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Diagnostic application of two-color flow cytometry in 161 cases of hairy
cell leukemia
BA Robbins, DJ Ellison, JC Spinosa, CA Carey, RJ Lukes, S Poppema, A Saven and LD Piro
Department of Pathology, Scripps Clinic and Research Foundation, La Jolla,
CA 92037.
Recent immunophenotypic studies of hairy cell leukemia (HCL) have suggested
specific patterns of immunoreactivity that may aid in diagnosis. We studied
peripheral blood (PB) from 161 cases of HCL using two-color direct
immunofluorescence flow cytometry and an extended panel of antibody
combinations. Circulating hairy cells were identified by immunophenotypic
features in 92% of the cases and could be detected even when representing
< or = 1% of circulating lymphocytes. The 133 cases with > or = 2%
detectable hairy cells were analyzed in detail. HCL showed a uniform and
unique B-cell phenotype, with each of the following features identified in
99% to 100% of cases: (1) positive staining for B-ly7, coexpressed with
CD19; (2) very intense, uniform expression of CD11c, with CD19; (3)
moderately intense staining for CD25, with CD19; (4) very intense staining
for CD22; (5) moderate to very intense staining for CD20; and (6)
moderately intense monoclonal surface Ig. Phenotypic variability existed in
expression of CD10 (26%) and CD5 (4%). Based on these features, HCL was
easily distinguished from 50 cases of chronic lymphocytic leukemia (CLL).
Although CLL exhibited frequent expression of CD11c (74%) and CD25 (68%),
the intensity of staining was significantly less than HCL. Furthermore, CLL
was uniformly positive for CD5 and showed weak staining for CD20, CD22, and
surface Ig. B-ly7 proved to be the most specific marker, reacting with 100%
of HCL cases, but absent in all cases of CLL. We conclude that two-color
flow cytometry with specific antibody combinations is an efficacious method
for characterization and sensitive detection of hairy cells in PB.
Application of the phenotypic criteria described should help to increase
accuracy in diagnosis of HCL.
Volume 82,
Issue 4,
pp. 1277-1287,
08/15/1993
Copyright © 1993 by The American Society of Hematology
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