sperling
- Department of Hematology/Oncology, Klinikum Steglitz, Free University Berlin, Fed. Rep. of Germany
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Haas OA, Köller U, Grois N, Nowotny H. Immunophenotype of hematologic neoplasms with a translocation t(8;21). Recent Results Cancer Res 1993; 131:361-8. [PMID: 8210654 DOI: 10.1007/978-3-642-84895-7_32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- O A Haas
- Children's Cancer Research Institute, St. Anna Children's Hospital, Vienna, Austria
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16
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Moscinski LC, Nowell PC, Hoxie JA, Berger MS, Prystowsky MB. Surface marker analysis and karyotype distinguish acute biphenotypic leukemia from acute myelogenous leukemia expressing terminal deoxynucleotidyl transferase. Cancer 1991; 68:2161-8. [PMID: 1913454 DOI: 10.1002/1097-0142(19911115)68:10<2161::aid-cncr2820681013>3.0.co;2-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Surface phenotyping by flow cytometry and cytochemical study were used to identify 15 adult patients with acute leukemia displaying ambiguous phenotypes. Differences were found in the blast cell karyotype and immunoglobulin gene rearrangements of terminal deoxynucleotidyl transferase (TdT)-positive acute myelogenous leukemia (AML) and biphenotypic leukemia expressing B lymphoid and myeloid markers. The karyotypic abnormalities, t(9;22) and t(4;11), were noticed in acute biphenotypic leukemia, and were consistently associated with rearrangement at the immunoglobulin locus. Furthermore, coexpression of CD19/CD20 and either myeloperoxidase or myeloid surface markers were predictive of finding the t(9;22) or t(4;11) karyotype. Patients with TdT-positive AML, on the other hand, were less likely to show rearrangement at the immunoglobulin locus, and did not have the t(9;22) or t(4;11). Instead, a variety of nonrandom karyotypic abnormalities were seen, including trisomy 13. Unlike common AML, the majority of TdT-positive cases demonstrated an abnormal karyotype with duplications and/or deletions present in all cases. In no instance was trisomy 8, t(8;21), t(15;17), or any other isolated translocation identified. The authors therefore suggest that immunophenotyping, when combined with cytochemical analysis of TdT and myeloperoxidase or Sudan black B, may aid in the characterization of subgroups of atypical acute leukemia, such that alternate approaches to therapy can be evaluated.
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MESH Headings
- Antigens, Neoplasm/analysis
- Antigens, Surface/analysis
- Blotting, Northern
- Blotting, Southern
- Burkitt Lymphoma/enzymology
- Burkitt Lymphoma/genetics
- Burkitt Lymphoma/immunology
- DNA Nucleotidylexotransferase/analysis
- DNA, Neoplasm/analysis
- Female
- Gene Rearrangement
- Humans
- Immunophenotyping
- Karyotyping
- Leukemia, Myeloid, Acute/enzymology
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/immunology
- Male
- Middle Aged
- RNA, Neoplasm/analysis
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Affiliation(s)
- L C Moscinski
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia
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17
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Gucalp R, Paietta E, Weinberg V, Papenhausen P, Dutcher JP, Wiernik PH. Terminal transferase expression in acute myeloid leukaemia: biology and prognosis. Br J Haematol 1991; 78:48-54. [PMID: 2043481 DOI: 10.1111/j.1365-2141.1991.tb04381.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Clinical and biological features were assessed in 114 consecutive previously untreated adult acute myeloid leukaemia (AML) patients whose diagnosis was based on FAB criteria and detailed immunophenotyping. All patients received standard intensive chemotherapy. The main purpose of this study was to establish the prognostic value, if any, of terminal transferase (TdT) expression in myeloid leukaemia. TdT positive cells (7-80% of total blast cells) were detected in 40% of the cases. Among clinical characteristics, a low lactate dehydrogenase (LDH) (less than 250 I.U.) (P = 0.003), a low initial white blood cell count (less than 10 x 10(9)/l) (P = 0.002), and an absolute neutrophil count (less than 5 x 10(9)/l) (P = 0.02) were associated with TdT-positivity. FAB classification was not predictive of TdT expression, and there was no difference in the distribution of FAB subtypes between the groups. Multivariate analysis combining clinical and laboratory data indicated that a low expression of the monocytic antigen CD14 was predictive of TdT positivity in AML (P = 0.01). Karyotyping showed no difference in the pattern of occurrence of specific abnormalities between the TdT+ and the TdT- group. When clinical and immunophenotype data were included in a prognostic model, the patient's age was highly predictive of response (P less than 0.001), and only the CDw65 antigen contributed to the response model (P = 0.07). TdT+ patients with a low expression of CD11b achieved a higher frequency of response at a borderline level of significance (P = 0.06). Frequency of response to chemotherapy, the response duration or overall survival were not influenced by TdT expression.
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Affiliation(s)
- R Gucalp
- Department of Oncology, Montefiore Medical Center, Bronx, New York 10467
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18
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Drach J, Gattringer C, Huber H. Combined flow cytometric assessment of cell surface antigens and nuclear TdT for the detection of minimal residual disease in acute leukaemia. Br J Haematol 1991; 77:37-42. [PMID: 1998595 DOI: 10.1111/j.1365-2141.1991.tb07945.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To define more precisely the immunophenotype of lymphoid blast cells, a new flow cytometric technique for the simultaneous detection of surface antigens and nuclear terminal deoxynucleotidyl transferase (TdT) was established. After staining for the cell surface marker, mononuclear cells were treated with paraformaldehyde (1%) and methanol to permeabilize the cell membrane. Then the cells were stained by indirect immunofluorescence using a rabbit anti-human TdT antibody. Dilution experiments were performed to reveal the sensitivity of the described flow cytometric assay: 0.02% leukaemic cells could reliably be detected above background level among normal peripheral blood lymphocytes. It is concluded that the double-staining procedure described here is a sensitive tool that contributes to the detection of minimal residual disease in a substantial proportion of acute leukaemias.
