Evaluation of aberrant expression of CD markers in acute leukemia cells
Keywords:Aberrant phenotype, Flow cytometry, Acute leukemia, AML, B-ALL, T-ALL
Background and objective: Worldwide immunophenotyping by flow cytometry (FCM) in acute leukemia (AL) is the golden step in the diagnosis. It’s very common for acute leukemias to aberrantly express antigens or cluster of differentiation (CD) markers which are usually expressed in other lineages of the disease hence this study aimed at determining the prevalence of aberrancy in AL and to find out the frequency of each aberrant CD marker and their association with the clinic-hematological profile of the cases.
Methods: Following history and clinical examination of enrolled patients, blood and/or bone marrow aspirate was drawn for morphological examination and immunophenotyping by FCM from 86 newly diagnosed acute leukemia cases then multiple steps procedure was applied followed by interpretation of the results.
Results: The prevalence of aberrant phenotype was 46.5%. The proportional frequency of aberrant phenotype in acute myeloid leukemia (AML) was 41%, in B-acute lymphoblastic leukemia (B-ALL) was 48.8% and in T-acute lymphoblastic leukemia (T-ALL) was 66.6%. The commonest aberrant CD markers in AML were CD22 and CD2, in B-ALL were CD66c and CD13 while in T-ALL were CD13 and CD33. The aberrant phenotype harbored lower white blood cell (WBC) count and blast percentage in PB, also splenomegaly was more frequent in lymphoid positive (Ly+) AML and myeloid positive (My+) T-ALL while in B-ALL, splenomegaly was more frequent in myeloid negative (My-) B-ALL.
Conclusion: Aberrant phenotype prevalence in our study sample was comparable to other studies, considerable frequency of aberrant markers is present in cases of AL and some variations exist regarding the clinical and hematological profile of the aberrant group.
Othman GO, Mohammad NS, Saeed CH. Molecular study of Nucleophosmin 1 (NPM1) gene in acute myeloid leukemia in Kurdish population. Afr Health Sci. 2021; 21(2):687–92. doi:10.4314/ahs.v21i2.26
Pouls RK, Shamoon RP, Muhammed NS. Clinical and haematological parameters in adult AML patients: a four year experience at Nanakaly Hospital for blood diseases. Zanco J Med Sci. 2012; 16(3):199–203. https://doi.org/10.15218/zjms.2012.0035
Jahan N, Sattar H, Tarafder S, Roy CK, Rahman I, Johora FT. Aberrant Antigen Expression in Children with Acute Leukemia A Flow Cytometric Analysis. Bangladesh J Med Microbiol 2018; 12(1):10–4. https://doi.org/10.3329/bjmm.v12i1.51685
Sarma A, Hazarika M, Das D, Kumar Rai A, Sharma JD, Bhuyan C, et al. Expression of aberrant CD markers in acute leukemia: A study of 100 cases with immunophenotyping by multiparameter flowcytometry. Cancer Biomark. 2015; 15(4):501–5. doi:10.3233/CBM-150482
Pinheiro LH, Trindade LD, de Oliveira Costa F, de Lima Silva N, Sandes AF, Nunes MA, et al. Aberrant Phenotypes in Acute Myeloid Leukemia and Its Relationship with Prognosis and Survival: A Systematic Review and Meta-Analysis. Int J Hematol Oncol Stem Cell Res. 2020; 14(4):274. doi:10.18502/ijhoscr.v14i4.4484
Al-Anizi WM, Al-Mashta MA. The frequency of aberrant lymphoid antigens expression in 202 Iraqi patients with de novo acute myeloid leukemia. Iraqi J Hematol. 2017; 6(2):49. doi:10.4103/ijh.ijh_17_17
Ibrahim AM, Hameed BM. Prognostic value of myeloid antigens expression in childhood acute lymphoblastic leukemia. Iraqi J Hematol. 2017; 6(1):12. doi:10.4103/ijh.ijh_5_17
Abdullah NF, Wafa AE, Ahmed H, Allam AA, Mohamed AM. Aberrant Expression of CD Markers in Cases with Acute Leukemia in Sohag University Hospital. SMJ. 2018; 22(2):287–95. doi:10.21608/smj.2018.40953
Abdulateef NA, Ismail MM, Aljedani H. Clinical significance of co-expression of aberrant antigens in acute leukemia: a retrospective cohort study in Makah Al Mukaramah, Saudi Arabia. Asian Pac J Cancer Prev. 2014; 15(1):221–7. https://doi.org/10.7314/APJCP.2014.15.1.221
Lopes TC, Andrade KN, Camelo NL, Rodrigues VP, Oliveira RA. Influence of aberrant myeloid expression on acute lymphoblastic leukemia in children and adolescents from Maranhão, Brazil. Genet Mol Res. 2014; 13(4):10301–7. doi:10.4238/2014.December.4.25
Bene MC, Nebe T, Bettelheim P, Buldini B, Bumbea H, Kern W, et al. Immunophenotyping of acute leukemia and lymphoproliferative disorders: a consensus proposal of the European Leukemianet work package 10. Leukemia. 2011; 25:567–74. doi:10.1038/leu.2010.312
Swerdlow S, Campo E, Harris N, Jaffe E, Pileri S, Stein H, et al. WHO Classification of Haematopoietic and Lymphoid Tissues. 4th ed. Lynon:IARC; 2017.
