Clinical significance of CD34 / 医学前沿

t(8;21)(q22;q22) acute myeloid leukemia (AML) is a highly heterogeneous hematological malignancy with a high relapse rate in China. Two leukemic myeloblast populations (CD34

Identification of Volatile Organic Compounds Used to Diagnose and Evaluate Acute Promyelocyte Leukemia / 中国实验血液学杂志

OBJECTIVE@#To analyze the characteristics of volatile organic compounds (VOCs) in expiratory air components of patients with acute promyelocytic leukemia (APL), and assess the feasibility of VOCs for the diagnosis and prognostic evaluation of APL.@*METHODS@#The VOCs exhaled from the patients with APL and healthy volunteers should be analyzed with SPME-GC/MS, and compared between newly-diagnosed group, relapse group, remission group, and healthy group with Wilcoxon/Kruskal-Wallis one-way analysis of variance and Dunn-Bonferroni test.@*RESULTS@#Dimethyl sulfide, toluene, and dodecane obtained of newly-diagnosed APL patients were significantly higher, while ethanol, n-hexanal, and benzaldehyde were significantly lower than those of healthy people (P<0.05). Compared with the newly-diagnosed group, dimethylsulfide, toluene, and dodecane of the remission group significantly decreased, while ethanol, n-hexanal, and benzaldehyde significantly increased (P<0.05), which was just opposite from the relapse group.@*CONCLUSION@#Dimethyl sulfide, toluene, dodecane, ethanol, n-hexanal, and benzaldehyde can be used as biomarkers for the diagnosis and prognosis assessment of APL patients.

Leucemia promielocítica aguda M3. Reporte de un caso clínico / Acute promyelocytic leukemia M3. Report of a clinical case

La leucemia es una neoplásica hemática que contiene múltiples subtipos, entre ellos la leucemia promielocítica aguda, caracterizada por la multiplicación clonal del linaje mieloide y eritroide. El presente caso pertenece a un paciente masculino de 20 años, sin antecedentes de importancia y con un cuadro evolutivo de 20 días con sangrado del dedo anular de la mano derecha, y con ausencia de proceso cicatricial. A partir de los exámenes de laboratorio se identifica bicitopénia eritroide y plaquetaria, con evidencia de un 93% de promielocitos. El tratamiento con ATO, ATRA y Antraciclinas logró una leve mejoría. Durante su estadía hospitalaria desarrolló síndrome de diferenciación, lo que ocasionó su fallecimiento.

Leukemia is a hematic neoplastic that contains multiple subtypes, including acute promyelocytic leukemia, characterized by the clonal multiplication of the myeloid and erythroid lineage. The present case belongs to a 20-year-old male patient without health history of importance and with a 20-day evolutionary picture with bleeding from the ring finger of his right hand, and without scarring process. Erythroid and platelet bicytopenia is identified from laboratory tests with evidence of 93% promyelocytes. The treatment including ATO, ATRA and Anthracyclines achieved a slight improvement. He developed differentiation syndrome during hospitalization, which caused his death.

Promyelocytic Leukemoid Reaction: Unusual Findings in a Patient with Sepsis

Neutrophilic leukemoid reaction may occur in many situations, including hemolysis, malignancy, infection, and exposure to certain toxins. It usually shows morphological overlap with chronic myeloid leukemia in which promyelocytes are not majorly associated. Here, we present a case of promyelocytic leukemoid reaction in a patient with sepsis. A 28-year-old man was admitted for renal stone removal. After percutaneous nephrolithotomy, his condition deteriorated with fever (37.8℃), tachycardia (130/min), acute renal failure, pleural effusion, and pulmonary edema. Complete blood count indicated a white blood cell count of 73.39×10⁹/L including 82% promyelocytes, hemoglobin 8.9 g/dL, and platelet count of 85×10⁹/L. A bone marrow aspirate showed that promyelocytes accounted for 73.8% of all nucleated cells. Following bone marrow examination, treatment with all-trans retinoic acid (ATRA) was started immediately. Reverse transcription polymerase chain reaction (RT-PCR) study revealed the absence of PML-RARA (promyelocytic leukemia-retinoic acid receptor alpha) and other RARA (retinoic acid receptor alpha) rearrangements. Once the chromosome analysis of bone marrow cells demonstrated the normal karyotype, ATRA was discontinued.

