International Journal of Hematological Disorders
ISSN (Print): ISSN Pending ISSN (Online): ISSN Pending Website: https://www.sciepub.com/journal/ijhd Editor-in-chief: Apply for this position
Open Access
Journal Browser
Go
International Journal of Hematological Disorders. 2015, 2(1), 10-17
DOI: 10.12691/ijhd-2-1-3
Open AccessArticle

Flowcytometric Immunophenotypic Characterization of Acute Myeloid Leukemia (AML) in Sudan

Ihsan M. Osman1, , Amira A. K. Humeida2, Osama Eltayeb1, Inaam Abdelrhman1 and Taghreed A. Elhadi1

1Laboratory Department, Radio-Isotope Centre Khartoum

2Faculty of Medicine, Alneelain University

Pub. Date: January 20, 2015

Cite this paper:
Ihsan M. Osman, Amira A. K. Humeida, Osama Eltayeb, Inaam Abdelrhman and Taghreed A. Elhadi. Flowcytometric Immunophenotypic Characterization of Acute Myeloid Leukemia (AML) in Sudan. International Journal of Hematological Disorders. 2015; 2(1):10-17. doi: 10.12691/ijhd-2-1-3

Abstract

Introduction: Acute Myeloid Leukaemia (AML) accounts for approximately 20% of acute leukemia in children and 80% of acute leukemia in adults. Immunophenotyping has become extremely important not only in diagnosis and subclassification of AML but also in the detection of the minimal residual disease. Immunophynotypic pattern of AML in Sudanese patients have not been addressed before. This study was conducted to characterize immunophenotypic patterns of AML in Sudanese patients. Multiparameter flow cytometry and CD45/SSC gating were used to analyze the surface and cytoplasmic antigen expressions in 106 cases of AML during the period mid2010 to mid2011 at Radioisotope Centre Khartoum (RICK). The following antigens: CD45, HLA-DR, CD34, CD117, CD13, CD33, CD19, CD7, cytoplasmic markers (CD3, CD79a, MPO), CD11c, CD14, CD64, CD42a, CD41 and CD61 were used. Results: Almost all AML blasts were expressing CD45 with no significant differences between the subtypes. CD34 have different expressions in AML subtypes. CD13 and CD33 were also studied among the blast population having mean positivity of 51.5% and 49.8% respectively in all AML subtypes collectively. CD33 was found to have higher positivity among AML-M4 and AML-M5 with mean positivity of 75.9% and 76.6% respectively. CD13 and CD33 had no correlation for all AML subtypes except for AML-M5 with very strong negative correlation(r=-0.913). Apparent expression of CD7 and CD19 were expressed in 45.1% and 13.6% of all cases respectively. CD7 was mostly expressed in AML-M2 and AML-M3 (75%) and least in AML-M5, while CD19 was only expressed in cases of AML-M0 and AML-M7. Conclusion: Flowcytometric analysis of acute leukemia by combining the patterns and intensity of antigen expression improved the diagnosis of AML in our centre. Immunophenotyping results and FAB classification of our AML patients were comparable to international published studies.

Keywords:
acute myloidleukemia Immunophenotyping flowcytometry

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Weinstein HJ. Acute Myeloid Leukemia. In: Pui CH, editor. Childhood Leukemias. UK: Cambridge University Press; 1999. pp. 322-35.
 
[2]  Kaleem Z, Crawford E, Pathan MH, Jasper L, Covinsky MA, Johnson LR, White G. Flow cytometric analysis of acute leukemias. Diagnostic utility and critical analysis of data. Arch Pathol Lab Med. 2003; 127: 42-48.
 
[3]  Bradstock KF The diagnostic and prognostic value of immunophenotyping in acute leukemia. Pathology 1993; 25: 367-374.
 
[4]  Peterson L. C. andGoolsby C.. Mini-symposium: Bone marrow pathology Flow-cytometricimmunophenotypingof haematologic malignancies involving blood and bone marrow. Current Diagnostic Pathology (1997) 4, 187-195.
 