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Affiliation(s)
- J Drach
- Department of Internal Medicine, University of Innsbruck, Austria
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19
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Sun GX, Sparkes RS, Wormsley S, Naeim F, Champlin R, Gale RP. Are some cases of acute leukemia with t(8;21) hybrid leukemias? CANCER GENETICS AND CYTOGENETICS 1990; 49:177-84. [PMID: 2170002 DOI: 10.1016/0165-4608(90)90140-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Translocations between chromosomes 8 and 21, t(8;21)(q22;q22), occur most commonly in acute myelogenous leukemia (AML) of the M2 FAB type. We studied two cases of acute leukemia with t(8;21) by immune phenotyping and IgH and T-cell receptor beta chain gene rearrangement analyses. These cases had increased blasts in bone marrow (greater than 50%). Auer rods, and evidence of granulocyte maturation. Blasts from both cases expressed CD19(B4), a B-cell antigen, as well as myeloid antigens including CD13(My7) and CD33(My9). HLA-DR, CD34, and TdT were also strongly positive. IgH or TCR beta gene rearrangements were not detected. We suggest that some cases of acute leukemia with t(8;21) may be hybrid leukemias with transformation in a multipotent stem cell.
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MESH Headings
- Adult
- Antigens, CD/analysis
- Blotting, Southern
- Chromosomes, Human, Pair 18
- Chromosomes, Human, Pair 21
- Gene Rearrangement, beta-Chain T-Cell Antigen Receptor
- Humans
- Immunophenotyping
- Karyotyping
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/immunology
- Male
- Middle Aged
- Translocation, Genetic
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Affiliation(s)
- G X Sun
- Department of Medicine, UCLA School of Medicine 90024-1678
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20
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Storr J, Dolan G, Coustan-Smith E, Barnett D, Reilly JT. Value of monoclonal anti-myeloperoxidase (MPO7) for diagnosing acute leukaemia. J Clin Pathol 1990; 43:847-9. [PMID: 1977771 PMCID: PMC502837 DOI: 10.1136/jcp.43.10.847] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The expression of myeloperoxidase (MPO) was studied in 100 cases of acute leukaemia (83 with acute myeloid leukaemia (AML) and 17 acute lymphoblastic leukaemia (ALL) by both a conventional cytochemical method and the immunocytochemical antiperoxidase (APAAP) technique using the monoclonal antibody MPO7. In each case the staining was evaluated by light microscopical examination (percentage of positive cells). Of the 83 cases of AML, 78 (93.9%) were positive for MPO7 compared with 70 (84.3%) by cytochemistry. Antibodies against the myeloid markers CD13 and CD33 were positive in 71 (85.5%) and 70 (84.3%) cases, respectively. Importantly, all cases of ALL were negative for both MPO7 and cytochemical MPO staining even when they were positive for CD13 and CD33. These results indicate that the anti-myeloperoxidase antibody MPO7 is the most sensitive and specific reagent for the diagnosis of AML and should therefore be included in routine immunophenotyping panels.
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Affiliation(s)
- J Storr
- Department of Haematology, Northern General Hospital, Sheffield
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21
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Adriaansen HJ, Hooijkaas H, Kappers-Klunne MC, Hählen K, van't Veer MB, van Dongen JJ. Double marker analysis for terminal deoxynucleotidyl transferase and myeloid antigens in acute nonlymphocytic leukemia patients and healthy subjects. HAEMATOLOGY AND BLOOD TRANSFUSION 1990; 33:41-9. [PMID: 2323649 DOI: 10.1007/978-3-642-74643-7_7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
MESH Headings
- Antigens, Differentiation/analysis
- Antigens, Neoplasm/analysis
- Biomarkers, Tumor/analysis
- Bone Marrow/analysis
- DNA Nucleotidylexotransferase/analysis
- Follow-Up Studies
- Hematopoietic Stem Cells/analysis
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/enzymology
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myelomonocytic, Acute/drug therapy
- Leukemia, Myelomonocytic, Acute/enzymology
- Leukemia, Myelomonocytic, Acute/immunology
- Neoplasm Proteins/analysis
- Neoplastic Stem Cells/analysis
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Affiliation(s)
- H J Adriaansen
- Department of Immunology, University Hospital Dijkzigt/Erasmus University, Rotterdam, The Netherlands
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22
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Ortuño F, Soler J, Vilella R, Bordes R, Guanyabens C, Rubiol E, Pujol-Moix N. Immunophenotype of blast cells in acute myelofibrosis. Leuk Res 1990; 14:849-56. [PMID: 2259222 DOI: 10.1016/0145-2126(90)90173-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The immunophenotype of peripheral blood blast cells from six patients with acute myelofibrosis was studied using a panel of monoclonal antibodies directed against granulocytic, erythroid, megakaryocytic and lymphoid antigenic determinants. In all patients most of the blast cells were labeled with anti-HLA-DR and with the early myelomonocytic antibodies My7 (CD13), My9 (CD33) and B1-3C5 (CD34) (3/3). In three cases, platelet antibodies Edu3 (CD41) and GPIIIa (CD61) reacted with about 30% of blast cells. TdT was positive in two out of six samples studied. Lymphoid markers T3 (CD3), Leu9 (CD7), J5 (CD10), B4 (CD19) and B1 (CD20) were negative in all cases. These results suggest that blast cells are mainly of immature myelocytic origin. However, the coexistence of megakaryoblasts cannot be ruled out in the cases with a proportion of cells that are positive with Edu3 and GPIIIa antibodies.