Disulfram Treatment of NUP98-PHF23 AML Is Not Effective In Vivo: Potential Role for Hematopoietic Stem Cells Niche / 임상소아혈액종양

BACKGROUND: NUP98 has numerous partner genes of which plant homeodomain (PHD) finger protein 23 (PHF23) fusion with NUP98 (NP23) can be detected by RT-PCR in patients with cytogenetically normal acute myelogenous leukemia (AML). In this fusion transcript of NP23 PHD of PHF23 is known to specifically bind H3K4me3 residues and act as a chromatic modifier. Disulfiram (DSF) which inhibits the binding of PHD to H3K4me3 residues selectively killed NP23 myeloblasts in vitro and therefore, we planned to evaluate the efficacy of DSF in vivo. METHODS: Cultured 961C cells (CD45.2), NP23 myeloblast cells were transplanted into B57BL/6 mice (CD45.1). Using limit dilution assay the number of leukemic stem cells (LSCs) could be calculated. A certain amount of 961C cells were transplanted into B57BL/6 mice and DSF was treated after 1 week. The engraftment level was monitored with CD45.2. Kaplan Meier survival curve was used to compare the survival between therapeutic and control group. RESULTS: 961C cells could be transplanted without radiation in recipient mice. Calculated LSC was estimated to be 1 out of 184 cells (95% CI range, 56–609). When treated with DSF of different doses and administration routes in 961C recipient mice no survival advantage of DSF was observed in 961C transplanted immunocompetent mouse, however it was evident that engraftment level was consistent in both groups. CONCLUSION: No survival advantage of DSF in 961C transplanted immunocompetent mouse was observed, however it was evident that 961C cells shared niche with normal hematopoietic stem cells (HSCs). We expect that 961C cells and transplanted recipient mice have the potential to be used as in vivo system for new drugs development as well as for research dealing with niche for normal HSCs and LSCs.

Primary Myelofibrosis with MPL S505N Mutation: The First Case Reported in Korea

MPL mutation is an important molecular marker in myeloproliferative neoplasms (MPN). Although MPL W515 is a hot spot for missense mutations in MPN, MPL S505 mutations have been reported in both familial and non-familial MPN. A 72-year-old male visited the hospital, complaining mainly of dizziness and epistaxis. Leukocytosis, anemia, thrombocytopenia, tear drop cells, nucleated RBCs, and myeloblasts were observed in both complete blood cell counts and peripheral blood smears. Bone marrow aspiration failed due to dilution with peripheral blood. BM biopsy indicated hypercellular marrow, megakaryocytic proliferation with atypia, and grade 3 reticulin fibrosis. Conventional cytogenetics results were as follows: 46,XY,del(13)(q12q22)[19]/46,XY[1]. Molecular studies did not detect JAK2 V617F, BCR/ABL translocation, JAK2 exon 12, and CALR exon 9 mutations. The MPL S505N mutation was verified by colony PCR and Sanger sequencing following gene cloning. Based on the above findings, a diagnosis of overt primary myelofibrosis (PMF) was indicated. Mutation studies of buccal and T cells were not conducted. Further, family members were not subjected to mutation studies. Therefore, we were unable to determine whether this mutation was familial or non-familial. Six months after the first visit to the hospital, the patient died due to pneumonia and sepsis. Thrombotic symptoms or major bleeding events did not develop during the survival period following diagnosis of PMF. To the best of our knowledge, this may be the first reported case of PMF with the MPL S505N mutation in Korea.

