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Near-triploid and near-tetraploid acute lymphoblastic leukemia of childhood
CH Pui, AJ Carroll, D Head, SC Raimondi, JJ Shuster, WM Crist, MP Link, MJ Borowitz, FG Behm and VJ Land
Department of Hematology-Oncology, St Jude Children's Research Hospital,
Memphis, TN 38101.
Cytogenetic and DNA flow cytometric analyses of leukemic cells from 1,971
children with newly diagnosed acute lymphoblastic leukemia (ALL) identified
stem lines with modal chromosome numbers greater than 65 in 26 patients
(1.3%). Near-triploidy (66 to 73 chromosomes) was found in six cases and
near-tetraploidy (82 to 94 chromosomes) in 20. A striking morphologic
finding was the presence of clumped chromatin with grooved nuclei or Rieder
cell formation in 20 cases. Other than a slight excess of the pre-B
immunophenotype, the near-triploid cases did not appear to differ
substantially from the general ALL population in clinical features. In
contrast, near-tetraploid cases were more often associated with a T-cell
immunophenotype (47% v 14%, P less than .001) and L2 morphology (30% v 22%,
P less than .01), and were older at diagnosis (median age, 8.6 v 4.8 years,
P = .01) than cases with other ploidies. Moreover, an unusually high
proportion of near-tetraploid cases tested (6 of 15) expressed one or more
of the myeloid-associated antigens CD13, CD15, and CD33. Despite the use of
contemporary intensive chemotherapy and short follow-up for most patients,
6 of the 20 near- tetraploid cases have relapsed or died. This study
suggests that the near-tetraploid subtype differs from other cases of
hyperdiploid greater than 50 ALL, which have been associated with a
favorable prognosis.
Volume 76,
Issue 3,
pp. 590-596,
08/01/1990
Copyright © 1990 by The American Society of Hematology
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