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Affiliation(s)
- F Ortuño
- Servei D'Hematologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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23
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Davey G, Bradstock KF, Kefford RF, Wishart Y, Kabral A, Grimsley P, Hughes WG. Lack of correlation between immunoglobulin and T cell receptor gene rearrangements and TdT expression in acute myeloid leukaemia. Leuk Res 1990; 14:77-83. [PMID: 1689438 DOI: 10.1016/0145-2126(90)90149-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Thirty-two cases of acute myeloid leukaemia (AML) were examined for expression of terminal deoxynucleotidyl transferase (TdT) and rearrangements of the genes coding for the immunoglobulin heavy chain and the beta chain of the T cell receptor, in order to establish whether these two forms of lineage infidelity are linked. In 17 cases of AML with greater than or equal to 10% TdT+ cells, three cases showed evidence of gene rearrangement, two having clonal rearrangements in the immunoglobulin gene and one with a rearranged T cell receptor gene. Among 15 AML cases without significant numbers of TdT-positive blasts, three cases had rearrangements in both immunoglobulin and T cell receptor genes, while a fourth case had an immunoglobulin gene rearrangement. No relationship was seen between lymphoid gene rearrangements and expression of the lymphoid surface antigens CD7 and CD10. The lack of association between TdT expression and gene rearrangements does not support the concept of an orderly activation of the recombinase machinery in those cases of AML with features of early lymphoid differentiation.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antigens, CD7
- Antigens, Differentiation/analysis
- Antigens, Differentiation, T-Lymphocyte/analysis
- Antigens, Neoplasm/analysis
- Blotting, Southern
- Child
- Child, Preschool
- DNA Nucleotidylexotransferase/metabolism
- Female
- Fluorescent Antibody Technique
- Gene Rearrangement
- Gene Rearrangement, beta-Chain T-Cell Antigen Receptor
- Genes, Immunoglobulin
- Humans
- Leukemia, Myeloid, Acute/enzymology
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/immunology
- Male
- Middle Aged
- Neprilysin
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Affiliation(s)
- G Davey
- Department of Haematology, Westmead Hospital, N.S.W., Australia
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24
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Bradstock KF, Kirk J, Grimsley PG, Kabral A, Hughes WG. Unusual immunophenotypes in acute leukaemias: incidence and clinical correlations. Br J Haematol 1989; 72:512-8. [PMID: 2673329 DOI: 10.1111/j.1365-2141.1989.tb04315.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The incidence and clinical implications of unusual patterns of expression of leucocyte differentiation antigens in acute leukaemia were assessed on 568 newly diagnosed paediatric and adult cases undergoing immunophenotyping with a panel of monoclonal antibodies at a single centre. Among patients with the precursor B (common) form of acute lymphoblastic leukaemia (ALL), the major variant seen was the group of 15 cases with expression of myeloid surface antigens. 4.5% of ALL cases tested with antibody to CD-11b were positive, 5.1% were CD-13+, and 10.8% CD-33+. All 15 patients achieved a complete remission with chemotherapy, with six of eight children and four of seven adults remaining disease free. A smaller proportion (1.5%) of precursor B ALL patients showed expression of the T lineage marker, CD-7. The only significant variant seen in the precursor T-ALL group was expression of HLA-DR antigen, which was found in five of 35 cases; although all responded to treatment, only one remains a disease-free survivor. Among patients with acute myeloid leukaemia (AML), expression of the lymphoid markers terminal transferase (TdT) and CD-7 were commonly seen (22.2% and 28.4% respectively of cases tested). Other lymphoid markers detected on AML cases were CD2 (11.1%), CD-10 (1%) and CD-19 (4.4%). These results confirm that examples of lineage infidelity are regularly seen in large series of patients with acute leukaemia. Prospective studies using uniform treatment protocols are required to establish whether these patients have significantly different disease outcomes.
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Affiliation(s)
- K F Bradstock
- Haematology Department, Westmead Hospital, New South Wales, Australia
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25
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Lo Coco F, Lopez M, Pasqualetti D, Montefusco E, Cafolla A, Monarca B, Sgadari C, De Rossi G. Terminal transferase positive acute myeloid leukemia: immunophenotypic characterization and response to induction therapy. Hematol Oncol 1989; 7:167-74. [PMID: 2646199 DOI: 10.1002/hon.2900070208] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A quantitative evaluation of terminal deoxynucleotidyl transferase (TdT) was performed using a highly sensitive enzyme immunoassay (EIA) in 72 previously untreated patients with acute myeloid leukemia (AML). Biological analysis of the leukemic cells included in all cases cytochemistry, search for Ph' chromosome and immunophenotyping with both anti-lymphoid and anti-myeloid monoclonal antibodies (MoAbs). Thirteen AML cases (18 per cent) were considered TdT+ by EIA. According to the FAB classification, almost all of them (12 out of 13) were within the M1 and M2 subgroups. A mixed lymphoid-myeloid phenotype was observed in one of the 13 TdT+ cases, while in none of the others were lymphoid features detected. Nine of the 10 EIA TdT+ cases studied in parallel were TdT positive with the conventional immunofluorescence assay. All patients received standard protocol chemotherapy and in 61 (13 TdT+, 48 TdT--) the response to induction treatment was analysable. Only 3/13 TdT+ patients (23 per cent) achieved a complete remission (CR), while in the TdT- group 38 patients had a CR (79 per cent) and 10 were resistant (p less than 0.01). It is suggested that the incidence, biological interest and prognostic significance of TdT+ AML should encourage the routine and more accurate search for this marker in all patients with AML.
