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Abstract
Background
HLA-DR negativity is known to be useful for distinguishing acute promyelocytic leukemia (APL) from other subtypes of AML, but non-APL cases without HLA-DR antigen expression have been reported. The purpose of this study was to evaluate and compare the characteristics of APL, HLA-DR negative non-APL, and HLA-DR positive non-APL cases.
Methods
A total of 114 cases of AML admitted at Ewha Womans University, Mokdong Hospital between March 1997 and June 2006 were included in this study. A diagnosis of AML was made based on the results of morphology, cytochemistry, immunophenotype, cytogenetics, and/or fluorescence in situ hybridization.
Results
Among the 114 AML patients, HLA-DR antigen was not expressed in 39 (34%), including 24 non-APL (62%) and 15 APL patients (38%). The HLA-DR negative non-APL group showed higher leukocyte counts and positive rate of CD19 expression than did APL group (P<0.05). The remaining laboratory findings were not statistically different between the HLA-DR negative non-APL and APL groups. CD34 expression was more frequent in the HLA-DR positive non-APL group than in the HLA-DR negative non-APL group and APL group. Of the 24 patients with HLA-DR negative non-APL, 7 patients had disseminated intravascular coagulation and 2 patients showed morphologic features similar to those of APL.
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Fig. 1.
A case of 21 yr-old female patient diagnosed as HLA-DR negative AML. Immature cells showed indented nuclear margins and coarse cytoplasmic granules (BM aspiration, Wright stain, ×1,000).
Table 1.
Comparison of the characteristics of non-APL and APL according to HLA-DR expression
| APL (N=16) | HLA-DR negative non APL (N=24) | HLA-DR positive non APL (N=74) | |
|---|---|---|---|
| Age (yr), median (range) | 36 (16-80) | 46 (4-68) | 49 (5-81) |
| Sex (M:F) | 9:7 | 11:13 | 38:36 |
| WBC (×109/L)∗, median (range) | 2.2 (0.4-76.2) | 47.4 (1-497.6) | 13.1 (0.3-554.4) |
| BM leukemic cell (%)†, median (range) | 74 (47.6-97.8) | 89.8 (21.4-99.2) | 67.1 (22.0-98.8) |
| Hb (g/dL), median (range) | 7.7 (4.7-11.2) | 8.5 (5.7-12.0) | 8.1 (4.6-14.9) |
| PLT (×109/L)†, median(range) | 32 (10-104) | 37 (1-177) | 50 (4-538) |
| DIC (%)† | 7/15 (46.7) | 7/18 (38.9) | 5/44 (11.3) |
| FAB classification (%) | 2 (8) | 5 (7) | |
| M0 | |||
| M1 | 16 (67) | 20 (27) | |
| M2 | 4 (17) | 36 (49) | |
| M3 | 16 (100) | ||
| M4 | 1 (4) | 11 (15) | |
| M5 | 0 (0) | 0 (0) | |
| M6 | 1 (1) | ||
| Others‡ | 1 (4) | 1 (1) | |
| Positive of antigen expression (%) | |||
| CD 13 | 15 (94) | 18 (75) | 66 (89) |
| CD 33 | 16 (100) | 22 (92) | 71 (96) |
| HLA-DR† | 1 (6) | 0 (0) | 74 (100) |
| CD 34† | 1 (6) | 5 (21) | 52 (70) |
| CD 7 | 1 (6) | 1 (4) | 13 (18) |
| CD 5 | 0 (0) | 0 (0) | 1 (1) |
| CD 3 | 0 (0) | 0 (0) | 2 (3) |
| CD 19∗ | 1 (6) | 11 (46) | 23 (31) |
| CD 10 | 0 (0) | 0 (0) | 1 (1) |
| CD 22 | 0 (0) | 1 (4) | 6 (8) |
| CD 20 | 0 (0) | 0 (0) | 2 (3) |
| CD 14 | 0 (0) | 1 (4) | 10 (14) |
| CD 16/56 | 0 (0) | 3 (13) | 7 (9) |
| Karyotype (%) | |||
| t(8;21)(q22;q22) | 0 (0) | 8 (12) | |
| t(15;17)(q22;q21) | 16 (100) | 0 (0) | 0 (0) |
| inv(16) | 0 (0) | 2 (3) | |
| t(9;22)(q34;q11) | 0 (0) | 3 (5) | |
| Other abnormalities | 2 (12) | 14 (22) | |
| Normal karyotype | 14 (88) | 38 (58) | |
| Not available | 8 | 9 |
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