Leukemic Pleural Effusion in Acute Promyelocytic Leukemia: A Case Report

In patients with acute myeloid leukemia (AML), pleural effusion may be attributed to various factors, including infection, hypoalbuminemia, and renal failure. However, leukemic infiltration of the pleural fluid is rarely reported and poorly understood. Extramedullary diseases have been reported with increasing frequency as the survival rates of patients with AML have increased. However, the reported prognostic effects of leukemic pleural effusion in patients with AML range from none to a worse prognosis. Here, we report a case of acute promyelocytic leukemia (APL) in a patient exhibiting leukemic pleural effusion with fluorescence in situ hybridization (FISH) results indicating the presence of the PML-RARA fusion gene. A 52-year-old man presented with pancytopenia, dyspnea, and fever. He had a medical history of hypertension, end-stage renal disease, and hepatitis B virus-related liver cirrhosis. A peripheral blood smear revealed the presence of multiple abnormally hypergranular promyelocytes. White blood cell differential counts were not performed due to severe pancytopenia. A bone marrow examination, immunophenotyping analysis, and cytogenetic and molecular studies revealed APL. The patient was treated with all-trans retinoic acid immediately after abnormal promyelocytes were observed in the peripheral blood smear, but induction chemotherapy was delayed because of his poor condition. His persistent dyspnea and abdominal discomfort led to a thoracentesis and the observation of abnormal promyelocytes that were positive for PML-RARA fusion gene by FISH. To our knowledge, this is the first report of leukemic pleural infiltration with PML-RARA fusion gene-positivity via FISH.

Clinical observation of Shuanghuang Shengbai Granule () on prevention and treatment of myelosuppression caused by chemotherapy in cancer patients / 中国结合医学杂志

<p><b>OBJECTIVE</b>To study the efficacy and safety of Shuanghuang Shengbai Granule (, SSG), a traditional Chinese herbal medicine, on myelosuppression of cancer patients caused by chemotherapy.</p><p><b>METHODS</b>A total of 330 patients were randomly assigned to the treatment group (220 cases, analysed 209 cases) and the control group (110 cases, analysed 102 cases) with a 2:1 ratio by envelope method. The patients in the treatment group at the first day of chemotherapy started to take SSG for 14 days, while the patients in the control group took Leucogon Tablets. The changes of the blood routine, clinical symptoms and immune function in both groups were observed for safety and efficacy evaluation.</p><p><b>RESULTS</b>At the 7th day of chemotherapy, the white blood cells (WBCs) level in the treatment group was significantly higher than that in the control group (P<0.05). After treatment, the WBCs rate in the normal range accounted for 50.2% in the treatment group, the myelosuppression of WBCs and neutrophil were mainly grade I, while 8.1% and 5.7% of patients emerged grade III and grade IV myelosuppression, respectively. The incidence of myelosuppression of the treatment group was significantly lower than that of the control group (P<0.05). The total effective rate of Chinese medicine syndrome in the treatment group was significantly higher than that in the control group (84.2% vs. 72.5%, P<0.05). The immune cell levels in both groups were maintained in the normal range. Compared with that before treatment, the levels of CD3and CD4cells were significantly increased in the treatment group after treatment (P<0.05). The discrepancy of CD3and CD4cell activity before and after treatment in both groups were significantly different (P<0.05). No obvious adverse event occurred in both groups.</p><p><b>CONCLUSION</b>SSG had a protection effect on bone marrow suppression, and alleviated the clinical symptoms together with clinical safety.</p>

