Prognostic Effect of cytoplasmic CD79a Expression in Acute Myeloid Leukemia with t(8;21)

Hee-Jung Chung; Hyun-Sook Chi; Young-Uk Cho; Eun-Hye Lee; Seongsoo Jang; Chan-Jeoung Park; Eul-Ju Seo

doi:10.3343/kjlm.2007.27.6.388

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Chung, Chi, Cho, Lee, Jang, Park, and Seo: Prognostic Effect of cytoplasmic CD79a Expression in Acute Myeloid Leukemia with t(8;21)

Original Article

Korean J Leg Med 2007;27(6):388-393.

Published online: 14 February 2007

DOI: https://doi.org/10.3343/kjlm.2007.27.6.388

Prognostic Effect of cytoplasmic CD79a Expression in Acute Myeloid Leukemia with t(8;21)

Hee-Jung Chung, M.D., Hyun-Sook Chi, M.D., Young-Uk Cho, M.D., Eun-Hye Lee, M.D., Seongsoo Jang, M.D., Chan-Jeoung Park, M.D., Eul-Ju Seo, M.D.

Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea

Received 5 July 200712 October 2007 Accepted 9 November 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Although cytoplasmic CD79a (cytCD79a) is a highly lineage-specific marker of B lymphoid cells and plays an important role in the diagnosis of acute leukemia, its clinical significance is not fully understood. We aimed to investigate the relationship between cytCD79a positivity and survival probability, and to evaluate the prognostic value of cytCD79a expression in AML with t(8;21) (q22;q22).

Methods

A total of 68 cases of AML with t(8;21)(q22;q22) were diagnosed based on conventional morphology, cytochemistry, flow cytometrty, and cytogenetic and molecular genetic analysis. Immuno-histochemistry of cytCD79a was performed retrospectively. Laboratory and clinical findings were reviewed.

Results

Five patients among 68 AML with t(8;21)(q22;q22) revealed cytCD79a positive reaction; scores for myeloid lineage/B-lymphoid lineage were 5/3-3.5. Among the five cytCD79a positive patients, only one patient was a child. Three patients were with refractory AML or relapsed, and two patients died within 10 months. Median survival time of cytCD79a positive group was shorter (8.0 months) than that (61.3 months) of cytCD79a negative group. The survival probability of the cytCD79a expression group was significantly lower than classical AML with t(8;21)(q22;q22) (P=0.0001).

Conclusions

These findings emphasize the necessity of investigating cytCD79a, especially in AML with t(8;21)(q22;q22), for a different clinical prognostic value.

Keywords: Acute myeloid leukemia with t(8;21), Cytoplasmic CD79a, Prognosis

REFERENCES

1.Bene MC., Castoldi G., Knapp W., Ludwig WD., Matutes E., Orfao A, et al. Proposals for the immunological classification of acute leukemias. European Group for the Immunological Characterization of Leukemias (EGIL). Leukemia. 1995. 9:1783–6.

2.Brunning RD., Head D. Acute leukaemias of ambiguous lineage. Jaffe ES, editor. World Health Organization classification of tumors. Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. Washington: IARC press;2001. p. 106–7.

3.Lai R., Juco J., Lee SF., Nahirniak S., Etches WS. Flow cytometric detection of CD79a expression in T-cell acute lymphoblastic leukemias. Am J Clin Pathol. 2000. 113:823–30.

4.Engel P., Tedder TF. New CD from the B cell section of the Fifth International Workshop on Human Leukocyte Differentiation Antigens. Leuk Lymphoma. 1994. 13(S):S61–4.

5.Paredes-Aguilera R., Romero-Guzman L., Lopez-Santiago N., Burbano-Ceron L., Camacho-Del Monte O., Nieto-Martinez S. Flow cytometric analysis of cell-surface and intracellular antigens in the diagnosis of acute leukemia. Am J Hematol. 2001. 68:69–74.

6.Kozlov I., Beason K., Yu C., Hughson M. CD79a expression in acute myeloid leukemia t(8;21) and the importance of cytogenetics in the diagnosis of leukemias with immunophenotypic ambiguity. Cancer Genet Cytogenet. 2005. 163:62–7.