[5]  Belson M, Kingsley B, Holmes A Risk factors for acute leukemia in children: a review. Environ Health Perspect 2007; 115: 138-145.
 
[6]  Ghosh S, Shinde SC, Kumaran GS, Sapre RS, Dhond SR, Badrinath Y, Ansari R, Kumar A, Mahadik S, Chougule AB, Nair CN, Haematologic and immunophenotypic profile of acute myeloid leukemia: an experience of Tata Memorial Hospital. Indian journal of cancer 2003; 40: 71-76.
 
[7]  Salem DA, Abd El-Aziz SM.Flowcytometricimmunophenotypic profile of acute leukemia: mansoura experience.Indian J Hematol Blood Transfus. 2012 Jun; 28(2):89-96. Epub 2011 Sep 21.
 
[8]  Harani MS, Adil SN, Shaikh MU, Kakepoto GN, KhurshidM. Frequency of fab subtypes in acute myeloid leukemia patients at Aga Khan University Hospital Karachi. J Ayub Med Coll Abbottabad. 2005 Jan-Mar; 17(1):26-9.
 
[9]  Horibe K, Tsukimoto I, Ohno R. Clinicopathologic characteristics of leukemia in Japanese children and young adults. Leukemia, 2001; 15: 1256-1261.
 
[10]  Otero JC, Santillana S &Fereyros G. High frequency of acute promyelocytic leukemia among latinos with acute myeloid leukemia. Blood, 1996; 88: 377-379.
 
[11]  Loureiro P, Azevedo A, Maia A, Freire AD, Souto F, Bandeira F, Vasconcelos J &Paiva A. Acute myeloid leukemia: presentation of the disease and response to treatment in Northeast Brazil. Medical and Pediatric Oncology, 1992; 20: 439.
 
[12]  Fagundes EM, Rocha VG, Azevedo WM, Clementino NCD, Quintão JS, Ferraz MHC &Viana MB. Leucemiamieloideaguda do adulto: análiseretrospectiva de 99 casos. Boletim da Sociedade Brasileira de Hematologia e Hemoterapia, 1995; 17: 33-39.
 
[13]  Scott CS, Ottolander GJD, Swirsky D et al. Recommended procedures for the classification of acute leukemias. Leukemia and Lymphoma, 1995; 18 (Suppl 1): 1-12.
 
[14]  Brandalise S, Odone V, Pereira W, Andrea M, Zanichelli M &Aranega V. Treatment results of three consecutive Brazilian cooperative childhood ALL protocolos: GBTLI-80, GBTLI-82 and -85. ALL Brazilian Group.Leukemia, 1993; 7 (Suppl 2): S142-S145.
 
[15]  Nakase K, Bradstock K, Sartor M, Gottlieb D, Byth K, Shiku H, Kamada N & The Japanese Cooperative Group of Leukemia/Lymphoma. Geographic heterogeneity of cellular characteristics of acute leukemia: a comparative study of Australian and Japanese adult cases. Leukemia, 2000; 14: 163-168.
 
[16]  Khalidi HS, Medeiros LJ, Chang KL, Brynes RK, Slovak ML, Arber DA. The immunophenotype of adult acute myeloid leukemia: high frequency of lymphoid antigen expression and comparison of immunophenotype, French-American-British classification, and karyotypic abnormalities. Am J ClinPathol. 1998 Feb; 109(2): 211-20.
 
[17]  Ollivier L, Jean P, Marion B, Annie C, Re´gineL, GhislaineS, Robert Z, Nicole C, and Jean M. The immunophenotype of 177 adults with acute myeloid leukemia: proposal of a prognostic score. Blood, 1 August 2000, volume 96, number 3, 870-877.
 
[18]  Claudio Ortolani.Flow Cytometry of Hematological Malignancies Wiley BlackWell publication, 2011.
 