Immunophenotypic Analysis of Acute Promyelocytic Leukemia / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the immunophenotype of leukemia promyelocytes (LP) in bone marrow of patients with acute promyelocytic leukemia (APL) and to explore their characteristics and significance.</p><p><b>METHODS</b>The immunophenotypes of leukemia cells in 43 patients with APL were analyzed by means of 4 color immunophenotypes; the cell population in which CD45 strength localized at 10(2) and the SSC strength locatized at 10(2) was defined as R3, the cell population in which CD45 strength localized at 10(3) and the SSC strength localized at 10(2) was defined as R5, moreover the ratio of positive cells >80% was defined as strong positive expression, the ratio of positive cells between 20%-80% was difined as weak positive expression, the ratio of positive cells <20% was difined as negative by gating method of CD45/SSC.</p><p><b>RESULTS</b>There was a abnormal cell population (R3) in 79.07% cases; the immunophenotypes of R3 was cheracteried by high SSC, weaker expression of CD45, the rate of CD38, CD9 and CD13 all was 100%, moreover their bright expression (>80%) was 86.05%, 90.70% and 86.05%, respectively; the positive expression rate of CD33, CD117 and CD64 was 97.67%, 95.35% and 83.80% respectively, moreover thier bright expression was 84.04%, 69.77% and 30.23% respectively; the CD15 was weakly expressed in 39.53% cases, the CD34 and HLA-DR were weakly expression in 16.28% and 6.98% cases respectively. All the cases did not express CD116. There were 2 cell populations (R3 and R5) in 20.93% cases, the immunophenotypic features of R3 were cosistant with above mentioning, while the immunophenotypes of R5 were lower than those of R3 SSC; the fluorescence intensity of CD45 was higher, but lower than that in normal lymphycytes, the positive rate of CD9, CD13, MPO was 100%, moreover thier fluorescence intensity was high; they did not expressed CD123, CD25, CD22, CD4, CD64 and CD14. Thereby it can be concluded that the typical immunophenotypes is characterized by CD13(+) CD9(+) CD38(+) CD33(+) CD117(+) CD64(+) CD11b(-) CD34(-) HLA-DR(-) in APL. There was a special immunophenotype in the APL with basophilic granules. Conclusoin: APL has a characteristic immunophenotypic profile, whose typical immunophenotype is characterized by CD13(+) CD9(+) CD38(+) CD33(+) CD117(+) CD64(+) CD11b(-) CD34(-) HLA-DR(-). The special immunophenotype exists in the APL with basophilic granules. Flow cytometric immunophenotyping may be a useful for rapid recognition of APL and has significant for prognosis.</p>

A Case of Myeloid Sarcoma of Intestine / 대한소화기학회지

Myeloid sarcoma (MS) is an extramedullary involvement of immature myeloid proliferation. An isolated MS is defined as a myeloblastic tumor when it arises without any concomitant circulating disease. A diagnosis of MS is established using pathologic features including infiltration of myeloblasts and strong myeloperoxidase expression with negative cytokeratin immunohistochemical staining. We report a rare case of colonic MS without any peripheral blood abnormality. If the affected patient were left untreated, the MS could evolve into acute myeloid leukemia (AML) within one year. Several studies recommend the same regimens of chemotherapy as used for circulating AML to treat isolated MS. We focused on the diagnosis of MS in this study. The correct diagnosis of MS is important for adequate treatment. In conclusion, MS should be considered in the differential diagnosis of intestinal tumor.

Case of Acute Myeloid Leukemia with Mass of Eyelid and Conjunctiva in the Early Stage

PURPOSE: To report a case of an 82-year-old male with acute myeloid leukemia presenting with bilateral isolated conjunctival and eyelid masses. CASE SUMMARY: An 82-year-old male presented with a bilateral conjunctival mass and right eyelid mass occurring 10 days prior. He was diagnosed with prostate cancer 8 years ago and complete recovery was achieved using selective mass chemotherapy. He experienced a stroke 4 years ago and was treated using a carotid artery stent insertion and medication. In the initial laboratory test, hemoglobin was 13.7 g/dL and leukocyte count 5,530/mm3(neutrophil 74.4%, lymphocyte 10%, monocyte 11.8%). Light reflex, movement of extraocular muscle and fundus examination were all normal. Biopsy was performed 1 week after the first visit. Seven days after biopsy, he complained of sudden dyspnea and febrile sense and was admitted to the intensive care unit via the emergency room (ER). The laboratory tests performed in the ER showed hemoglobin was 9.6 g/dL and leukocyte count was 78,020/mm3(neutrophil 0%, lymphocyte 7%, monocyte 5%, promyelocyte 1%, metamyelocyte 4%, myelocyte 6%, blast 67%). The biopsy revealed diffuse proliferation of atypical plasmacytoid cells, consistent with leukemic infiltration. Under the diagnosis of acute myeloid leukemia, chemotherapy was administered. However, the patient died due to aggravated pneumonia. CONCLUSIONS: Even if non-specific findings appear on the peripheral blood tests, eyelid and conjunctival masses should be considered as possible tumors in acute myeloid leukemia.

