Is Flow Cytometric Immunophenotyping Useful for Predicting Acute Myeloid Leukemia Prognosis?

Abstract

Acute myeloid leukemia (AML) is an aggressive clonal myeloid neoplasia that causes accumulation of myeloblast in the blood or bone marrow. For diagnosing AML, at least 20% of nucleated cells in the blood or bone marrow are required to include myeloblasts according to the current classification of the World Health Organization (WHO). This threshold value is 30% according to the French-American-British (FAB) classification system (1).Flow cytometry with multiple parameters is used for determining the relationship of the origin in newly diagnosed acute leukemia (2-4). For diagnosing AML, particularly CD3, CD7, CD13, CD14, CD33, CD34, CD64, and CD117, cytoplasmic myeloperoxidase (MPO) and human leukocyte antigen D-related (HLA-DR) should definitely be evaluated while performing immunophenotypic studies. In lymphoid cells such as cCD3 and cCD79a, the absence of specific surface markers should be demonstrated. In order to determine the rate of blasts in immunophenotypic studies, CD45, CD34, or CD117 should be used (5).Variables used to aid the prediction of the course of disease and response to treatment beforehand are called prognostic factors. These prognostic factors can be divided into two groups as those related to the general health state of the patient and those related to the biological features of leukemia. Patients with advanced age (>60 years), poor performance, comorbid diseases, secondary AML, presence of dysplasia, absence of Auer rods, sub-types of M0, M5, M6, and M7, CD34 expression, CD56 expression, presence of extramedullary disease, presence of fibrosis in the bone marrow, slow response to cytoreduction, more than one chemotherapy applied for obtaining full response, presence of Philadelphia chromosome, monosomies in the 5th and 7th chromosomes, complex karyotypes, and presence of FMS-like tyrosine kinase 3 (FLT3) are associated with poor prognosis. On the other hand, the presence of Auer rods, M3 and M4Eo sub-types according to the FAB classification, presence of t(8;21), t(15;17), inversion (inv) 16, and t(16;16), and presence of nucleophosmin-1 (NPM1) and CCAAT/enhancer binding protein alpha are associated with good prognosis (6, 7). Is Flow Cytometric Immunophenotyping Useful for Predicting Acute Myeloid Leukemia Prognosis?Introduction: Acute myeloid leukemia (AML) is an aggressive clonal myeloid neoplasm that causes the accumulation of myeloblasts in blood and bone marrow. This study aimed to determine immunophenotypic characteristics and their prognostic value in patients with AML, to compare the results of patients with the literature and to reveal regional differences. Results: Fifty-two patients (52%) were males and 48 (48%) were females; the mean age at diagnosis was 49±11.4 (18-62) years. The overall survival was 203.0±74.6 (0-1666) days, and the disease-free survival time was 137.0±46.7 (0-1588) days. Considering the response to induction therapy, complete response was 53% (n=53), non-response was 16% (n=16), and death during the induction was 31% (n=31). At the time of statistical analy...

"Prognostic Evaluation in Patients with Acute Myeloid Leukemia, From Diagnosis to Treatment: A Single- Center Experience"

“…presence of the pan-myeloid marker in their study [19]; however, Üsküdar Teke et al did not reveal this relationship in their study [20]. The recurrence rate was lower in myeloid marker and HLA-CD34 copositive patients despite the statistically in significant relationship even though no relationship was determined between the cell surface markers and survival in our study.…”