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Shin, Kahng, Kim, Lim, Kim, and Han: Distribution of Antigenic Aberration in the Bone Marrow of Acute Leukemia in Complete Remission
Original Article

Korean J Leg Med 2008;28(1):1-7.

Published online: 14 February 2008

DOI: https://doi.org/10.3343/kjlm.2008.28.1.1

Distribution of Antigenic Aberration in the Bone Marrow of Acute Leukemia in Complete Remission

Soyoung Shin, M.D., Jimin Kahng, M.D., Myungshin Kim, M.D., Jihyang Lim, M.D., Younggoo Kim, M.D., Kyungja Han, M.D.

Department of Laboratory Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea

Received 19 October 20074 January 2007       Accepted 4 January 2007

Copyright © 2008 by the Korean Society for Legal Medicine

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

The aberrant, leukemia-associated antigen expression patterns allow us to discriminate leukemic blasts from normal precursor cells. Our major goal was to determine a guideline for the detection of minimal residual disease using CD20+/CD34+ and myeloid Ag+/CD19+ combination in the bone marrow of acute leukemia in complete remission (CR) after chemotherapy.

Methods

Bone marrow samples from 117 patients with acute leukemia in complete remission after chemotherapy and from 22 healthy controls were immunophenotyped by triple staining and measured by flow cytometry.

Results

The CD20+/CD34+ cells in the large lymphocyte gate (R1) ranged from 0% to 3.24% (0.8±0.82%, P=0.000) in CD20+/CD34+ B-lineage ALL CR (N=31), from 0.03% to 4.2% (0.7±0.83 %, P=0.000) in CD20-/CD34- B-lineage ALL CR (N=66), from 0.1% to 0.96% (0.45±0.32%, P=0.016) in T-ALL CR (N=10), and from 0.02% to 0.48% (0.18±0.15%, P=0.776) in AML CR (N=10). The CD13,33+/CD19+ cells in R1 gate ranged from 0% to 2.69% (0.37±0.48%, P<0.001) in CD13,33+/CD19+ B-lineage ALL CR (N=31), from 0% to 1.8% (0.31±0.28%, P<0.001) in CD13,33-/CD19+ B-lineage ALL CR (N=65), from 0.02% to 0.64% (0.29±0.22%, P=0.071) in T-ALL CR (N=9), and from 0% to 0.17% (0.07±0.09%, P=0.341) in AML CR (N=3).

Conclusions

Using an immunophenotypic method for the detection of early relapse or minimal residual disease of B-lineage ALL bone marrow in CR after chemotherapy, different cutoff values should be applied according to antigen combination and gating. When the proportion of aberrant antigen combination was less than 5% in large lymphocyte gate, the results should be interpreted with caution.

Keywords: Aberrant antigen, CD20+/CD34+, Myeloid Ag+/CD19+

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Fig. 1.
Dot plot scattergrams of bone marrow cells of a B-lineage ALL patient stained with anti-CD20-PE/anti-CD34-PerCP. The large lymphocyte gate (R1) and all nucleated element gate (R2) were set using forward scatter (FSC) and side scatter (SSC) characteristics. The CD20+/CD34+ cells in the R1 gate (upper right quadrant) were 1.26%.
kjlm-28-1f1.tif
Table 1.
Proportion of CD20+/CD34+ cells in the large lymphocyte gate (R1) and all nucleated element gate (R2) in the bone marrow of acute leukemia patients in complete remission (mean±SD %)
Gate Normal control (N=22) B-ALL, CR (N=97) T-ALL, CR (N=10) AML, CR (N=10)
Initial Dx CD20,34+ (N=31) Initial Dx CD20,34- (N=66)
R1 0.18±0.12 (0-0.47) 0.8±0.82∗ (0-3.24) 0.7±0.83∗ (0.03-4.2) 0.45±0.32∗ (0.1-0.96) 0.18±0.15 (0.02-0.48)
    P<0.001 P<0.001 P=0.016 P=0.776
R2 0.13±0.12 (0-0.3) 0.17±0.18 (0-0.72) 0.16±0.17 (0.01-1.76) 0.17±0.2 (0.01-0.49) 0.23±0.17 (0.01-0.43)
    P=0.796 P=0.548 P=1.0 P=0.11

P, compared with normal control.

∗ , P<0.05.

Abbreviation: CR, complete remission.

Table 2.
Proportion of CD13,33+/CD19+ cells in the large lymphocyte gate (R1) and all nucleated element gate (R2) in the bone marrow of acute leukemia patients in complete remission (mean±SD %)
Gate Normal control (N=17) B-ALL, CR (N=96) T-ALL, CR (N=9) AML, CR (N=3)
CD13,33+ (N=31) Initial Dx CD13,33- (N=65)
R1 0.12±0.08 (0-0.29) 0.37±0.48∗ (0.06-2.69) 0.31±0.28∗ (0-1.8) 0.29±0.22 (0.02-0.64) 0.07±0.09 (0-0.17)
    P<0.001 P<0.001 P=0.071 P=0.341
R2 0.42±0.29 (0.01-0.98) 0.43±0.26 (0.01-0.94) 0.52±0.34 (0.01-1.76) 0.49±0.28 (0.01-0.81) 0.36±0.15 (0.23-0.52)
    P=0.737 P=0.101 P=0.483 P=0.916

P, compared with normal control.

∗ , P<0.05.

Abbreviation: See Table 1.

Table 3.
Proportion of CD15+/CD19+ cells in the large lymphocyte gate (R1) and all nucleated element gate (R2) in the bone marrow of patients with B-lineage ALL complete remission (mean±SD %)
Gate Normal control (N=17) B-ALL, CR (N=11)
R1 1.49±0.98 (0.22-2.9) 0.38±0.41 (0.01-1.17)
    P=0.001∗
R2 1.4±0.64 (0.29-2.41) 1.39±0.85 (0.27-2.98)
    P=0.744

P, compared with normal control.

∗ , P<0.05.

Abbreviation: See Table 1.

Table 4.
Proportion of CD11b+/CD19+ cells in the large lymphocyte gate (R1) and all nucleated element gate (R2) in the bone marrow of acute leukemia patients in complete remission (mean±SD %)
Gate Normal control (N=6) B-ALL, CR (N=85) T-ALL, CR (N=8)
R1 0.61±0.62 0.5±0.58 0.73±0.14
  (0.12-1.76) (0.02-4.03) (0.09-1.98)
    P=0.648 P=0.897
R2 0.35±0.23 0.55±0.42 0.46±0.49
  (0.03-0.62) (0.01-2.33) (0.01-1.48)
    P=0.269 P=0.948

P, compared with normal control. ∗, P<0.05.

Abbreviation: See Table 1.

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