Cytochemistry of acute promyelocytic leukemia (M3): leukemic promyelocytes
exhibit heterogeneous patterns in cellular differentiation
M Tomonaga, Y Yoshida, M Tagawa, I Jinnai, K Kuriyama, T Amenomori, A Yoshioka, T Matsuo, H Nonaka and M Ichimaru
Cytochemical investigation of leukemic promyelocytes from 25 cases of acute
promyelocytic leukemia (M3) disclosed two major cellular differentiation
categories: (1) the pure neutrophilic (N) type (16 cases) with strong
myeloperoxidase (MPO) and naphthol-ASD chloroacetate esterase (Es-chl), but
lacking the monocytic enzyme NaF-sensitive alpha- naphthyl butyrate
esterase (Es-b), and (2) the mixed neutrophilic/monocytoid (N/M) type
(seven cases) with strong Es-b as well as strong MPO, all cases exhibiting
Es-dual (Es-b + Es-chl) positive cells. Two more cases with unusual
phenotypes were noted: one with intense lysozyme activity but without Es-b
and the other with toluidine blue-methachromasia and negative MPO.
Promyelocytes from the control group, consisting of nine cases of t(8;21)
M2 AML and ten cases with normal bone marrow, lacked such cytochemical
heterogeneity. HL-60, an M3 cell line that can be induced to differentiate
toward monocytic lineage in vitro, was almost negative for Es-b in the
uninduced condition. Cytogenetically, eight cases of N type and five of N/M
type had the t(15;17) abnormality. Thus at least two differentiation
patterns were observed in M3 leukemia with fidelity (N type) and infidelity
(N/M type) for normal granulocytic differentiation. In this series, there
was no statistically significant difference in clinical features (remission
rate and survival) between the two types. Our study suggests that the
development of M3 leukemia is not exclusively restricted to the
neutrophilic pathway, but more heterogeneously related to myelomonocytic
differentiation.
Volume 66,
Issue 2,
pp. 350-357,
08/01/1985
Copyright © 1985 by The American Society of Hematology
