Painel racionalizado de anticorpos monoclonais para leucemias agudas : seu valor diagnostico e prognostico

AUTOR(ES)
DATA DE PUBLICAÇÃO

2005

RESUMO

Acute leukemia is characterized by a c1onal proliferation of haematopoietic stem cell substituting the normal bone marrow. The recent WHO c1assification for acute leukemia separates entities by recurrent cytogenetic abnormalities and immunophenotypic features presenting prognostic impact. We have examined the distribution and impact on survival of the expression of severallineage and maturation linked antigens used in routine immunophenotyping of patients with de novo acute leukemía. Cases were diagnosed by peripheral blood counts,bone marrow cytology, cytochemistry, cytogenetics and immunophenotyping using a first screening panel with 3 colors (CD45, CD3, CD7, CDI9, CD13, CD33 e HLA-DR) and secondary panel for precursor B ALL (CDI0, CD20, k e À) and AML (CD2, CDI4, CD15, CD34, CD56 e MPO). Antigen expression was measured by mean fluorescence intensity (MFI) by flow cytometry using the Paint-a-gate software. We analysed 5 cases of T-ALL. Median age: 29 years (14-51). In 80% of the cases were defined by primary panel. CD13 was the most expressed cross-lineage marker (80%). We analysed 31 cases ofB-ALL. Median age: 27 years (7-67). In 61% of the cases were defined by screening panel and the remaining, by secondary panel defined others. CD13 (35%) and CD33 (38%) were the cross-lineage markers most expressed. In Cox multivariate analysis, MFI of CD45 and age were significant for worse prognosis. We analysed 35 cases of AML. Median age: 51 years (11-79). The screening panel defined all cases. Predomínant FAB types were M2 and M4. In 5 cases we could detect 2 phenotypically different blast subpopulations and in 1 case we detected 3 subpopulations. The immaturity marker CD7 was expressed in 20% ofthe cases, the cross-lineage CD2 and CD19 were expressed in 11% of the cases and we could observe asynchronous in 20% with co-expression of CD34/CD15 and 22% with co-expression of CD34/CD56. In Cox multivariate analysis, MFI of CD45 and MPO, age, WBC and karyotype were significant for worse survival. By measuring the fluorescence intensity of the antigens, we could detect prognostic parameters as well as phenotypically different blast subsets. These did not influence survival, but may represent a pitfall in studies of mínimal residual diseaseby flow cytometry, as chemotherapy may select one of these subsets

ASSUNTO(S)

leucemia aguda diagnostico citometria de fluxo prognostico

ACESSO AO ARTIGO

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