7.Rooney DE, Czepulkowski BH, editors. Human cytogenetics: malignancy and acquired abnormalities. A practical approach. 3rd ed.New York: Oxford university press;2001. p. 2–17.

8.Shaffer LG, Tommerup N, editors. An international system for human cytogenetic nomenclature. Basel: S. Karger;2005.

9.Sarriera JE., Albitar M., Estrov Z., Gidel C., Aboul-Nasr R., Manshouri T, et al. Comparison of outcome in acute myelogenous leukemia patients with translocation (8;21) found by standard cytogenetic analysis and patients with AML1/ETO fusion transcript found only by PCR testing. Leukemia. 2001. 15:57–61.

10.Carbonell F., Swansbury J., Min T., Matutes E., Farahat N., Buccheri V, et al. Cytogenetic findings in acute biphenotypic leukaemia. Leukemia. 1996. 10:1283–7.

11.Kim SH. Consensus for immunophenotyping of hematologic malignancy. Korean J Lab Med. 2006. 26(S2):S306–9. (김선희. Consensus for immunophenotyping of hematologic malignancy. 대한진단검사의학회지 2006;26(부록 2): S306-9.).

12.Gupta R., Bain BJ., Knight CL. Cytogenetic and molecular genetic abnormalities in systemic mastocytosis. Acta Haematol. 2002. 107:123–8.

13.Swolin B., Rodjer S., Roupe G. Cytogenetic studies in patients with mastocytosis. Cancer Genet Cytogenet. 2000. 120:131–5.

14.Killick S., Powles RL., Hamblin M., Treleaven JG., Zomas A., Matutes E, et al. Outcome of biphenotypic acute leukemia. Haematologica. 1999. 84:699–706.

15.Scolnik MP., Aranguren PN., Cuello MT., Palacios MF., Sanjurjo J., Bracco MM, et al. Biphenotypic acute leukemia with t(15;17). Leuk Lymphoma. 2005. 46:607–10.

16.He G., Wu D., Sun A., Xue Y., Jin Z., Qiu H, et al. CytCD79a expression in acute leukemia with t(8;21): biphenotypic or myeloid leukemia? Cancer Genet Cytogenet. 2007. 174:76–7.

17.Tiacci E., Pileri S., Orleth A., Pacini R., Tabarrini A., Frenguelli F, et al. PAX5 expression in acute leukemias: higher B-lineage specificity than CD79a and selective association with t(8;21)-acute myelogenous leukemia. Cancer Res. 2004. 64:7399–404.

18.Konoplev S., Bueso-Ramos CE. Advances in the pathologic diagnosis and biology of acute myeloid leukemia. Ann Diagn Pathol. 2006. 10:39–65.

19.Bene MC. Immunophenotyping of acute leukaemias. Immunol Lett. 2005. 98:9–21.

20.Yoo SJ., Chi HS., Jang S., Seo EJ., Seo JJ., Lee JH, et al. Quantification of AML1-ETO fusion transcript as a prognostic indicator in acute myeloid leukemia. Haematologica. 2005. 90:1493–501.

21.Miyamoto T., Nagafuji K., Harada M., Niho Y. Significance of quantitative analysis of AML1/ETO transcripts in peripheral blood stem cells from t(8;21) acute myelogenous leukemia. Leuk Lymphoma. 1997. 25:69–75.

22.Nimer SD., Moore MA. Effects of the leukemia-associated AML1-ETO protein on hematopoietic stem and progenitor cells. Oncogene. 2004. 23:4249–54.

23.The value of c-kit in the diagnosis of biphenotypic acute leukemia. EGIL (European Group for the Immunological Classification of Leukaemias). Leukemia. 1998. 12:2038.

24.Lee ST., Kim HJ., Kim SH. Defining an optimal number of immunophenotypic markers for lineage assignment of acute leukemias based on the EGIL scoring system. Korean J Lab Med. 2006. 26:393–9. (이승태, 김희진, 김선희. 급성백혈병의 lineage assignment에있어서면역표현형표지자의적정개수. 대한진단검사의학회지 2006;26: 393-9.).

