Tag Archives: immunophenotyping

The Role of Immunophenotyping in Diagnosis of Biphenotypic Acute Leukemias

Köpeczi Judit Beáta1, Benedek I1,2, Benedek Erzsébet1, Kakucs Enikő1, Tunyogi Aliz1, Istrati Monica1

1 Clinical Hematology and Bone Marrow Transplantation Clinic, Târgu Mureş
2 University of Medicine anf Pharmacy, Târgu Mureş

Introduction: The majority of acute leukemias can be classified as myeloid, B, or T lymphoid. In some cases this is not possible because of the evidence of expression of both lymphoid and myeloid lineage-specific antigens in the blast cells. These cases were defined as biphenotypic acute leukemias. The aim of this study was to present the importance of immunophenotyping in diagnosis of biphenotypic acute leukemias.
Material and method: In our report we present 8 cases of biphenotypic acute leukemia from a total of 218 patient diagnosed with acute leukemia. We performed immunophenptyping of bone marrow samples. Three-or four-color immunoflourescence staining was used. The diagnosis was established according to EGIL (European Group for the Immunological Classification of Leukemias) classification.
Results: Immunophenotyping identified 4 cases with B-lymphoid+myeloid immunophenotype, 2 cases had T-lymphoid+myeloid immunophenotype, 1 patient had B+T-lymphoid immunophenotype and 1 patient had biclonal AL. Except one patient, all of them had blasts positive for CD34 marker. 4 of the patients were treated with acute lymphoblastic leukemia protocol, 2 with acute myeloblastic leukemia protocol and 2 cases with acute myeloblastic leukemia protocol after failure of ALL protocol. The outcome was poor, the median survival was 4 months.
Conclusions: Immunophenotyping of blasts cells is indispensable in the diagnosis of biphenotypic acute leukemia. The most common immunophenotype is co-expression of myeloid and B-lymphoid markers and co-expression of myeloid and B-lymphoid markers. Most cases show expression of stem cell marker CD34. The outcome of this type of leukemias are poor.

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Routine Immunophenotyping in Acute Leukemia, the Importance of Lineage Assessment

Bacârea Anca1, Dorcioman Bogdana2, Bacârea V3, Tilincă Mariana4, Demian Smaranda5, Șchiopu A1, Băţagă Simona6

1 Department of Physiopathology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Hematology, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
3 Department of Medical Research Methodology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Department of Cell Biology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
5 Department of Hematology, Medical Clinic I, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
6 Department of Internal Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

We present the case of an adult male patient, where the assessment of cell line could not be done without corroboration of the immunophenotype and cytological analysis. The correct lineage assessment is needed in order to treat the patient correctly. Morphology, cytochemistry, and immunophenotyping were used and the diagnosis we established was B acute lymphoblastic leukemia with aberrant myeloid markers (CD13, CD33). Periodic Schiff Acid stain was very useful to obtain an accurate diagnosis. Adult B acute lymphoblastic leukemia usually has an unfavorable prognosis because of certain cytogenetic abnormalities (Philadelphia chromosome) and different reactivity to treatment. This case strongly supports the continued use of immunophenotyping in the diagnosis and monitoring of acute leukemia and corroboration of different diagnostic techniques for the diagnosis.

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A Case of Plasmacytoid Dendritic Cell Leukemia

Köpeczi Judit Beáta1, Benedek I1,2, Benedek Erzsébet1, Kakucs Enikő1, Tunyogi Aliz1, Istrati Monica1, Kurtus Aranka1

1 Clinical hematology and Bone Marrow Transplantation Clinic, Tîrgu Mureş, Romania
2 University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.2478/amma-2013-0027

Introduction: Plasmacytoid dendritic cell leukemia is a rare subtype of acute leukemia, which has recently been established as a distinct pathologic entity that typically follows a highly aggressive clinical course in adults. The aim of this report is to present a case of plasmacytoid dendritic cell leukemia due to its rarity and difficulty to recognize and diagnose it.
Case report: We present a case of a 67 year-old man who presented multiple subcutaneous lesions on his face, neck, chest and upper extremities with reddish-brown, brown colour. In the bone marrow aspirate 83% of the blast cells were found. Immunophenotypically the blasts were positive for CD4, CD56, CD123 (high intensity), CD36, CD22, CD10 (10.42%), CD33, HLA-DR, CD7 (9.24%), CD38 (34.8%) and negative for CD13, CD64, CD14, CD16, CD15, CD11b, CD11c, CD3, CD5, CD2, CD8, CD19, CD20, CD34. The skin biopsy showed lymphohistiocytoid infiltration in the dermis. The patient was diagnosed with acute plasmacytoid dendritic cell leukemia and received polychemotherapy with rapid response of skin lesions and blastic infiltration of the bone marrow. After 3 courses of polychemotherapy the cutaneous lesions reappeared and multiplied. The blast infiltration in the bone marrow increased to 70%. A more aggressive polychemotherapy regimen was administered, but the patient presented serious complications (febrile neutropenia) and died in septic shock 8 months after the initiation of treatment.
Conclusions: Immunophenotyping of blasts cells is indispensable in the diagnosis of plasmacytoid dendritic cell leukemia. The CD4+, CD56+, lin-, CD123 ++high, CD11c-, CD36+, HLA-DR+, CD34-, CD45+ low profile is highly suggestive for pDCL. The outcome of plasmacytoid dendritic cell leukemia is poor. Despite the high rate of initial response to treatment, early relapses occur and the patients die of disease progression.

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