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Affiliation(s)
- F Lo Coco
- Biopathology Department, University La Sapienza of Rome, Italy
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26
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Ohyashiki JH, Ohyashiki K, Toyama K, Kimura N, Minowada J, Kinniburgh AJ, Sandberg AA. T-cell receptor gene rearrangement and its expression in human myeloid leukemia cell lines. CANCER GENETICS AND CYTOGENETICS 1989; 37:193-200. [PMID: 2702618 DOI: 10.1016/0165-4608(89)90048-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
ML cell lines (ML-1, -2, and -3) were derived from the cells of a patient with acute myelocytic leukemia preceded by a T-cell malignant lymphoma. A deletion of chromosome 11 (11q-) was common to the affected cells in both neoplastic phases. We report here that the three ML cell lines have DNA rearrangements of the T-cell receptor (TcR)-beta and gamma-chain genes in addition to immunoglobulin heavy-chain gene rearrangement, though they do not have TcR gene messages. The findings presented here indicate that ML cell lines could be used as models for the elucidation of the bilineal nature of hematopoietic neoplastic cells, though they have a biphenotypic (myelomonocytic/T-cell) marker expression.
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Affiliation(s)
- J H Ohyashiki
- Department of Internal Medicine, Tokyo Medical College, Japan
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27
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Neudorf S, DeLaat C, Jones M. Expression of the CD4 molecule on acute nonlymphocytic leukemia (ANLL) cell lines. J Clin Lab Anal 1989; 3:312-5. [PMID: 2809881 DOI: 10.1002/jcla.1860030510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Mature and immature monocytes express the CD4 molecule similar to that expressed on lymphocytes. Since monocytes and cells of myeloid lineage are derived from a common progenitor, we studied a panel of nine myeloid leukemia cell lines for the expression of the CD4 molecule. We found that six of nine myeloid leukemia cell lines (U937, KG1-B, HL-60, THP-1, HEL 92.1.7, KMOE) expressed CD4, the exceptions being the erythroleukemia line K562, myeloblast line KG1-REV, and megakaryocytic line, CHRF-288. SDS-PAGE analysis of HL-60 cells immunoprecipitated with OKT4 showed the presence of a 55 kd molecule similar in weight to that seen on lymphocytes. These data suggest that some myeloid progenitor cells express the CD4 molecule and that the CD4 may have a broader distribution within hematopoietic cells.
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MESH Headings
- CD4 Antigens/analysis
- Cell Line
- Hematopoietic Stem Cells/immunology
- Humans
- Leukemia, Erythroblastic, Acute/immunology
- Leukemia, Megakaryoblastic, Acute/immunology
- Leukemia, Monocytic, Acute/immunology
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Promyelocytic, Acute/immunology
- Monocytes/immunology
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Affiliation(s)
- S Neudorf
- Division of Hematology/Oncology, Children's Hospital Research Foundation, Cincinnati, OH 45229
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28
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Cytochemistry and Immunocytochemistry in Bone Marrow Examination: Contemporary Techniques for the Diagnosis of Acute Leukemia and Myelodysplastic Syndromes: A Combined Approach. Hematol Oncol Clin North Am 1988. [DOI: 10.1016/s0889-8588(18)30583-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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29
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Swirsky DM, Greaves MF, Gray RG, Rees JK. Terminal deoxynucleotidyl transferase and HLA-DR expression appear unrelated to prognosis of acute myeloid leukaemia. Br J Haematol 1988; 70:193-8. [PMID: 2973345 DOI: 10.1111/j.1365-2141.1988.tb02463.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Mononuclear cells from peripheral blood or bone marrow from 314 patients with acute myeloid leukaemia were examined for the presence of nuclear terminal deoxynucleotidyl transferase (304 patients), surface membrane expression of HLA-DR (314 patients) and the common acute lymphoblastic leukaemia antigen (281 patients). All patients were treated with identical remission induction chemotherapy, and morphological diagnosis was carried out in a central laboratory. The overall complete remission rate was 70%. There were no significant correlations between the immunological markers and complete remission rate, duration of remission, or survival.
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Affiliation(s)
- D M Swirsky
- Department of Haematological Medicine, Cambridge University
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30
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Parreira A, Pombo de Oliveira MS, Matutes E, Foroni L, Morilla R, Catovsky D. Terminal deoxynucleotidyl transferase positive acute myeloid leukaemia: an association with immature myeloblastic leukaemia. Br J Haematol 1988; 69:219-24. [PMID: 3164631 DOI: 10.1111/j.1365-2141.1988.tb07625.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The morphology, membrane markers and ultrastructural cytochemistry of 39 cases of acute myeloid leukaemia (AML) with variable proportion (10-99%) of terminal deoxynucleotidyl transferase (TdT) positive blasts was compared with that of 134 cases of TdT negative AML. The incidence of TdT positive AML was 22.5% and this was significantly higher in poorly differentiated myeloblastic (M0 and M1) types (54%) than in all other FAB subtypes (10%; P less than 0.001). Our findings suggest heterogeneity among TdT positive cases. Whilst the majority correspond to genuine TdT positive AML in which evidence for exclusive myeloid nature was demonstrated by phenotypic, cytochemical and ultrastructural markers, a distinct minority (22%) of cases had mixtures of lymphoid and myeloid blasts. A change in phenotype occurred in three out of six cases studied in relapse. There was no difference in the incidence of immunoglobulin (Ig) gene rearrangement between TdT positive (two out of 12) and TdT negative (one out of 11) cases, although published data suggests that Ig gene rearrangement is significantly more common in TdT positive cases. The determination of TdT in AML allows the identification of cases of mixed acute leukaemia which probably represent proliferations of multipotent progenitor cells. The majority of TdT positive cases, nevertheless, correspond to immature types of myeloblastic leukaemia which may constitute a clinically distinct subgroup.