Mohamed MA, Shafik EA, Ahmed AO, Sayed DM. Expression of aberrant markers in acute leukemia at south Egypt cancer institute: A retrospective study. SECI Oncol. 2021; 9:53–63.
Momani A, Abbasi N, Alsokhni H, Habahbeh L, Khasawneh R, Kamal N. Aberrant antigen expression in patients with acute leukemias; experience of King Hussein Medical Center in Jordan. JRMS. 2016; 23(2):59–67. doi:10.12816/0027107
Hussein GA, Jawad AM. Impact of aberrant antigens expression on remission rate after first induction course of chemotherapy in de novo adult acute myeloid leukemia. Iraqi J Hematol. 2021; 10(2):118–122. doi:10.4103/ijh.ijh_17_21
Ahuja S, Malviya A. Spectrum of immunophenotypic aberrancies in acute leukemia along with their correlation with adverse hematological parameters. Indian J Health Sci Biomed Res. 2022; 15(1):76. doi:10.4103/kleuhsj.kleuhsj_170_21
Gupta M, Monga L, Mehrotra D, Chhabra S, Singhal S, Sen R. Immunophenotypic aberrancies in acute leukemia: A tertiary care centre experience. Oman Med J. 2021; 36(1):e218. doi:10.5001/omj.2021.03
Tipu HN, Muhammad MB, Altaf C, Noman M, Malik HS. Spectrum of acute leukemias and aberrant markers expression based on flowcytometry in a tertiary care centre. PAFMJ. 2018; 68(3):450–4.
Sharma M, Varma N, Sachdeva MU, Bose P, Varma S. Clinical and hematological correlates of aberrant immunophenotypic profiles in adult and pediatric acute myeloid leukemia at presentation. J Cancer Res Ther. 2020; 16(1):105–9. doi:10.4103/jcrt.JCRT_770_17
Jahedi M, Shamsasenjan K, Sanaat Z, Aliparasti M, Almasi S, Mohamadian M, et al. Aberrant phenotype in Iranian patients with acute myeloid leukemia. Adv Pharm Bull. 2014; 4(1):43–7. doi:10.5681/apb.2014.007
Muhsin SY, Al-Mudallal SS. Expression of Aberrant Antigens CD7 and CD19 in Adult Acute Myeloid Leukemia by Flow Cytometry. Iraqi J Hematol. 2014; 3(1):1–13.
Mahmoud MS, Abd Elhafeez HA, Abd Elmouez SM. Verification of aberrant expression of CD7 in acute myeloid leukemia. Curr Med Res Prac. 2020; 5(2):133–40. doi:10.4103/JCMRP.JCMRP_115_18
Chughtai O, Chughtai A. Aberrant expression of CD markers in acute leukemia. Ann Pak Inst Med Sci. 2013; 9(2):99-102.
Shahni A, Saud M, Siddiqui S, Mukry SN. Expression of aberrant antigens in hematological malignancies: A single center experience. Pak j Med Sci. 2018; 34(2):457–62. doi:10.12669/pjms.342.13996
Aref S, Abousamara N, El-Helaly E, Mabed M. Clinical significance of CD200 and CD56 expression in patients with acute myeloid leukemia. Asian Pac J Cancer Prev. 2020; 21(3):743–8. doi:10.31557/APJCP.2020.21.3.743
Jalal SD, Al-Allawi NA, Al Doski AA. Immunophenotypic aberrancies in acute lymphoblastic leukemia from 282 Iraqi patients. Int J Lab Hematol. 2017; 39(6):625–32. https://doi.org/10.1111/ijlh.12716
Sharma M, Sachdeva MU, Varma N, Varma S, Marwaha RK. Characterization of immunophenotypic aberrancies in adult and childhood acute lymphoblastic leukemia: A study from Northern India. J Can Res Ther. 2016; 12(2):620–6. doi:10.4103/0973-1482.147716
Ibrahim AM, Hameed BM. Prognostic value of myeloid antigens expression in childhood acute lymphoblastic leukemia. Iraqi J Hematol. 2017; 6(1):12–16. doi:10.4103/ijh.ijh_5_17
Tang GS, Wu J, Liu M, Chen H, Gong SG, Yang J, et al. BCR-ABL1 and CD66c exhibit high concordance in minimal residual disease detection of adult B-acute lymphoblastic leukemia. Am J of Transl Res. 2015; 7(3):632–9. PMC4448202
Jain S, Mehta A, Kapoor G, Bhurani D, Jain S, Agrawal N, et al. Evaluating new markers for minimal residual disease analysis by flow cytometry in precursor B lymphoblastic leukemia. Indian J Hematol Blood Transfus. 2018; 34(1):48–53. doi:10.1007/s12288-017-0845-5
Hamid GA, Akrabi A. Aberrant antigen expression in patients with acute leukemia. EC Clin Med Case Report. 2019; 53–60.
Hoffbrand A, Steensma D. Hoffbrand`s Essential Haematology. 8th ed.UK: John Wiley & Sons Ltd; 2020.
Tong H, Wang H, Wang Q, Liu Z, Lu C. Immunophenotypic, cytogenetic and clinical features in Chinese adult acute lymphoblastic leukaemia (ALL) patients. Ann Acad Med Singapore. 2014; 43(3):152–9.
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