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Blood, 2 April 2009, Vol. 113, No. 14, pp. 3287-3296.
Prepublished online as a Blood First Edition Paper on January 15, 2009; DOI 10.1182/blood-2008-04-154187.


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LYMPHOID NEOPLASIA

Expression of CD133 on leukemia-initiating cells in childhood ALL

Charlotte V. Cox1,2, Paraskevi Diamanti1,2, Roger S. Evely3, Pamela R. Kearns4, and Allison Blair1,2

1 Bristol Institute for Transfusion Sciences, Bristol; 2 Department of Cellular and Molecular Medicine, University of Bristol, Bristol; 3 Bristol Haematology and Oncology Centre, Bristol; and 4 Division of Reproductive and Child Health, University of Birmingham, Birmingham, United Kingdom

Optimization of therapy for childhood acute lymphoblastic leukemia (ALL) requires a greater understanding of the cells that proliferate to maintain this malignancy because a significant number of cases relapse, resulting from failure to eradicate the disease. Putative ALL stem cells may be resistant to therapy and subsequent relapses may arise from these cells. We investigated expression of CD133, CD19, and CD38 in pediatric B-ALL. Cytogenetic and molecular analyses demonstrated that karyotypically aberrant cells were present in both CD133+/CD19+ and CD133+/CD19 subfractions, as were most of the antigen receptor gene rearrangements. However, ALL cells capable of long-term proliferation in vitro and in vivo were derived from the CD133+/CD19 subfraction. Moreover, these CD133+/CD19 cells could self-renew to engraft serial nonobese diabetic–severe combined immunodeficient recipients and differentiate in vivo to produce leukemias with similar immunophenotypes and karyotypes to the diagnostic samples. Furthermore, these CD133+/CD19 ALL cells were more resistant to treatment with dexamethasone and vincristine, key components in childhood ALL therapy, than the bulk leukemia population. Similar results were obtained using cells sorted for CD133 and CD38, with only the CD133+/CD38 subfraction demonstrating xenograft repopulating capacity. These data suggest that leukemia-initiating cells in childhood B-ALL have a primitive CD133+/CD19 and CD38 phenotype.


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