[19]  Repp R, Schaekel U, Helm G, Thiede C, Soucek S, Pascheberg U, Wandt H, Aulitzky W, Bodenstein H, Sonnen R, Link H, Ehninger G, Gramatzki M; AML-SHG Study Group.. Immunophenotyping is an independent factor for risk stratification in AML. Cytometry 2003; 53B(1): 11-19.
 
[20]  Brian A. Webber, Melissa M. Cushing and Shiyong Li. Prognostic Significance of Flow CytometricImmunophenotyping in Acute Myeloid Leukemia. Int J ClinExpPathol 2008; 1, 124-133.
 
[21]  Bradstock K, Matthews J, Benson E, Page F, BishopJ,and the Australian Leukaemia Study Group. Prognostic Value of Immunophenotypingin Acute Myeloid Leukemia, Blood, Vol 84, No 4 (August 15), 1994: pp 1220-1225.
 
[22]  Borowitz MJ, Gockerman JP, Moore JO, Civin CI, Page SO, Robertson J, et al. Clinicopathologic and cytogenetic features of CD34 (My10)- positive acute nonlymphocytic leukemia. Am J ClinPathol. 1989; 91: 265-70.
 
[23]  van Lochem EG, van der Velden VH, Wind HK, teMarvelde JG, Westerdaal NA, van Dongen JJ. Immunophenotypic differentiation patterns of normal hematopoiesis in human bone marrow: reference patterns for age-related changes and disease-induced shifts. Cytometry 2004; 60B(1): 1-13.
 
[24]  Basso G, Lanza F, Orfao A, Moretti S, Castoldi G. Clinical and biological significance of CD34 expression in acute leukemia. J BiolRegulHomeost Agents 2000; 15(1): 68-78.
 
[25]  Mehdi J, Karim S, ZohrehS, Mohammad, Shohreh A, MozhdehM, BabakN, Amir K, Ali M. Aberrant Phenotype in Iranian Patients with Acute Myeloid Leukemia.Adv Pharm Bull. Mar 2014; 4(1): 43-47.
 
[26]  Terstappen L, Hollander Z, Meiners H, Loken MR. Quantitative comparison of myeloid antigens on five lineage of mature peripheral blood cells. J LeukocBiol 1990; 48(2): 138-148.
 
[27]  Gorczyca W, Sun ZY, Cronin W, Li X, Mau S, Tugulea S.Immunophenotypic pattern of myeloid populations by flow cytometry analysis.Methods Cell Biol. 2011; 103: 221-66.
 
[28]  Hans C, Finn W, SingletonT, Schnitzer B, Ross C. Usefulness of anti-CD117 in the flowcytometric analysis of acute leukemia. Am J ClinPathol 2002; 117(2): 301-305.
 
[29]  Chapiro E, Delabesse E, Asnafi V, Millien C, Davi F, Nugent E, Beldjord K, Haferlach T, Grimwade D, Macintyre EA.. Expression of T-lineage affiliated transcripts and TCR rearrangements in acute promyelocytic leukemia: implications for the cellular target of the t(15;17). Blood 2006; 108 (10): 3484-3493.
 
[30]  Haynes B, Denning SM, Singer KH, Kurtzberg J. Ontogeny of T-cell precursors: a model for the initial stages of human T-cell development. Immunol Today 1989; 10(3): 87-91.
 
[31]  Jensen A, Hokland M, Jørgensen H, Justesen J, Ellegaard J, Hokland P. Solitary expression of CD7 among T-cell antigens in acute myeloid leukemia: identification of a group of patients with similar T-cell receptor beta and delta rearrangements and course of disease suggestive of poor prognosis. Blood 1991; 78(5): 1292-1300.
 
[32]  Tedder T, Zhou L, Engel P. The CD19/CD21 signal transduction complex of B lymphocytes.Immunol Today 1994; 15(9): 437-442.
 
[33]  Launder TM, Bray RA, Stempora L, Chenggis ML, Farhi DC. Lymphoid-associated antigen expression by acute myeloid leukemia. Am J ClinPathol. 1996 Aug; 106(2): 185-91.