Patients with ≥ 20% leukemic blasts expressing an antigen of interest were considered positive for that specific antigen. To identify the expression of our antigens of interest, normal B, T and NK lymphocytes within each corresponding sample served as internal controls. 14 For the current study, surface expression of CD1a, CD4, CD7, CD5, CD8 and CD56 were evaluated on the leukemic B-lymphoblasts identified by sequential gating strategy. The diagnostic FCI panel (supplementary Table S1) and sample processing steps are as described in our previous publication. Diagnosis of B-ALL was by morphologic assessment of Romanowsky-stained bone marrow aspiration and peripheral blood smears, followed by FCI. Patients in the age group of 1–14 years, 15–29 years and >30 years were considered as pediatric, adolescents-young adults (AYAs) and adults, respectively. This study, in which all treatment-naïve B-ALL patients diagnosed between November 2017 and September 2019 were included, was conducted at a tertiary cancer care hospital. In the current manuscript, we have documented our experience with CD1a, CD4, CD5, CD7, CD8 and CD56 antigen expression in patients with B-ALL and have compared the clinicopathologic relevance associated with aberrant expression of these individual antigens against each other. 2,3 Regarding these T/NK cell antigen-expressing B-ALL patients, individual antigen-wise clinical-hematologic profiles and their prognostic relevance is yet to be compared. having compared the clinical-laboratory profile of these patients against conventional B-ALL patients. have documented large cohorts (18 cases each) of T/NK cell antigen-expressing B-ALL patients, with only Hussein et al. 2–13 Among this literature, only Seegmiller et al. 1,2Įnglish literature regarding aberrant expression of T-cell or natural killer (T/NK)-cell lineage antigens (i.e., CD1a, CD2, CD4, CD5, CD7, CD8 and CD56) in B-ALL patients dates back to 1989.
1 In this context, the cytogenetic and prognostic relevance associated with aberrant expression of myeloid lineage markers in B-ALL has been well documented. During FCI diagnosis of B-ALL, expression of certain non B-lineage antigens are of prognostic significance and provide clues towards underlying molecular-genetic aberrancies. In comparison to conventional B-ALL patients, there are significant differences in the age, cytogenetic profile and event-free survival of T/NK-cell antigen-expressing B-ALL patients.įlow cytometric immunophenotyping (FCI) plays a major role in the diagnosis and follow-up of patients with precursor B-lineage acute lymphoblastic leukemia (B-ALL). CD7-expressing B-ALL patients had inferior event-free survival ( p = 0.040) than their CD56-expressing counterparts, but there was no significant difference in the overall survival ( p = 0.317). On the contrary, CD7-expressing B-ALL patients were adolescent-young adult/adult-age skewed (83%) and had an adverse cytogenetic profile ( p = 0.001), especially for the frequent presence of BCR-ABL1 fusion ( p = 0.004) and KMT2A rearrangement ( p = 0.045). CD56-expressing B-ALL patients were predominantly children (89%) and presented as standard clinical risk ( p = 0.010) disease with frequent ETV6-RUNX1 fusion ( p = 0.021) positivity. In our B-ALL cohort, CD5, CD7 and CD56 expression were observed in one, six and nine patients, respectively. The clinical and laboratory profile of these T/NK-cell antigen-expressing B-ALL patients was statistically analyzed against conventional B-ALL patients. This is a prospective study where 152 consecutive B-ALL patients were analyzed for aberrant expression of T/NK cell antigens (CD1a, CD5, CD4, CD7, CD8 and CD56) by FCI. There is a paucity of studies that have comprehensively analyzed the clinical and laboratory profiles of B-ALL patients showing aberrant T/natural killer (NK) cell antigen expression. In patients diagnosed with precursor B-lineage acute lymphoblastic leukemia (B-ALL), expression of certain non-lineage/cross lineage antigens is of prognostic and cytogenetic relevance. Flow cytometric immunophenotyping (FCI) plays a major role in diagnosing hematologic malignancies.
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