DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20210882

Aberrant immunophenotypic expressions in acute lymphoid leukemia: an observational analytical study

Monica Sivakumar, Atoshi Basu

Abstract


Background: This study aims to find out the expression of aberrant immunophenotypic markers in acute lymphoid leukemia (ALL) and to co-relate its expression with cytogenetic and molecular data.

Methods: Retrospective cum prospective study was carried out in 75 patients of ALL who presented to Apollo Gleneagles hospitals, Kolkata from January 2014 and March 2019. Flow cytometry analysis was done using FC500 (Beckman coulter) All cases were classified according to latest WHO classification.

Results: Out of 75 cases of ALL, 23 cases (30.67%) showed aberrant cross-lineage expression. Amongst the B-ALL cases, the most common aberrant antigen expressed were myeloid antigens 17 cases (77.27%). Aberrant T- antigens were noted in 4 cases (18.10%). Aberrant co-positivity of myeloid as well as T-antigens was seen in 1 case (4.54%). The most common aberrant myeloid antigen expressed was CD33 (77.7%) followed by CD13 (22.2%) and then CD15 (11.1%). Co-positivity of CD13 and CD33 was noted in 2 cases. CD2 and CD33 co-positivity was noted in 1 case. The most frequently expressed aberrant T-antigen was CD2 seen in 3 out of 5 cases (60%).

Conclusions: In B-ALL, the most common aberration was myeloid antigen positivity followed by cross-lineage T-antigen expression. Aberrant CD33 expression was most frequently associated with t(9;22) followed by t(12;21).  Aberrant CD15 was most frequently associated with t(4;11).  No association with adverse hematological parameters or any significant increase in cytogenetic and molecular abnormality was noted in cases expressing aberrant antigen in comparison to cases not expressing aberrant antigens.

 


Keywords


ALL, Aberrant immunophenotypic markers, Flow cytometry, Cytogenetic and molecular abnormalities, Adverse haematological parameters

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References


Mooman A. New and emerging prognostic and predictive genetic Biomarkers in B-cell precursor Acute lymphoblastic leukemia. Hematologica. 2016;101(4):407-16.

Inaba H, Greaves M, Mulligan C. Acute Lymphoblastic Leukemia. Science Direct. 2013;381(9881):1943-55.

Kulkarni KP, Marwaha Rk. Significant male preponderance in childhood acute lymphoblastic leukemia in India and regional variation: tertiary care center experience, systematic review, and evaluation of population-based data. Pediatric hematol oncol. 2013;1;30(6):557-67.

Mrózeka K, Heeremab NA, Bloomfield CD. Cytogenetics in acute leukemia. Blood reviews. 2004;1;18(2):115-36.

Sharma RK, Puri V, Mutreja D, Kumar S, Chauhan P, Purohit A, et al. Applicability of a single 5 Color Cytoplasmic Markers Tube as Primary Panel in Routine Immunophenotyping of Acute Leukemia. J Blood Disord Transfus. 2015;6(309).

Khurram MM, Jafri SA, Mannan A. Frequency of aberrant expression of CD markers in cases of acute leukemia. Med J Islamic World Academy Sci. 2010;109(395):1-6.

Sharma M, Sachdeva MUS, Varma N, Varma S, Marwaha RK. Characterization of immunophenotypic aberrancies in adult and childhood acute lymphoblastic leukemia: A study from Northern India. J cancer res therap. 2016;1;12(2):620.

Swerdlow S, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H et al. (eds). WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon: IARC Press 2008.

Seegmiller AC, Kroft SH, Karandikar NJ, McKenna RW. Characterization of Immunophenotypic Aberrancies in 200 Cases of B Acute Lymphoblastic Leukemia. Am J Clin Pathol. 2009;132(6):940-9.

Vitale A, Guarini A, Ariola C, Meloni G, Perbellini O, Pizzuti M et al. Absence of prognostic impact of CD13 and/or CD33 antigen expression in adult acute lymphoblastic leukemia. Results of the GIMEMA ALL 0496 trial. Haematologica. 2007;1;92(3):342-8.

Hussein S, Gill KZ, Sirieci AN, Colovai AI, Small T, Emmons FN et al. Aberrant T-cell antigen expression in B lymphoblastic leukaemia. Bri j haematol. 2011;155(4):449-56.

Preti HA, Huh YO, O'Brien SM, Andreeff M, Pierce ST, Keating M et al. Myeloid markers in adult acute lymphocytic leukemia. Correlations with patient and disease characteristics and with prognosis. Cancer. 1995;76(9):1564-70.

Kurec AS, Belair P, Stefani C, Barrett DM, Dubowy RL, Davey FR. Significance of aberrant immunophenotypes in childhood acute lymphoid leukemia. Cancer. 1991;15;67(12):3081-6.