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Affiliation(s)
- A Parreira
- MRC Leukaemia Unit, Royal Postgraduate Medical School, London
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31
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32
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Abstract
In recent years immunophenotyping and analysis of clonal rearrangement of immunoglobulin and T-cell antigen receptor genes have proved valuable for the diagnosis and classification of leukaemia. These techniques aid in the assignment of cell lineage in cases of acute leukaemia in which the standard FAB criteria of morphology and cytochemistry do not reveal clear lymphoid or myeloid phenotype. These new techniques have also revealed that the leukaemic blasts in a sizable minority of otherwise typical cases of acute leukaemia express 'inappropriate' lineage-associated markers and have been termed mixed acute leukaemias. The spectrum of characteristics encompassed by mixed acute leukaemias ranges from fairly common cases expressing one or two inappropriate markers to the more extreme, rare cases of acute leukaemia termed 'hybrid' in which a truly scrambled picture is seen. A subgroup of these mixed cases have two distinct populations of blasts, e.g. one lymphoid and the other myeloid. These observations raise a number of issues about the cell of origin of these leukaemias and about the mechanisms controlling the developmental regulation of expression of different lineage-associated markers. In addition, accumulating evidence suggests that inappropriate expression of markers may identify sub-groups of both acute myeloid and lymphoblastic leukaemia with an inferior prognosis.
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Affiliation(s)
- A V Hoffbrand
- Department of Haematology, Royal Free Hospital School of Medicine, London, UK
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33
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Oster W, König K, Ludwig WD, Ganser A, Lindemann A, Mertelsmann R, Herrmann F. Incidence of lineage promiscuity in acute myeloblastic leukemia: diagnostic implications of immunoglobulin and T-cell receptor gene rearrangement analysis and immunological phenotyping. Leuk Res 1988; 12:887-95. [PMID: 2851073 DOI: 10.1016/0145-2126(88)90015-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Sixty-nine blood or bone marrow samples from both children and adults with acute myeloblastic leukemia (AML) were investigated to elucidate the frequency of immunoglobulin (IG) and T-cell receptor (TCR)-gene rearrangements. Non-germline configuration for the IG heavy chain (h) gene was detected in the specimens of nine patients of various subtypes according to the French-American-British classification (FAB), including FAB M1, M2, M4 and M5. Rearrangement of the IG kappa chain (k) gene was present in one of these cases which simultaneously revealed a rearranged TCR-beta (b) chain gene. In another two AML samples we found TCR-b gene rearrangements, in one case in combination with an IG-h gene rearrangement. IG-h gene rearrangements were detected in 10 cases, in one case in conjunction with an IG-kappa (k) and TCR-b gene rearrangement. A highly significant correlation between the occurrence of DNA rearrangements of the IG-h locus and nuclear staining with the enzyme terminal deoxynucleotidyl transferase (TdT) and surface expression of the CD 19 and CD 34 antigen could be identified: all 10 TdT positive AML samples rearranged IG-h. Similarly, six out of 69 AML samples exhibited surface expression of CD 19, five of these in combination with CD 34 and all of them rearranged the IG-h gene. The one leukemia with TCR-b gene rearrangement only was TdT positive as well, but did not express CD 19 or CD 34. We conclude that IG-h gene is rearranged in a substantial proportion of AML, strongly associated with a specific immunophenotype (TdT+, CD19+, CD34+), whereas TCR-b gene rearrangement appears more rarely. No positive correlation between occurrence of IG-h and TCR-b gene-rearrangements and one AML FAB-subtype was found, although a clustering of M1 and M4 FAB subtypes in the AML group showing reconstructed IG-h gene became evident.
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Affiliation(s)
- W Oster
- Department of Hematology, Johannes Gutenberg-Universität, Mainz, Federal Republic of Germany
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34
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Stark AN, MacKarill ID, Limbert HJ, Evans P, Scott CS. TdT expression in acute myeloid leukaemia. Haemopoietic immaturity or maturational asynchrony? BLUT 1988; 56:33-8. [PMID: 3422168 DOI: 10.1007/bf00321057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A total of 412 cases of acute leukaemia were examined for the presence of nuclear terminal deoxynucleotidyl transferase (TdT) by indirect immunofluorescence. Of the 129 cases of acute myeloblastic leukaemia (AML FAB groups M1/M2) examined, 18% (n = 23) had significant proportions (greater than 10%) of TdT-positive blasts. Although most of these AML cases (n = 18) were of poorly differentiated (M1) type; 5 cases of AML showing features of granulocytic differentiation (M2) were also found to be TdT-positive. Even though TdT was generally more strongly expressed in the M1 group and associated with other markers of myeloid immaturity (Ia positive and lack of chloroacetate esterase), there was no inverse relationship with Sudan black or myeloperoxidase activity. In addition, although the proportion of AML-M1 cases with increased TdT-positive cells was slightly higher (18/95, 19%) than for the AML-M2 group (5/34, 15%) the results suggest that the presence of nuclear TdT in leukaemic myeloblasts may not only reflect cellular immaturity but may also be due to maturational asynchrony in otherwise well-differentiated blasts.
