Summary
In 91 of 106 adult patients with acute lymphoblastic leukemia (ALL) enrolled in the treatment protocol ALL HOVON-5 between May 1988 and October 1991, the immunophenotype of the leukemia was determined and correlated with clinical characteristics at presentation. The immunological marker analysis was performed in ten laboratories, all members of the Dutch Study Group on Immunophenotyping of Leukemias and Lymphomas (SIHON). Undifferentiated blasts were found in four patients, 67 had B-lineage ALL, 18 had T-lineage ALL, and two had biphenotypic ALL. The age of T-lineage ALL patients was lower (mean 29.3) than that of B-lineage ALL patients (mean 35.5). Tumor mass, as expressed by leukocyte count, organomegaly, and LDH, was more pronounced in T-lineage ALL. Hemoglobin and platelet count was similar in all (sub)types. CD34 was expressed in 58% of the leukemias, but most frequently in the common B-ALL (70%). Thirteen percent of the leukemias expressed one or more markers not associated with their lineage. In this prospective study immunological data were not evaluable for 15 patients. On four of them data were not available because of dry tap, for six patients the typing was technically insufficient, and for four patients the results were unclassifiable; with one patient the marker analysis was not performed.
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References
Baccarani M, Gobbi M, Tura S (1980) Prognostic value of immunologic markers in adults with acute lymphoblastic leukaemia. N Engl J Med 302: 123
Baccarani M, Corbelli G, Amadori S, Drenthe-Schonk A, Willemze R, Meloni G, Lopez Cardozo P, Haanen C, Mandelli F, Tura S (1982) Adolescent and adult acute lymphoblastic leukaemia: prognostic features and outcome of therapy. Blood 60: 677–684
Bain BJ (1990) Leukemia diagnosis, a guide to the FAB classification. Lippincott, Philadelphia
Barnett MJ, Greaves MF, Amess JAL, Gregory WM, Rohatiner AZS, Dhaliwal HS, Slevin ML, Biruls R, Malpas JS, Lister TA (1986) Treatment of acute lymphoblastic leukaemia in adults. Br J Haematol 64: 455–468
Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DAG (1976) Proposals for the classification of the acute leukaemias (FAB cooperative group). Br J Haematol 33: 451–458
Bennett JN, Catovsky D, Daniel MT, Flandrin G, Galton DAG, Gralnich HR, Sultan C (1985) Proposed revised criteria for the classification of acute myeloid leukaemia. Ann Intern Med 103: 620–629
Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DAG, Gralnick HR, Sultan C (1985) Criteria for the diagnosis of acute leukemia of megakaryocytic lineage (M7): a report of the French-American-British cooperative group. Ann Intern Med 103: 460–462
Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DAG, Gralnick HR, Sultan C (1991) Proposal for the recognition of minimally differentiated acute myeloid leukaemia (AML-MO). Br J Haematol 78: 325–329
Childs C, Hirsch Ginsberg C, Walters RD, Andersson BS, Reuben J, Trujilo JM, Cork A, Stass SA, Freireich EJ, Zipf TF (1989) Myeloid surface antigen positive acute lymphoblastic leukemia (My+ALL): immunophenotyping ultrastructural, cytogenetic and molecular characteristics. Leukemia 3: 777–783
Clarkson B, Ellis S, Litle C, Gee T, Arlin Z, Mertelsmann R, Andreef M, Kempin S, Koziner B, Chaganti R, Jhanwar S, McKenzie S, Cirrincione C, Gaynor J (1985) Acute lymphoblastic leukemia in adults. Semin Oncol 12: 160–179
Dongen JJM, Adriaansen HJ, Hooijkaas H (1988) Immunophenotyping of leukaemias and non-Hodgkin's lymphomas. Immunological markers and their CD codes. Neth J Med 33: 298–314
Drexler HG, Thiel E, Ludwig W-D (1991) Review of the incidence and clinical relevance of myeloid antigen-positive acute lymphoblastic leukemia. Leukemia 5: 637–645
Foa R, Baldini L, Cattoretti G, Foa P, Gobbi M, Lauria F, Madon E, Masera G, Miniero R, Paolucci G, Perona G, Pizzolo G, Saitta M, Gavosto F (1985) Multimarker phenotypic characterization of adult and childhood acute lymphoblastic leukaemia: an Italian multicentre study. Br J Haematol 61: 251–259
Foon KA, Todd RF (1986) Immunological classification of leukaemia and lymphoma. Blood 68: 1–31
Garand R, Vannier JP, Bene MC, Faure GC, Bernard A (1989) Correlations between acute lymphoid leukemia (ALL) immunophenotype and clinical and laboratory data at presentation. A study in 350 patients. Cancer 64: 1437–1446
Gimema cooperative group (1989) GIMEMA ALL 0183: study on adult acute lymphoblastic leukaemia in Italy. Br J Haematol 71: 377–386
Greaves MF, Lister TA (1981) Prognostic importance of immunologic markers in adult lymphoblastic leukaemia. N Engl J Med 304: 119–120
