CD79 alpha expression in acute myeloid leukemia. High frequency of expression in acute promyelocytic leukemia.

CD79 alpha is a subunit of an intracytoplasmic protein reported to be specific for B lymphocytes, including immature B lineage cells. To evaluate expression of the CD79 alpha antigen in acute myeloid leukemia (AML), we studied forty-eight cases of AML by paraffin section immunohistochemistry. The cases included four MO, nine M1, nine M2, ten M3, ten M4, and six M5 AMLs using criteria of the French-American-British cooperative group. Eleven cases demonstrated cytoplasmic staining for the CD79 alpha antigen, including one M1, nine M3, and one M5 AML. These CD79 alpha-positive cases represented 5% of all non-promyelocytic AMLs and 90% of all acute promyelocytic leukemias studied. All acute promyelocytic leukemias had the characteristic t(15;17)(q24;q21), including two cases of the microgranular variant (M3v). No other B-lineage-associated antigens were found in the CD79 alpha-positive cases, with the exception of a subpopulation of CD19-positive leukemic cells in one patient. The two non-promyelocytic leukemias that expressed CD79 alpha had no evidence of t(15;17) and did not express any additional B-lineage-associated antigens that might suggest a mixed lineage proliferation. This study demonstrates that CD79 alpha expression in acute leukemia is not restricted to B-lineage acute lymphoblastic leukemias and that CD79 alpha expression is frequently associated with t(15;17) acute myeloid leukemia.     

Expression of CD117 and CD11b in bone marrow can differentiate acute promyelocytic leukemia from recovering benign myeloid proliferation

The morphologic characteristics of bone marrow aspirates from patients recovering from acute agranulocytosis may be closely similar to the pattern observed in cases of acute promyelocytic leukemia (APL). The clinical manifestation also can be ambiguous in a substantial number of cases. The immunophenotypic features of bone marrow from 5 patients recovering from acute agranulocytosis, showing an increase in the percentage of promyelocytes (26%-66%), were compared with the immunophenotype of 31 consecutive patients with APL whose diagnosis was confirmed by PML-RAR alpha gene rearrangement. All markers were similarly expressed, except for CD117 and CD11b. CD117 was positive in 24 (77%) of the APL cases and in none of the acute agranulocytosis cases. On the other hand, CD11b was positive in 5 (100%) of the acute agranulocytosis cases and in only 2 (6%) of the APL cases. Thus, the CD117-CD11b+ phenotype was detected in all patients recovering from agranulocytosis and in only 1 (3%) of 31 APL cases. Therefore, we suggest that the combination of both markers is helpful in the differentiation of APL from recovering benign myeloid proliferation.     

Tetraploid acute promyelocytic leukemia with large bizarre blast cell morphology

We describe a case of atypical acute promyelocytic leukemia (APL) with a tetraploid clone and multiple karyotypic abnormalities in addition to the translocation (15;17)(q22;q21). Microscopically, the leukemic cells were highly heterogeneous in morphology and granularity, being bizarre and large in size compared with classical APL blasts. The patient responded to treatment with chemotherapy and all-trans-retinoic acid, at diagnosis and at relapse 10 months later. He is currently in clinical and molecular remission, 3 years after initial diagnosis. Tetraploidy in association with large and bizarre blasts has not been previously reported in APL. Although tetraploidy and complex karyotypic aberrations confer a poor prognosis in other types of acute myeloid leukemia, in the presence of t(15;17) they did not appear to affect the prognosis, inasmuch as the clinical features and treatment outcome in our case followed those of APL in general.     

Benign extramedullary myeloid proliferations.

Extramedullary proliferations of bone marrow elements are infrequently encountered in routine pathology practice. On occasion, they can present diagnostic difficulties when seen in unusual or unanticipated sites. This review serves to cover aspects of underlying embryogenesis of myeloid elements, as well as sites and circumstance of benign proliferations of myeloid elements along with their occasional confusion with neoplastic myeloid proliferations. Benign proliferations associated with hematologic disorders and hematopoietic growth factors are discussed. Immunohistochemical evaluation of myeloid proliferations is considered as well.     

The comparison of bone marrow kinetics between patients with acute myeloid leukemia and acute promyelocytic leukemia after induction chemotherapy

Abstract

Background and Aim: Recently, acute promyelocytic leukemia (APL) has shifted from the most hazardous to the best curable type of acute myeloid leukemia. Anthracyclines, all-trans retinoic acid (ATRA) and arsenic derivatives are the most important developments for the treatment of APL. ATRA promotes the terminal differentiation of malignant promyelocytes to mature neutrophils. We aimed to compare platelet and neutrophil recovery time after induction chemotherapy in patients with acute myeloid leukemia (AML) and APL.

Materials and Methods: Two hundred and fifteen patients with AML and APL, who were diagnosed and treated in our tertiary care center between the years of 2001 and 2018 were evaluated.

Results: One hundred and eighty one AML patients (84.2%) and 34 (15.8%) APL patients were included in this study. The time between neutrophil nadir after induction chemotherapy and neutrophil recovery was longer in APL patients than in AML patients [30.5 (4–52) vs. 20 (5–58), p?<?0.001]. The time between platelet nadir after induction chemotherapy and platelet recovery was longer in APL patients than in AML patients [21.5 (4–42) vs. 17 (4–45), p?=?0.02].