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Affiliation(s)
- A N Stark
- Department of Hematology, Cookridge Hospital, Leeds, United Kingdom
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35
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Wain SL, Borowitz MJ. Practical application of monoclonal antibodies to the diagnosis and classification of acute leukaemias. CLINICAL AND LABORATORY HAEMATOLOGY 1987; 9:221-44. [PMID: 3308289 DOI: 10.1111/j.1365-2257.1987.tb00087.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- S L Wain
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
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36
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Umiel T, Nadler LM, Cohen IJ, Levine H, Stark B, Mammon Z, Dzaldetti M, Rechavi G, Simoni F, Katzir N. Undifferentiated leukemia of infancy with t(11:17) chromosomal rearrangement. Coexpressing myeloid and B cell restricted antigens. Cancer 1987; 59:1143-9. [PMID: 3102033 DOI: 10.1002/1097-0142(19870315)59:6<1143::aid-cncr2820590618>3.0.co;2-j] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
It has been suggested that the malignant transformation, in some of the acute leukemias, may involve totipotent stem cells resulting in a biphenotypic leukemia expressing both myeloid, and lymphoid characteristics. We describe here a hybrid cell acute leukemia, in a 16-day-old infant, in whom leukemic cells coexpressed myeloid and lymphoid B cell antigens. Blast cells in the bone marrow showed L2 morphology according to the French American British (FAB) classification, with positive periodic-acid Schiff, and nonspecific esterase staining. Sudan black, and specific esterase were negative. Terminal deoxynucleotidyl transferase, was strongly positive in 5% of blasts, and faintly reactive with the rest. Karyotypic analysis demonstrated a translocation of t(11:17);(q23;p13). Immunoglobulin gene analysis revealed rearrangement of the heavy chain genes. The blasts' phenotype was HLA/DR+ B4+ My7+ My9+ common acute lymphoblastic leukemia antigen (CALLA) B1- T11-. Dual immunofluorescence staining using anti My7, and My9 fluorescein isothiocyanate, and anti B4 pycoerythrin conjugated monoclonal antibodies, and flow cytofluorometry, revealed a labeling pattern of 25% B4+; 10% to 15% My7+; 17% My9+; and 50% of cells coexpressing B4 My7, and My9 antigens. These results provide evidence for a hybrid leukemia with lymphomyeloblasts being part of a single clone, which may indicate the origin of this leukemic clone from a pluripotent (lymphoid/myeloid) stem cell.
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MESH Headings
- Antibodies, Monoclonal
- Antigens, Neoplasm/analysis
- Antigens, Surface/analysis
- B-Lymphocytes/cytology
- B-Lymphocytes/immunology
- Cell Differentiation
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 17
- Hematopoietic Stem Cells/immunology
- Hematopoietic Stem Cells/pathology
- Humans
- Immunoglobulin Heavy Chains/genetics
- Infant, Newborn
- Leukemia/genetics
- Leukemia/immunology
- Leukemia/pathology
- Neoplastic Stem Cells/immunology
- Neoplastic Stem Cells/pathology
- Recombination, Genetic
- Translocation, Genetic
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37
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38
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Foa R, Casorati G, Giubellino MC, Basso G, Schirò R, Pizzolo G, Lauria F, Lefranc MP, Rabbitts TH, Migone N. Rearrangements of immunoglobulin and T cell receptor beta and gamma genes are associated with terminal deoxynucleotidyl transferase expression in acute myeloid leukemia. J Exp Med 1987; 165:879-90. [PMID: 3102679 PMCID: PMC2188294 DOI: 10.1084/jem.165.3.879] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The cell origin of the rare terminal deoxynucleotidyl transferase (TdT)-positive acute myeloid leukemias (AML) was investigated at the molecular level, by examining the configuration of the Ig H (Igh) and L (Ig kappa, Ig lambda) chain gene regions, and of the T cell receptor (TCR) beta and T cell rearranging (TRG) gamma loci. In 8 of the 10 TdT+ AML analyzed (classified as myeloid according to morphological and cytochemical criteria, and to the reactivity with one or more antimyeloid mAbs), a rearrangement of the Igh chain gene was found. In TdT- AML, evidence of an Igh gene reorganization was instead observed only in 2 of the 42 patients studied. Furthermore, evidence of TCR-beta and/or TRG-gamma gene rearrangement was observed in four AML, all of which belonged to the Igh-rearranged TdT+ group. In three cases (one TdT+ and two TdT-), the Ig kappa L chain gene was also in a rearranged position. These findings demonstrate a highly significant correlation between TdT expression and DNA rearrangements at the Igh and TCR chain gene regions and support the view that this enzyme plays an important role in the V-(D)-J recombination machinery. Overall, the genomic configuration, i.e., JH gene rearrangement sometimes coupled to a kappa L chain and TCR gene reorganization, similar to that found in non-T-ALL, suggests that in most cases of TdT+ AML, the neoplastic clone, despite the expression of myeloid-related features, is characterized by cells molecularly committed along the B cell lineage.