Expression of HIF-1α in primary acute myeloid leukemia cells and its relationship with prognosis / 中国实验血液学杂志

<p><b>OBJECTIVE</b>This study was aimed to detect the expression of HIF-1α in acute myeloid leukemia (AML) except acute promyelocyte leukemia (APL) and investigate the relationship of its expression levels with clinical parameters and prognosis.</p><p><b>METHODS</b>The primary AML cells were collected from peripheral blood of 53 newly diagnosed AML patients by using CD3 negative sorting. The expression of HIF-1α was measured by real-time fluorescent quantitative PCR (FQ-PCR) , and the relationship between expression level of HIF-1α and clinical parameters (age, sex, WBC count, clinical typing, prognosis) was analysed according to relative expression level. Furthermore, Western blot was used to detect the protein level of HIF-1α in AML patients with or without extramedullary infiltration.</p><p><b>RESULTS</b>The expression level of HIF-1α did not correlate with age, sex, WBC count, Hb level, Plt count and the percentage of blast. There was no significant difference of HIF-1α expression between different AML subtype based on FAB. The higher level of HIF-1α was found in AML patients who did not get complete remission after one or two courses of chemotherapy, however, the difference was not statistically significant. The relapse rate was higher in AML patients with the higher expression of HIF-1α. In addition, the higher level of HIF-1α mRNA and protein were found in bone marrow of AML patients with extramedullary infiltration (P < 0.01). The negative correlation between HIF-1α and PTEN was observed (r = -0.48, P = 0.001).</p><p><b>CONCLUSIONS</b>Overexpression of HIF-1α are closely related with extramedullary infiltration and prognosis of acute myeloid leukemia, and may be used as an early indicator of extramedullary infiltration and prognosis.</p>

Establishment of the human acute promyelocytic leukemia pathological model in the SCID beige mice by using NB4 cell line / 中国实验血液学杂志

<p><b>OBJECTIVE</b>This study was to establish a stable, effective and reproducible human acute promyelocytic leukemia model in severe combined immunodeficient (SCID) mice by using NB4 cell line, and to investigate the disease course character and biological behaviors.</p><p><b>METHODS</b>Three-five-week-old SCID beige mice were divided randomly into two groups: experimental and control group. SCID mice of experimental group were transplanted by tail vein (iv) injection of 5×10(6) NB4 cells. The WBC cell count and the positive rate of promyelocytes in peripheral blood were dynamically monitored by using smears. Morphological examination and histopathological assay were employed to confirm NB4 cell infiltration in organs (liver, spleen, lung, kidney and brain). The expression level of PML-RARα fusion protein was detected by Western blot.</p><p><b>RESULTS</b>Within two weeks there was no significant difference in peripheral blood WBC count between two groups (P > 0.05), meanwhile, NB4 cells were not found. At the day 21 and 28 after inoculation, the peripheral blood white blood cell count of experimental group reached to (4.79 ± 1.13)×10(9)/L and (7.62 ± 2.24)×10(9)/L respectively, which were significantly higher than that in control group (P < 0.05); simultaneously, the positive rates of promyelocytes on smears were (2.14 ± 0.63)% and (6.6 ± 2.76)%, respectively. Morphological observation showed single or multiple tumor lumps at day 21 after inoculation; HE staining of tissue biopsies demonstrated a large number of promyelocyte in the liver, spleen, lung, kidney and brain tissue. Cell immunofluorescence results showed that the CD33 expression of bone marrow cells in mice of experimental group was strongly positive (P < 0.05). Western blot confirmed that the PML-RARα fusion protein was expressed variously in liver, kidney and brain tissue.</p><p><b>CONCLUSIONS</b>The human acute promyelocytic leukemia SCID mouse model is succesfully established by tail vein injection of NB4 cells. This model can mimic the characters of involved bone marrow and diffuse growth of cells. This model is a useful tool to explore the pathogenic mechanism and experimental treatment of human leukemia.</p>