Conclusion: Neutrophil and platelet recovery times were longer in APL patients than in AML patients in our present study. In 60?days, mortality rate was higher in APL patients than AML patients. Non-relapse mortality (NRM) rate was similar between two groups. There was a significant difference between two groups in terms of NRM causes. Platelet and neutrophil recovery time is very important because infection is the most important cause of NRM.     

Development of acute promyelocytic leukemia with isochromosome 17q after BCR/ABL positive chronic myeloid leukemia

We describe a pediatric case of acute promyelocytic leukemia with an i(17q) after treatment of BCR/ABL positive chronic myeloid leukemia (CML) for 3.5 years. The patient was treated with Busulphan, alpha-2a interferon, hydroxyurea, and cytosine arabinoside at various times in the course of the chronic phase of CML, because he had no HLA-identical donor for bone marrow transplantation. Hematologic remission was achieved for a short time, but cytogenetic remission was never possible. When promyelocytic blast crisis was diagnosed according to the French-American-British classification, cytogenetic studies revealed an i(17q) as a new feature in our patient. The promyelocytic transformation was associated with the appearance of an i(17q) preceding CML are discussed in the light of recent literature.     

Cytogenetic studies of acute promyelocytic leukemia

Translocation t(15;17) is reported in bone marrow cells from six of seven patients with active acute promyelocytic leukemia (APL). One patient who showed t(15;17) at final relapse did not show it in directly prepared or cultured cells taken from a previous relapse. Bone marrow samples from two patients showed only cells with a normal karyotype in the direct preparation, whereas more than 60% of cells cultured for 24 hr showed t(15;17). R-Banding, G-banding, and an attempt at high-resolution banding indicated the break points t(15;17)(q24;21) for one of our patients.     

48例急性早幼粒细胞白血病的细胞遗传学研究

目的　探讨不同病期急性早幼粒细胞白血病 (APL)的细胞遗传学特点及意义。方法　随机选取 4 8例APL患者 ,采集新鲜骨髓 ,采用 2 4h预加秋水仙素的短期培养法制备染色体 ,应用G显带技术进行核型分析并照相。结果　本研究4 8例患者 (未缓解期 16例 ,复发期 3例 ,完全缓解期 2 9例 )中 ,具有染色体异常的有 2 8例 ,其中未缓解期 16例 (16 /16 ) ,复发期 3例 (3/3) ,完全缓解期 9例 (9/2 9)。异常类型以染色体易位和片段缺失比例较高 ,其中具有典型t(15 ;17)易位者 7例 ,为未缓解期或复发期患者 ;易位涉及 8q2 2者 5例。其中 ,同时具有t(15 ;17) ,t(8;2 1)易位 1例 ;同时具有t(5 ;8) ,t(15 ;17)易位 1例 ;t(5 ;8)易位 1例 ;t(8;17)易位 1例 ;以t(8;2 1)为基础的复杂易位 1例。具有 17q2 1-者 6例。结论　对白血病进行细胞遗传学研究不但具有十分重要的诊断和预后价值 ,而且能发现与疾病发生有关的新基因及涉及白血病转化和增殖的分子损伤位点。     

Differentiation to myeloid cells of lymphoblastoid cells established from myelomonocytic leukemia

Summary It has been previously reported that a lymphoblastoid cell line (Mono-1) established from the peripheral blood of a patient with acute myelomonocytic leukemia (AMML) consisted of reticulum cells, possessing properties that were more characteristic of monocytes and macrophages than those which are traditionally attributed to lymphocytes. These cells (Mono-1-207) exhibit myeloid cell properties when cultured in arginine-deficient medium and after treatment with DNA synthetic inhibitors. A comparison has been made with lymphoblastoid cell lines derived from other types of disease.During culture in arginine-deficient condition, decreased DNA synthesis is accompanied by the appearance, at 48 h, of perinuclear pink cytoplasmic blushes; nuclear lobulation had developed by about the fifth day. At 12–14 days, the cytoplasmic granules developed from blushes could not be distinguished from azurophilic granules. Electron microscopy indicated that these granules were due to the development of lysosomes in which acid phosphatase was strongly present but which lacked any peroxidase activity. Mono-1-207 also has phagocytic activity. It is considered that the induction of differentiation of these cells in response to DNA synthesis by arginine-deficiency is related to possession of the characteristics described: they are hemopoietic precursor cells, and differentiate to myeloid cells.This work was supported by a cancer research grant 51101 and 52004 from Kawasaki Medical School.     

Clinical morphology of chronic myeloid leukemia]

The morphological features of chronic myeloid leukemia at different stages of the disease were specified basing on the study of bone marrow punch biopsies of 239 patients, surgically removed spleens of 32 patients, marginal liver biopsies of 22 patients and 69 autopsies. It was found valid to distinguish two histological variants: granulocytic and granulocytic-megakaryocytic. It was shown that in the latter form of leukemia myelofibrosis, primarily of reticulin type, often tends to develop. The granulocytic-megakaryocytic variant and the diffuse myelofibrosis were found to be related to the morphological manifestations of unfavourable prognosis of chronic myeloid leukemia. The accumulation of blast cells in the central parts of bone marrow cavities, as revealed in the punch biopsies is the indication of the beginning of the blast transformation.