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39
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Ludwig WD, Herrmann F, Gatzke A, Budde M, Creutzig U, Ritter J, Schellong G. Surface marker analysis by monoclonal antibodies: a valuable technique in childhood acute myeloid leukemia. HAEMATOLOGY AND BLOOD TRANSFUSION 1987; 30:418-22. [PMID: 3476375 DOI: 10.1007/978-3-642-71213-5_73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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40
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San Miguel JF, Gonzalez M, Cañizo MC, Anta JP, Zola H, Lopez Borrasca A. Surface marker analysis in acute myeloid leukaemia and correlation with FAB classification. Br J Haematol 1986; 64:547-60. [PMID: 3466644 DOI: 10.1111/j.1365-2141.1986.tb02211.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The immunological phenotype of blast cells in 102 patients with acute myeloid leukaemia (AML) was analysed with a panel of 20 monoclonal antibodies and the enzyme terminal transferase, and correlated with the FAB classification. Although a partial correlation between these two approaches could be observed, almost every morphological group contained patients from more than one immunological phenotype. The M1 and M5a leukaemias showed the most undifferentiated phenotype, often lacking in specific myelomonocytic antigens. The M3 formed a uniform group defined as My7+, Ia-, FMC8+, a phenotype which was also observed in two cases of the microgranular variant. The granulocytic (CDw15) and monocytic (CDw14) antibodies crossreacted with some M5b and M2 leukaemias, respectively. Compared with M5a, the M5b leukaemias showed a large increase in the expression of CDw14 antigen, confirming the validity of the morphological differentiation. Glycophorin-A was present in four out of five M6 leukaemias. TdT activity was demonstrated in 10% of AML cases, with a higher incidence among the monocytic variants: M4 and M5-. Eleven AML were considered as unclassifiable according to the FAB criteria and in seven of them a megakaryoblastic cell population (GP IIb/IIIa+, GPIb+) was demonstrated; this confirms the need to include the subgroup of megakaryoblastic leukaemias within the AML. Finally, a possible immunological classification for AML is proposed.
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41
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Bradstock KF, Kerr A, Kabral A, Favaloro EJ, Hewson JW. Coexpression of p165 myeloid surface antigen and terminal deoxynucleotidyl transferase: a comparison of acute myeloid leukaemia and normal bone marrow cells. Am J Hematol 1986; 23:43-50. [PMID: 3526873 DOI: 10.1002/ajh.2830230107] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A double immunofluorescence technique, using antibodies to terminal transferase (TdT) and a 165-kilodalton myeloid differentiation antigen (p165), has been used to investigate the phenomenon of TdT expression in cases of acute myeloid leukaemia (AML). Five cases of AML were shown to have significant (18-90%) numbers of leukaemic cells that concurrently expressed both TdT and p165 myeloid surface antigen. Examination of nonleukaemic bone marrow cells showed that the vast majority of normal TdT+ cells are p165 negative. However, in 5 of the 11 samples analyzed, rare cells staining for both p165 and TdT were found. These results suggest that some cases of TdT+ AML may arise from the clonal expansion of rare "biphenotypic" precursor cells existing in normal bone marrow.
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San Miguel JF, González M, Cañizo MC, Anta JP, Portero JA, López-Borrasca A. TdT activity in acute myeloid leukemias defined by monoclonal antibodies. Am J Hematol 1986; 23:9-17. [PMID: 3461712 DOI: 10.1002/ajh.2830230103] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Blast cells from eight out of 71 patients diagnosed with acute myeloid leukemia (AML) by morphological, cytochemical, and immunological criteria showed TdT activity. Their distribution according to the FAB classification was one M1, one M2, one M4, two M5a, one M5b, one M6, and one undifferentiated case. The TdT+ AML cases did not show major clinical and hematological differences when compared with the classical TdT- AML patients. Other phenotypical aberrations in the expression of membrane antigens, apart from the presence of nuclear TdT, were not observed in these TdT+ cases after study with a large panel of monoclonal antibodies. A higher incidence of TdT+ cases was found among the monocytic variants of AML (M4 and M5)--four cases--than in the granulocytic variants (M1, M2, and M3)--2 cases. These TdT+ cases should be distinguished from mixed leukemias by double labeling techniques, assessing in the TdT+ AML the coexpression of TdT and myeloid markers in individual cells as shown in four of our cases.
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Krause JR, Brody JP, Kaplan SS, Penchansky L. Terminal deoxynucleotidyl transferase activity in acute leukemia: a study of 100 cases comparing an immunoperoxidase (PAP) vs immunofluorescent method. Am J Hematol 1986; 22:179-84. [PMID: 3518417 DOI: 10.1002/ajh.2830220208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A comparison between the immunofluorescent (IF) method for terminal deoxynucleotidyl transferase (TdT) activity and the immunoperoxidase (IP) method by peroxidase-anti-peroxidase (PAP) technique was done for 100 cases of acute leukemia. For the acute lymphoblastic leukemias (ALL) there was agreement in 93% of the cases. However, the IP method detected 51/55 (93%) TdT+ cases versus 47/55 (85%) by the IF method. For the acute nonlymphocytic leukemias (ANLL), there was an agreement in 89% of the cases. The IP method detected 8/36 (22%) TdT-positive cases while IF detected 4/36 (11%) positive cases. If a figure of 10% TdT+ cells is considered significant in the marrow of the ANLLs, then the IP method would detect eight additional cases for a total of 16/36 (44%) TdT+ cases. This latter figure questions the ability of the IP TdT assay as a single test adequately to determine the lineage of a cell line. It may be rather that TdT is a marker that is expressed in a stem cell.
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Coleman MS, Ahn YH, Fairbanks T, Manderino G, Cibull M. Evaluation of a new enzyme-linked immunoassay for terminal deoxynucleotidyl transferase in haematologic malignancies. Br J Haematol 1986; 62:311-6. [PMID: 3511948 DOI: 10.1111/j.1365-2141.1986.tb02934.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We have evaluated a new solid phase enzyme immunoassay (EIA) for detection of terminal deoxynucleotidyl transferase (TDT). The EIA is greater than 100 times more sensitive than previously used tests for enzyme activity. In 284 clinical specimens of human peripheral blood and bone marrow, the EIA detected TdT antigen in 97% of peripheral blood and 100% of bone marrow samples that were positive for enzymatic activity. The excellent sensitivity and specificity of this new test suggests that it can be used in clinical situations where quantitative TdT measurements are desired.