A Case of Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia in an Adult Presenting with an Extramedullary Bone Tumor / 대한내과학회지

Acute lymphoblastic leukemia (ALL) is a lymphoid malignancy characterized by impaired differentiation and proliferation of leukemic myeloblasts. Normal hematopoietic cells are replaced by excess myeloblasts, causing bone marrow failure. Therefore, patients with ALL typically present with symptoms related to infection, anemia, and thrombocytopenia. Extramedullary involvement of ALL as an initial presenting symptom has rarely been reported in adults, although several such cases of relapse have been described. Isolated extramedullary manifestations may lead to a late diagnosis of ALL. We describe herein a patient with Philadelphia chromosome-positive ALL presenting with an extramedullary bone tumor.

Endobronchial Relapse of Acute Myeloid Leukemia after Allogeneic Stem Cell Transplantation / 대한내과학회지

Myeloid sarcoma is an uncommon extramedullary tumor of immature myeloid cells or myeloblasts. It may occur alone or concurrently with an underlying hematological malignancy. Although it can develop anywhere in the body, common sites include bones, particularly the skull and vertebra, soft tissues, and lymph nodes. However, there have been few reports of myeloid sarcoma occurring in the respiratory system, especially the large airways. We describe a case of endobronchial relapse of acute myeloid leukemia in a patient who achieved complete remission after allogeneic stem cell transplantation. To our knowledge, this is the first such report in Korea.

Diagnostic value of dysplasia characteristics in typing of myelodysplastic syndrome / 中国实验血液学杂志

This study was purpose to investigate the diagnostic value of hematopoietic cell dysplasia in myelodysplastic syndrome (MDS). Sixty-four cases of WHO-MDS were detected by cytomorphology, cytohistochemical staining and bone marrow biopsy. The characteristics of hematopoietic cell dysplasia were analyzed, and its sensitivity and specificity were evaluated for WHO-MDS diagnosis. The results showed that though myeloblast, megakaryocytes presented in peripheral blood and granular Auer body, abnormal granular pseudo Pelger-Huër, vacuole of erythroid, micro-megakaryocytes appeared in bone marrow for diagnosis sensitivity were not very high, and respectively were 34.4%, 3.1%, 3.1%, 75.0%, 6.3%, 42.4%, the specificity of these characteristics was 100%. Moreover, erythroid odd nucleus, nuclear deformity, fragmentation, nuclear budding, ring sideroblasts, single and more round nuclear megakaryocyte had better reference value for WHO-MDS diagnosis. By bone marrow biopsy, the dysplasia and abnormal localization of immature precursor (ALIP) also were found in patients with WHO-MDS. More than half patients with WHO-MDS had mild to moderate increase in reticulin fibres. It is concluded that the cytomorphology assay is the base and key for the diagnosis of WHO-MDS. Diagnostic accuracy can be improved by combinative use of a variety of detection methods.

Src Family Kinase Inhibitor PP2 Has Different Effects on All-Trans-Retinoic Acid or Arsenic Trioxide-Induced Differentiation of an Acute Promyelocytic Leukemia Cell Line / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Leukemic promyelocytes have the unique ability to undergo differentiation after exposure to retinoic acid and both differentiation and apoptosis after exposure to arsenic trioxide (ATO). Recent studies have shown that inhibition of Src family kinases (SFKs) resulted in enhancement of retinoic acid-induced myeloid differentiation. MATERIALS AND METHODS: In this study, we investigated the question of whether the SFK inhibitor PP2 enhanced the differentiation of NB4 cells when combined with ATO as well as when combined with all-trans-retinoic acid (ATRA). In addition, we attempted to determine the difference in retinoic acid-induced gene expression between cells treated with PP2 in combination with ATRA and in combination with ATO. RESULTS: SFK inhibitor PP2 induced significant enhancement of ATRA- or ATO-induced differentiation of NB4 cells. A significantly stronger synergistic effect was observed when PP2 was combined with ATRA than when combined with ATO. Flow cytometric analysis demonstrated a significant increase in CD11b-positive granulocytes up to 60.73% and 31.58%, respectively. These results were confirmed by nitroblue tetrazolium staining. These effects were not related to apoptosis. Results of Annexin-V-fluorescein staining revealed that PP2 combined with ATRA or PP2 combined with ATO did not induce apoptosis in NB4 cells. Retinoic acid-induced gene expression was different in both groups. Intercellular adhesion molecule-1 expression showed a significant increase in cells treated with PP2 in combination with ATRA, whereas cathepsin D expression showed a significant increase in cells treated with PP2 in combination with ATO. CONCLUSION: Our data showed that SFK inhibitor PP2 enhanced acute promyelocytic leukemia cell differentiation when combined with either ATRA or ATO with difference in activation of retinoic acid-induced genes.

