Abstract
Biphenotypic acute leukemia (BAL) is defined as the existence of multiple antigen coexpression in leukemic blasts or two different types of blast population. In this study, a patient who was first diagnosed with BAL and later with acute myeloid leukemia M1 (AML-M1) is presented. The patient was four-year-old male and had complaints about high fever, fatigue, lack of appetite, and weight loss for two months. % 96 L2 type blasts were identified in bone marrow aspiration, and positive values for CD79a, CD56, CD5, CD13, CD33, and MPO were observed in flow-cytometry. These findings, evaluated on the basis of “European Group for the Immunological Characterization of Leukemias (EGİL)” criteria, suggested BAL. As the steroid treatment returned no response, the flow-cytometry findings were reevaluated based on “World Health Organization (WHO)” criteria. BAL was excluded and AML M1 was considered as a diagnosis. The positive values for CD79a, CD56 , and CD5 were evaluated as coexpression. Chemotherapy was given as AML treatment, and the dramatic response was reported. This case is presented to show that, using EGİL criteria to evaluate BAL may be misleading , and thus using WHO criteria to evaluate BAL may be more appropriate
References
- Bene MC. Biphenotypic, bilineal, ambiguous or mixed lineage:
- strange leukemias! Haematologica 2009;94:891-893.
- Bene MC, Castoldi G, Knapp W, et al. Proposals for the immunological
- classification of acute leukemias. European
- Group for the Immunological Characterization of Leukemias
- (EGIL). Leukemia 1995;9:1783-1786.
- Vardiman JW, Thiele J, Arber DA, et al. The 2008 revision
- of the World Health Organization (WHO) classification of
- myeloid neoplasms and acute leukemia: rationale and important
- changes. Blood 2009;114:937-951.
- Ye Z, Wang S. Mixed phenotype acute leukemia. Chin Med J
- ;127: 2999-3003.
- Zhao XF, Gojo I, York T, et al. Diagnosis of biphenotypic
- acute leukemia: a paradigmatic approach. Int J Clin Exp
- Pathol 2009;3:75-86.
- Kozlov I, Beason K, Yu C, Hughson M. CD79a expression in
- acute myeloid leukemia t(8;21) and the importance of cytogenetics
- in the diagnosis of leukemias with immunophenotypic
- ambiguity. Cancer Genet Cytogenet 2005;163:62-67.
- Cruse JM, Lewis RE, Pierce S, et al. Aberrant expression of
- CD7, CD56, and CD79a antigens in acute myeloid leukemias.
- Exp Mol Pathol 2005;79:39-41.
Abstract
Bifenotipik akut lösemi (BAL), lösemik blastlarda aynı hücre üzerinde birden çok antijen ko-ekspresyonu varlığı veya iki farklı türde blast popülasyonu bulunması olarak tanımlanır. Burada öncelikle BAL tanısı alan, sonraki tetkiklerinde akut myelositer lösemi M1 (AML-M1) olduğu saptanan bir hasta sunuldu. Dört yaşında erkek hasta, iki aydır olan yüksek ateş, halsizlik, iştahsızlık ve kilo kaybı şikayeti ile başvurdu. Kemik iliği aspirasyonu incelemesinde %96 L2 tipi blastlar saptandı ve flow-sitometride CD79a, CD56, CD5, CD13, CD33, ve MPO pozitifiliği gözlendi. Bu sonuçlar “European Group for the Immunological Characterization of Leukemias (EGIL)” sınıflamasına göre değerlendirildiğinde BAL tanısı düşünüldü. Steroid tedavisine cevap vermemesi üzerine, flowsitometri sonuçları “Dünya Sağlık Örgütü (WHO)”nun sınıflaması- na göre tekrar değerlendirildi. BAL tanısı dışlandı ve AML M1 tanısı düşünüldü. Flowsitometrideki CD79a, CD56 ve CD5 pozitifliği ise ko-ekspresyon olarak değerlendirildi. AML tanısına yönelik verilen kemoterapiye dramatik olarak cevap verdi. Bu vaka BAL tanısında EGİL kriterlerinin kullanımının hatalı sonuçlara yol açabileceğini, WHO sı- nıflamasının kullanılmasının daha uygun olacağını vurgulamak amacıyla sunuldu. Anahtar kelimeler: Bifenotipik akut lösemi, akut myelositer lösemi, ko-ekspresyon.
References
- Bene MC. Biphenotypic, bilineal, ambiguous or mixed lineage:
- strange leukemias! Haematologica 2009;94:891-893.
- Bene MC, Castoldi G, Knapp W, et al. Proposals for the immunological
- classification of acute leukemias. European
- Group for the Immunological Characterization of Leukemias
- (EGIL). Leukemia 1995;9:1783-1786.
- Vardiman JW, Thiele J, Arber DA, et al. The 2008 revision
- of the World Health Organization (WHO) classification of
- myeloid neoplasms and acute leukemia: rationale and important
- changes. Blood 2009;114:937-951.
- Ye Z, Wang S. Mixed phenotype acute leukemia. Chin Med J
- ;127: 2999-3003.
- Zhao XF, Gojo I, York T, et al. Diagnosis of biphenotypic
- acute leukemia: a paradigmatic approach. Int J Clin Exp
- Pathol 2009;3:75-86.
- Kozlov I, Beason K, Yu C, Hughson M. CD79a expression in
- acute myeloid leukemia t(8;21) and the importance of cytogenetics
- in the diagnosis of leukemias with immunophenotypic
- ambiguity. Cancer Genet Cytogenet 2005;163:62-67.
- Cruse JM, Lewis RE, Pierce S, et al. Aberrant expression of
- CD7, CD56, and CD79a antigens in acute myeloid leukemias.
- Exp Mol Pathol 2005;79:39-41.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Case Reports |
| Authors | |
| Publication Date | May 9, 2015 |
| Submission Date | May 9, 2015 |
| Published in Issue | Year 2015 Volume: 42 Issue: 1 |