Immunophenotypic Profile of Acute Leukemia Cases Using Multicolor Flow Cytometry : Three Year Experience at King Hussein Medical Center

Abstract

Objective: To study the immunophenotypic profile of acute leukemia cases, using multicolor flow cytometry for lineage subtyping. Methods: This is a retrospective review of acute leukemia cases conducted at department of Hematopathology at King Hussein Medical Center between January2011 to December 2013. A total of 340 acute leukemia cases were analyzed using flow cytometry method. The diagnosis was based on morphological assessment of peripheral blood and bone marrow aspirate smears and immunophenotyping by flow cytometry. Results: A total of 340 cases of acute leukemia were studied. 164 cases (48.2%) were acute lymphoblastic leukemia, 176 (51.8%) were acute myeloid leukemia. Acute leukemia was diagnosed among adults in 51.8% whereas 48.2% were children. Of the acute lymphoblastic leukemia cases, 130 cases (79.3%) were B-cell type and 34 cases (20.7%) were T-cell type. All cases of B-acute lymphoblastic leukemia showed expression of pan B-cell markers (CD19,CD22 and cytoplasmic CD79a) and 117 (90%) of cases expressed CD10. Cytoplasmic CD3 and CD5 were the most sensitive markers for diagnosis of T-acute lymphoblastic leukemia. Of the 176 cases of acute myeloid leukemia, 16 cases (9%) were identified as acute promyelocytic leukemia, while the rest 160 cases showed expression of CD34 and HLA-DR in 41.4% and 68.7% retrospectively. None of the cases of acute promyelocytic leukemia were positive for both CD34 and HLA-DR. CD13 and CD33 were expressed in all cases of acute myeloid leukemia studied. Conclusion: Flow cytometric immunophenotyping is a powerful method for accurate diagnosis, identification and subtyping of acute leukemia. Furthermore, it has a great therapeutic and prognostic implications on such cases with unique usefulness in differentiation between acute lymphoblastic leukemia and acute myeloid leukemia-M0. Immunophenotyping results of acute leukemia in this group of Jordanian patients were comparable to the international data. By combining morphology and immunophenotyping, we were able to diagnose and classify cases of acute leukemia at our center where peripheral blood and adequate bone marrow aspirates are available.

Immunophenotypic aberrancies in acute lymphoblastic leukemia from 282 Iraqi patients

“…It is also consistent with most studies worldwide . Moreover, our relative rates of 88% for the common B‐ALL and 73.2% for cortical T‐ALL subtypes were within the ranges for these two subtypes reported worldwide at 67.2%‐90% and 31.5%‐80.4%, respectively …”

“…The high frequency of the aberrant expression of myeloid‐associated markers would be quite helpful in MRD assessment of B‐ALL that lacks one or more of the hematogone‐associated markers. Other than CD13 and CD33, the frequency of other myeloid markers (eg, CD15, CD117, and CD16) as markers of aberrant phenotype in B‐ALL is limited in the current study, as it was in previous reports …”

“…In our series, the proportion of cases with cross‐lineage antigen expression in B‐ALL was 81.3% with the most frequent cross‐lineage expression being the myeloid antigens CD13 and CD33. The reported rates of aberrant myeloid expression in B‐ALL vary between 13.8% and 86.5% with our rates being at the high end of this range . The high frequency of the aberrant expression of myeloid‐associated markers would be quite helpful in MRD assessment of B‐ALL that lacks one or more of the hematogone‐associated markers.…”

Expression of aberrant markers in acute leukemia at South Egypt Cancer Institute: A retrospective study

“…This agrees with the results of some studies (16, 35). To the contrary of these finding, others noted that the frequency of AL was higher in adults than pediatrics (36)(37)(38).…”

Frequency of Discrepancy between Bone Marrow Morphology and Immunophenotype in Acute Leukaemia

“…Cytoplasmic CD3 and CD5 were the most sensitive markers for diagnosis of T-acute lymphoblastic leukaemia. 7 With respect to myeloid antigens expression in lymphoid leukaemia, the most frequent was CD13, CD33.…”