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Acute nonlymphocytic leukemia: heterogeneity of stem cell origin
PJ Fialkow, JW Singer, JW Adamson, K Vaidya, LW Dow, J Ochs and JW Moohr
Four patients with acute nonlymphocytic leukemia who were heterozygous for
the X-chromosome-linked enzyme glucose-6-phosphate dehydrogenase (G6PD)
were studied to determine the numbers and types of progenitor cells in
which the disease arose. Both forms of enzyme were found in normal tissues,
but the malignant blast cells showed only one G6PD, indicating that the
disease was clonal at the time of testing. The observations that normal
erythroid cells were present in two young patients at diagnosis and relapse
indicate that the clone suppressed expression of normal granulopoiesis but
did not prevent normal erythroid differentiation. In contrast to this
situation, in two elderly patients, the disease involved stem cells
multipotent for granulocytes, red cells, and platelets. These results
indicate that acute nonlymphocytic leukemia is heterogeneous. In some
patients, the disease is expressed in cells with differentiation restricted
to the granulocyte-monocyte pathway; in others, it involves stem cells
capable of differentiating to granulocytes-monocytes, platelets, and
erythrocytes. This heterogeneity may reflect differences in causation and
could have prognostic and therapeutic importance.
Volume 57,
Issue 6,
pp. 1068-1073,
06/01/1981
Copyright © 1981 by The American Society of Hematology

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