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Leukemia-associated changes identified by quantitative flow cytometry. IV.
CD34 overexpression in acute myelogenous leukemia M2 with t(8;21)
A Porwit-MacDonald, G Janossy, K Ivory, D Swirsky, R Peters, K Wheatley, H Walker, A Turker, AH Goldstone and A Burnett
Department of Clinical Immunology, Royal Free Hospital School of Medicine,
London, UK.
During the immunodiagnosis of 517 cases of acute myelogenous leukemia (AML)
entered into the Medical Research Council (MRC) AML 10 trials, we have
observed the CD34 precursor cell antigen more frequently in AML of M2
morphology, especially in the 84% of cases with the t(8;21) chromosomal
translocation, than in any other French-American-British classification
group. CD34 expression was then quantified (using QIFI and Quantum Simply
Cellular beads [Flow Cytometry Standards, Research Triangle Park, NC] and
CD34+ standard cells). When CD34 antibody- binding capacity (ABC) of normal
bone marrow (BM) precursors and leukemic blasts was compared, it was shown
that AML M2 cases with t(8;21) not only had the highest percentages of
CD34+ blasts, but in > 80% of CD34+ cases the individual blasts
expressed higher than normal levels of CD34 antigen (> 60 x 10(3) ABC
per cell). In addition, in 73% of this group CD34 antigen was overexpressed
in an asynchronous combination with cytoplasmic myeloperoxidase (MPO).
Other signs of asynchrony included high CD34 expression with CD15 and/or
CD56, as well as aberrant combinations of CD13 with terminal
deoxynucleotidyl transferase (TdT) and CD19. These findings demonstrate
that asynchrony is identifiable in virtually every case of AML with
t(8;21), although it does not always involve the same antigens. M2 cases
with t(8;21), mostly CD34+, had a 100% remission rate and 71% 5-year
survival rate; other patients with CD34+ or CD34- AML showed 69% and 84%
remission rates and 31% and 36% 5-year survival rates, respectively.
Consequently, individual markers such as CD34 should be interpreted in
relation to other features such as chromosomal changes. These simple
methods, which are well suited to quantify the expression of ligands, are a
useful contribution to diagnosis: 60% to 65% of M2 cases with t(8;21) are
rapidly identified by CD34 overexpression alone. This aberration, together
with the other signs of asynchrony seen at presentation, can be used to
search for residual leukemia after therapy.
Volume 87,
Issue 3,
pp. 1162-1169,
02/01/1996
Copyright © 1996 by The American Society of Hematology
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