Hoelzer D, Thiel E, Loffler H, Buchner T, et al. (1988) Prognostic factors in a multicenter study for the treatment of acute lymphoblastic leukaemia in adults. Blood 71: 123–131
Hooijkaas H, Hahlen K, Adriaansen J, Dekker I, Zanen GE van, Dongen JJM van (1989) Terminal deoxynucleotidyl transferase (TdT)-positive cells in cerebrospinal fluid and development of overt CNS leukaemia: a 5-year follow-up study in 113 children with a TdT-positive leukemia or non-Hodgkin's lymphoma. Blood 74: 416–422
Liang R, Chan TK, Chan GTC, Todd D (1989) Treatment of adult acute lymphoblastic leukaemia using an intensive chemotherapy protocol. Cancer Chemother Pharmacol 23: 384–388
Linker CA, Leditt LJ, O'Donnell M, Forman SJ, Ries CA (1991) Treatment of adult acute lymphoblastic leukemia with intensive cyclical chemotherapy: a follow-up report. Blood 78: 2814–2822
Marcus RE, Catovsky D, Johnson SA, Gregory WM, Talavera JG, Goldman JM, Galton DAG (1986) Adult acute lymphoblastic leukaemia: a study of prognostic features and response to treatment over a ten-year period. Br J Cancer 53: 175–180
Mirro J, Zipf TF, Pui CH, Kitchingman G, Williams D, Melvin S, Murphy SB, Stass S (1985) Acute mixed-lineage leukemia: clinicopalhologic correlations and prognostic significance. Blood 66: 1115–1123
Pui CH, Behm FG, Singh B, Rivera GK, Schell MJ, Roberts WM, Crist WM, Mirro J (1990) Myeloid associated antigen expression lacks prognostic value in childhood acute lymphoblastic leukaemia treated with intensive multiagent chemotherapy. Blood 75: 198–202
Radford JE, Burns CP, Jones MP, Gingrich RD, Kemp JD, Edwards RW, McFadden DB, Dick FR, Wen BC (1989) Adult acute lymphoblastic leukemia: Results of the Iowa HOP-L protocol. J Clin Oncol 7: 58–66
Reijden HJ van der, Wering ER van, Rijn JM van de, Melief CJM, Veer MB van't, Behrend H, Borne AEGKr von dem (1983) Immunological typing of acute lymphoblastic leukaemia. Scand J Haematol 30: 356–366
Sobol RE, Royston I, LeBien TW, Minowada J, Anderson K, Davey FR, Cuttner H, Schiffer C, Ellison RR, Bloomfield CD (1985) Adult acute lymphoblastic phenotypes defined by monoclonal antibodies. Blood 65: 730–735
Sobol RE, Mick R, Royston J, Davey FR, Ellison RR, Newman R, Cuttner J, Griffin JD, Collins H, Nelson DA, Bloomfield C (1987) Clinical importance of myeloid antigen expression in adult acute lymphoblastic leukemia. N Engl J Med 316: 1111–1117
Thiel E, Kranz BR, Raghavachar A, Bartram CR, Loffler H, Messerer D, Ganser A, Ludwig W-D, Buchner T, Hoelzer D (1989) Prethymic phenotype and genotype of pre-T (CD7 + / ER-)-cell leukemia and its clinical significance within adult acute lymphoblastic leukemia. Blood 73: 1247–1258
Vaughan WP, Civin CI, Weisenburger DD, Karp JE, Graham ML, Sanger WG, Grierson HL, Joshi SS, Burke PJ (1988) Acute leukemia expressing the normal human haematopoietic stem cell membrane glycoprotein CD34 (My10). Leukemia 2: 661–666
Veer MB van't (1992) The diagnosis of acute leukemia with undifferentiated or minimally differentiated blasts. Ann Hematol 64: 161–165
Veer MB van't, Kluin-Nelemans JC, Schoot E van der, Putten WLJ van, Adriaansen HJ, Wering ER (1992) Quality assessment of immunological marker analysis and the immunological diagnosis of leukaemia and lymphoma: a multi-center study. Br J Haematol 80: 458–465
Wiersma SR, Ortega J, Sobel E, Weinberg KJ (1991) Clinical importance of myeloid-antigen expression in acute lymphoblastic leukemia in childhood. N Engl J Med 324: 800–808
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The following persons participated in the immunophenotyping studies:
E. van der Schoot, Central Laboratory Red Cross Blood Transfusion Service, Amsterdam;A. E. G. Kr. von dem Borne, Acad. Medical Center, Amsterdam; J.J.M. Hoffmann, Catharina Hospital, Eindhoven; P. Wijermans, Leyenburgh Hospital, The Hague; J. Mulder, Regional Immunologic Lab., Leeuwarden; J. C. Kluin-Nelemans, University Hospital, Leiden; D. J. van Rheenen, University Hospital Annadal, Maastricht; H. J. Adriaansen, Erasmus Univ., Rotterdam; M. B. van't Veer, Dr. Daniel den Hoed Cancer Center, Rotterdam; H. Lokhorst, University Hospital, Utrecht; The Netherlands.
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van't Veer, M.B., van Putten, W.L.J., Verdonck, L.F. et al. Acute lymphoblastic leukaemia in adults: Immunological subtypes and clinical features at presentation. Ann Hematol 66, 277–282 (1993). https://doi.org/10.1007/BF01695969
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DOI: https://doi.org/10.1007/BF01695969