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Characterization of childhood acute leukemia with multiple myeloid and
lymphoid markers at diagnosis and at relapse [see comments]
CH Pui, SC Raimondi, DR Head, MJ Schell, GK Rivera, J Mirro , WM Crist and FG Behm
Department of Hematology-Oncology, St. Jude Children's Research Hospital,
Memphis, TN 38101.
To define the clinical and biologic significance of childhood acute
mixed-lineage leukemia diagnosed by stringent criteria, we studied 25 cases
of acute lymphoblastic leukemia expressing greater than or equal to 2
myeloid-associated antigens (My+ ALL), and 16 cases of acute myeloid
leukemia expressing greater than or equal to 2 lymphoid associated antigens
(Ly+ AML). These cases represented 6.1% of 410 newly diagnosed ALLs (two
treatment protocols) and 16.8% of 95 AMLs (two protocols).
T-lineage--associated antigens were identified in 9 of the My+ ALL cases
and in 14 of those classified as Ly+ AML; all but 1 of the 19 cases that
could be subclassified had an early thymocyte stage of differentiation. The
My+ ALL cases had an increased frequency of French-American-British (FAB)
L2 morphology (36%); the Ly+ AML cases were characterized by FAB M1 or M2
morphology, low levels of myeloperoxidase reactivity and combined
populations of myeloperoxidase- positive large blasts and small blasts
generally of hand-mirror morphology. Karyotypic abnormalities included
t(9;22)(q34;q11) in three cases of My+ ALL, 11q23 translocations in two
cases of My+ ALL, and 14q32 translocations in three My+ ALL and five Ly+
AML cases. Mixed- lineage expression lacked prognostic significance in
either ALL or AML; however, the findings indicate that some patients with
Ly+ AML may respond to prednisone, vincristine, and L-asparaginase after
failing on protocols for myeloid leukemia. At relapse, two My+ ALLs had
converted to AML and two Ly+ AMLs to ALL; one case in each group showed
complete replacement of the original karyotype. Acute mixed-lineage
leukemia does not adequately describe the heterogeneity of the cases
identified in this study and should be replaced by a set of more
restrictive terms that indicate the unique biologic features of these
leukemias.
Volume 78,
Issue 5,
pp. 1327-1337,
09/01/1991
Copyright © 1991 by The American Society of Hematology
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