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Abstract
The pattern of certain groups of antigens expressed on the surface of hemopoietic cells changes either during the course of differentiation from pluripotent stem cells to mature functional cells or as a function of the proliferative state of the cells. A map of these changes is emerging and is providing valuable information for selecting and purifying rare stem cells and for classifying the acute leukemias. This knowledge is also beginning to provide insights into physiological and pathological cellular interactions affecting the early stages of hemopoiesis, and is being exploited to remove T lymphocytes from allogeneic bone marrow grafts in order to prevent graft-vs.-host disease as well as leukemic cells from bone marrow before autologous reinfusion. In this article I will briefly review the cellular basis of hemopoiesis and then discuss the methods used to determine the presence of antigens on normal hemopoietic cells. I will then summarize the pattern of membrane antigens expressed during differentiation and conclude by discussing the biological and therapeutic implications.
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MESH Headings
- Animals
- Anion Exchange Protein 1, Erythrocyte/immunology
- Antibodies, Monoclonal
- Antigens, Surface/analysis
- Antigens, Surface/immunology
- Blood Group Antigens/immunology
- Blood Proteins/immunology
- Bone Marrow Transplantation
- Cell Communication
- Cell Differentiation
- Cell Membrane/immunology
- Erythropoiesis
- Glycophorins/immunology
- HLA Antigens/immunology
- Hematopoiesis
- Hematopoietic Stem Cells/immunology
- Histocompatibility Antigens Class II/immunology
- Humans
- Immunologic Techniques
- Leukemia, Myeloid, Acute/classification
- Leukemia, Myeloid, Acute/immunology
- Lymphocytes/immunology
- Membrane Proteins/immunology
- Nucleoside Transport Proteins
- Receptors, Cell Surface/immunology
- Receptors, Colony-Stimulating Factor
- Receptors, Erythropoietin
- Receptors, Transferrin
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Hewson JW, Bradstock KF, Kerr A, Rose RG. Characterizing "difficult" acute leukemias. A combined electron microscopic and immunological marker study. Pathology 1986; 18:99-110. [PMID: 3014425 DOI: 10.3109/00313028609090835] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The techniques of transmission electron microscopy (TEM), including ultrastructural myeloperoxidase cytochemistry (MPO), and immunological marker analysis, have been used to classify 58 "difficult" cases of acute leukemia where a precise diagnosis could not be made on the basis of conventional light microscopy and cytochemistry. TEM with MPO proved most valuable in characterizing 15 cases of acute myeloid leukemia and its variants, as well as defining complex cellular subpopulations in 11 cases of chronic myeloid leukemia in blast crisis. Immunological marker studies provided conclusive evidence of lymphoid differentiation in 18 cases of acute lymphoblastic leukemia and related disorders. In addition, the combined techniques were used to document 14 cases of terminal transferase-positive acute myeloid leukemia. This study demonstrates that these 2 techniques provide overlapping and complementary information for accurate diagnosis and classification of morphologically difficult hematological malignancies.
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Katz FE, Lam G, Ritter MA. The human leucocyte-common antigen: differential expression of framework and restricted antigenic determinants on early haemopoietic progenitors. Br J Haematol 1985; 61:695-705. [PMID: 2417617 DOI: 10.1111/j.1365-2141.1985.tb02884.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Monoclonal antibodies have been raised against human LC determinants. One, F10.89.4, recognizes a 'framework' epitope on all LC molecules; the other, F8.11.13, recognizes a 'restricted' epitope present on only a subset of these molecules which are found mainly on B and a subpopulation of T cells. A previous study of leukaemias showed that some early lymphoid and myeloid leukaemic cells totally lack LC (35% of ALLs and AMLs are F10.89.4-, F8.11.13-). In contrast, a proportion of myeloid leukaemias carried both 'framework' and 'restricted' epitopes (30% AMLs and AMMLs are F10.89.4+, F8.11.13+). To determine whether comparable heterogeneity exists in normal bone marrow we have analysed LC expression during haemopoiesis, using FACS separated populations and in vitro progenitor assays. Our data show that the great majority of haemopoietic progenitors express the LC 'framework' epitope. These can be separated by size into myeloid (large) and lymphoid (small) progenitor populations. However, very few myeloid progenitors (11% CFU-GM, 6% CFU-GEMM) express the additional 'restricted' LC F8.11.13 epitope. Most F8.11.13+ progenitors are CFU-lymphoid; these generate both T and B lymphocytes, but show a preference for the B lineage. Thus there is some molecular heterogeneity of LC during normal haemopoiesis, but this is far less extensive than that found in leukaemias.
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Chan LC, Sheer D, Drysdale HC, Bevan D, Greaves MF. Monosomy 7 and multipotential stem cell transformation. Br J Haematol 1985; 61:531-9. [PMID: 3864487 DOI: 10.1111/j.1365-2141.1985.tb02858.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Monosomy 7 was the sole karyotypic abnormality seen in a case of biphenotypic leukaemia involving both the myeloid and lymphoid lineages and in a case of de novo ALL undergoing a phenotypic shift to acute myeloid leukaemia at relapse. These observations suggest that monosomy 7 can be associated with transformation of a common lymphoid-myeloid progenitor cell.
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MESH Headings
- Aged
- Cell Transformation, Neoplastic/pathology
- Child, Preschool
- Chromosome Aberrations/pathology
- Chromosome Deletion
- Chromosome Disorders
- Chromosomes, Human, 6-12 and X
- Hematopoietic Stem Cells/pathology
- Humans
- Leukemia, Lymphoid/genetics
- Leukemia, Lymphoid/pathology
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Male
- Monosomy
- Phenotype
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