ZBTB16-RARalpha variant of acute promyelocytic leukemia with tuberculosis: a case report and review of literature / 대한혈액학회지

A 23-year-old male presented with pulmonary tuberculosis and swelling of both lower limbs. He was put on antitubercular treatment. Hemogram showed mild anemia and Pseudo Pelger-huet cells. The bone marrow (BM) examination showed 52% promyelocytes with regular round to oval nuclei, few granules and were positive for CD13 and CD33, and negative for HLA-DR. Cytogenetic analysis of the BM aspirate revealed an apparently balanced t(11;17)(q23;q21). Final diagnosis rendered was acute promyelocytic leukemia (APL) with t(11;17)(q23;q21); ZBTB16/RARA. APL is a distinct subtype of acute myeloid leukemia. The variant APL with t(11;17)(q23;q21) cases that are associated with the ZBTB16/RARA fusion gene have been reported as being resistant to all-trans-retinoic acid (ATRA). Therefore, differential diagnosis of variant APL with t(11;17)(q23;q12) from classical APL with t(15;17)(q22;q12); PML-RARA is very important. Here we have discussed the importance of distinct morphology of variant APL and also significance of rare presentation with tuberculosis.

Immunophenotypic analysis of leukemia promyelocytes in 71 patients with acute promyelocytic leukemia / 中国实验血液学杂志

This study was purpose to investigate the immunophenotype of leukemia promyelocytes (LP) and its significance through retrospective analysis of LP immunophenotype and data in new diagnosis of patients with acute promyelocytic leukemia (APL). The immunophenotype of leukemia cells in 71 APL patients was analyzed by means of 6 color immunotyping. The results indicated that MPO, CD33 and CD13 were consistently expressed in leukemia cells of all APL cases with highest average percentages (> 88%) of positive cells among all studied markers. CD117 was found to be positive in 50.7%, and its average percentage of positive cells was 52.5%. Leukemia cells in about 10% cases expressed CD15 weakly, and its average percentage of positive cells was 42.5%. CD34 and HLA-DR showed decreased expressions in a small number of cases and were negative in the others. CD2 and CD56 were weakly expressed in nearly 25% APL cases, and the average percentage of positive cells were 39.3% and 42.3%, respectively. Thereby, it is of the opinion that the typical immunophenotype is characterized by MPO(+)CD13(+)CD33(+)CD117(±)CD15(±)CD34(-)HLA-DR(-) in APL. CD2 and CD56 were expressed significantly higher in CD34(+) or HLA-DR(+) group (including CD34(+) HLA-DR(+), CD34(+) HLA-DR(-) and CD34(-)HLA-DR(+)) than in CD34(-) and HLA-DR(-) group. Significant differences were also found in WBC and platelet counts, percentage of peripheral blood leukemic promyelocytes and the expression of CD13 among CD15 < 10%, 10% < CD15 < 20% and CD15 > 20% groups. It is concluded that the APL has a characteristic immunophenotypic profile, flow cytometric immunophenotyping may be considered as a useful tool for rapid recognition of APL and also may be considered to have an important significance for analysing origin of leukemic cells and clinical outcome of patients.