Supriyadi E, Veerman AJ, Purwanto I, Cloos J. Myeloid antigen expression in childhood acute lymphoblastic leukemia and its relevance for clinical outcome in Indonesian ALL-2006 protocol. J oncol. 2012;135186.

Bhushan B, Chauhan PS, Saluja S, Verma S, Mishra AK, Siddiqui S, et al. Aberrant phenotypes in childhood and adult acute leukemia and its association with adverse prognostic factors and clinical outcome. Clin exp med. 2010;1;10(1):33-40.

Ünal S, Çetin M, Tuncer AM, Gümrük F, Yetgin S. The prognostic impact of myeloid antigen expression in pediatric acute lymphoblastic leukemia patients. Turkish j pediat. 2008;1;50(6):533.

Terwilliger T, Abdul-Hay M. Acute lymphoblastic leukemia: a comprehensive review and 2017 update. Blood Cancer J. 2017;7(6):577.

Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le-Beau MM et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016;127(20):2391-2405.

Cohen J. Ch. 3. The Significance of a Product Moment rs. In Statistical Power Analysis for the Behavioral Sciences. 2nd ed.: Lawrence Erlbaum Associates, Inc. 1988;77-83.

Khalidi HS, Chang KL, Medeiros LJ, Brynes RK, Slovak ML, Murata-Collins JL et a. Acute lymphoblastic leukemia: survey of immunophenotype, French-American-British classification, frequency of myeloid antigen expression, and karyotypic abnormalities in 210 pediatric and adult cases. Am j clin pathol. 19991;111(4):467-76.

Foa R. Acute lymphoblastic leukemia: age and biology. Pediatric reports. 2011;3(2).

Katz AJ, Chia VM, Schoonen WM, Kelsh MA. Acute lymphoblastic leukemia: an assessment of international incidence, survival, and disease burden. Cancer causes and control. 2015;26(11).

Neelkamal, Rathee R. Acute Lymphoblastic Leukemia: Characterization and its Prognostic Values. Int J Pharma Res Review. 2013;2(11):27-36.

Jalal S, Al‐Allawi N, Al-Doski A. Immunophenotypic aberrancies in acute lymphoblastic leukemia from 282 Iraqi patients. Int j lab hematol. 2017;39(6):625-32.

Gupta N, Pawar R, Banerjee S, Brahma S, Rath A, Shewale S et al. Spectrum and Immunophenotypic Profile Of Acute Leukemia: A Tertiary Center Flow Cytometry Experience. Mediterranean J Hematol Infect Dis. 2019;11(1).

Kavianpour M, Ketabchi N, Saki N. Prognostic significance of aberrant expression of CD markers in acute lymphoblastic leukemia. memo-Magazine of Euro Medi Oncol. 2017;1;10(3):164-9.

Pituch-Noworolska A, Kowalczyk J, Balwierz W, Bukowska-Strakova K, Małek U, Cydejko-Kawałek J et al. The frequency and characteristics of aberrant immunophenotypes in acute lymphoblastic leukaemia (ALL) in children-A multi center study. Acta Haematologica Polonica. 2010;41:579-89.

Momani A, Aslokhni H, Hababeh L, Khasawneh R, Kamal N. Aberrant Antigen Expression in Patients with Acute Leukemias: Experience of King Hussein Medical Center in Jordan. J Royal Med Services. 2016;102(3396):1-9.

Mazher N, Malik N, Imran A, Chughtai O, Chughtai AS. Aberrant expression of CD markers in acute leukemia. Ann Pak Inst Med Sci. 2013;9(2):99-102.

Dalal BI, Al-Mugairi A, Pi S, Lee SY, Khare NS, Pal J et al. Aberrant expression of CD13 identifies a subgroup of standard-risk adult acute lymphoblastic leukemia with inferior survival. Clin Lymphoma Myeloma Leukemia. 2014;1;14(3):239-44.

Alkayed K, Khattab E, Madanat F. Aberrant T-cell antigen expression in Jordanian children with B lymphoblastic leukemia. Hematol/Oncol Stem Cell Therapy. 2015;132(4).

Dunphy CH, Gardner LJ, Evans HL, Javadi N. CD15+ acute lymphoblastic leukemia and subsequent monoblastic leukemia: Persistence of t (4; 11) abnormality and B-cell gene rearrangement. Arch pathol lab med. 2001;125(9):1227-30.

Jaso J, Thomas DA, Cunningham K, Jorgensen JL, Kantarjian HM, Medeiros LJ et al. Prognostic significance of immunophenotypic and karyotypic features of Philadelphia positive B‐lymphoblastic leukemia in the era of tyrosine kinase inhibitors. Cancer. 2011;1;117(17):4009-17.

Chiaretti S, Zini G, Bassan R. Diagnosis and subclassification of acute lymphoblastic leukemia. Mediterranean j hematol infect diseases. 2014;6:1.