Fig. 1.

Bone marrow findings of a patient in the cytCD79a expression group, ×1,000. (A: aspiration, Wright stain; B: biopsy, hematoxylin and eosin stain; C: biopsy, cytCD79a immunohistochemistry).

Abbreviation: cytCD79a, cytoplasmic CD79a.

Fig. 2.

The survival probability of the cytCD79a expression group was significantly lower than the AML with t(8;21).

Abbreviation: See Fig.1.

Table 1.

Scoring system for the definition of BAL proposed by European Group for the Immunologic Classification of Leukemia (EGIL)

Score	B lineage	T lineage	Myeloid lineage
2	cytCD79a	CD3 (m/cyt)	MPO^∗
	cyt IgM	Anti-TCR
	cytCD22
1	CD19	CD2	CD117
	CD20	CD5	CD13
	CD10	CD8	CD33
		CD10	CD65
0.5	TdT	TdT	CD14
	CD24	CD7	CD15
		CD1a	CD64

According to EGIL, BAL is defined when the score is over 2 for the myeloid and one of the lymphoid lineages.

^∗ MPO (myeloperoxidase) demonstrated by cytochemical or immuno-histochemical methods.

Abbreviations: BAL, biphenotypie acute leukemia; cytCD79a, cytoplasmic CD79a.

Table 2.

Characteristics of the five patients showing cytCD79a positivity in immunohistochemistry

UPN	Age	Sex	FAB subtype	Blast (%)	Cellularity (%)	Myeloid					B lymphoid					Karyotype	AML1/ETO rearrangement^∗
UPN	Age	Sex	FAB subtype	Blast (%)	Cellularity (%)	MPO	CD13	CD33	CD117	Score	cytC D79a	CD19	CD10	TdT	Score	Karyotype	AML1/ETO rearrangement^∗
1	5	F	M4	44.8	70	+	+	+	+	5	+	+	-	+	3.5	45,X,-X,t(8;21)(q22;q22)[20]	+
2	38	F	M1	25.4	95	+	+	+	+	5	+	+	-	-	3	46,XX,t(8;21)(q22;q22)[20]	+
3	54	M	M2	68.2	80	+	+	+	+	5	+	+	-	-	3	45,X,-Y,t(8;21)(q22;q22)[20]	+
4	49	M	M2	46.4	95	+	+	+	+	5	+	+	-	-	3	45,X,-Y,t(8;21)(q22;q22)[20]	+
5	45	F	M2	57.2	100	+	+	+	+	5	+	+	-	-	3	46,XX,t(8;21)(q22;q22), add(11)(p11.2)[20]	+

^∗ by both FISH and PCR.

Abbreviations: cytCD79a, cytoplasmic cD79a; UPN, unique patient number; MPO, myeloperoxidase; TdT, terminal deoxytransferase.

Table 3.

Clinical and laboratory findings according to cytCD79a expression on leukemic cells

	Expression of cytCD79a (n=68)		P value
	Positive (n=5)	Negative (n=63)	P value
Median age (yr)	49 (5-58)	36 (3-73)	0.466
Sex (M:F)	2:3	28:35	0.528
FAB subtype	M1, 2, 4	M1, 2, 4
Leukemic cells in BM (%)^∗	59.2±16.9	60.1±22.6	0.174
Cellularity (%)^∗	88.0±12.6	81.0±21.7	0.180
WBC count (μ/L)	46,190±6,860	29,920±5,610	0.070
BM fibrosis (%)	20	14.3	0.857
Immunophenotyping (%)
TdT	20.0 (1)	25.4 (16)	0.399
CD34	80.0 (4)	87.3 (55)	0.926
CD19	100.0 (5)	52.4 (33)	0.048
Prognosis
Relapse (%)	3 (60.0)	16 (25.4)
Mortality (%)	2 (40.0)	14 (22.2)
Median survival (months)	8.0	61.3	<0.001

^∗ mean±SD.

Abbreviation: See Fig. 1.

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