FLOW CYTOMETRIC AND DEMOGRAPHIC ANALYSIS OF T CELL ACUTE LYMPHOBLASTIC LEUKEMIA IN PAKISTANI POPULATION

Authors

  • MR Khawaja
  • SS Allana
  • AN Akbarali
  • SN Adil
  • M. Khurshid
  • S Pervez

Abstract

Background: This study was carried out to analyze the proportion of T cell acute lymphoblasticleukemia (TALL) among all acute lymphoblastic leukemia (ALL) in Pakistani population and itscorrelation with the demographic features. Accuracy of cell surface markers used in flowcytometric analysis of the leukemic cells was also determined. Methods: Data of 209 consecutivecases of acute lymphoblastic leukemia (ALL) presenting between July 1995 and July 2003 wasanalyzed. Flow cytometry was performed on all ALL cases using the standard protocols. TALLmarkers included CD3, CD5 and CD7. Results: Proportion of TALL among known ALLPakistani patients was 17.22%. Mean age of the TALL patients was 17.2 years. Proportion ofTALL was higher in adults than in children (21.95% vs. 14.17%). Overall in this study there weremore male patients affected by TALL (25/36 or 69.40%) than females (11/36 or 30.60%). Thefemale to male ratio among TALL patients was 1:2.27. However, the proportion (%) of TALL infemales was higher than males (18.96% vs. 15.82 %) i, e, 1.2:1. CD7 was found to be the mostsensitive among both adults & children. It was positive in 94.4% of the TALL cases. Conclusion:Proportion of TALL among ALL in Pakistan is similar to that reported in this region, indicating acandidate association with geographical location and socioeconomic status. The reactivity ofmarkers with TALL cells was similar to what we expected based upon literature. However, due tosome aberrant and cross reactivity displayed by each marker, we strongly recommend a panelapproach including B and myeloid markers to ensure a correct diagnosis of TALL.Keywords: Leukemia, T cell acute lymphoblastic leukemia (TALL), Flow Cytometry

References

Channa J, Shamsi T, Hashmi K. Role of

immunophenotyping in diagnosis of acute leukemia. J Coll

Physicians Surg Pak 2000;10(5):158-60

Huh YO, Ibrahim S. Immunophenotypes in adult acute

lymphoblastic leukemia. Hematol Oncol Clin North Am

(6):1251-65

Naeem S, Hayee A. Acute lymphoblastic leukemia – A

study of phenotypes. J Pak Med Assoc 1992;42:83-6

Foa R, Baldini L, Cattoretti G. Multimarker phenotypic

characterization of adult & childhood acute lymphoblastic

leukemia: an Italian multicenter study. Br J Haematol

;61:251-9

Pervaiz S, Khurshid M. Classification and

immunophenotyping of acute leukemia: A prospective

study. J Pak Med Assoc 1997;47:103-6

Kaleem Z, Crawford E, Pathan MH, Jasper L, Covinsky

MA, Johnson LR. Arch Pathol Lab Med 2003;127:42-8

Pui CH, Evans WE. Acute lymphoblastic leukemia. N

Engl J Med 1998;339:605-15

Pui CH. Childhood Leukemias. N Engl J Med 1995;

:1618-30

Taskov H, Dimitrova E, Serbinova M, Mendisova L,

Bobev D. Immunological subtypes of childhood acute

lymphoblastic leukemia in Bulgaria. Leuk Res

;19(11):877-81

Arya LS. Acute Lymphoblastic Leukemia: Current

Treatment Concepts. Indian Pediatr 2000;37:397-406.

Noorali S, Pervez S, Moatter T. Characterization of T-cell

Non-Hodgkin’s Lymphoma and its association with EBV

in Pakistani patients. Leuk Lymphoma 2003;44(5):807-13.

Yusuf RZ, Pervez S, Aziz SA, Khurshid M. Flow

cytometric analysis of childhood leukemias. J Pak Med

Assoc 2001;51(3).

Paredes-Aguilera R, Romero-Guzman L, Lopez-Santiago

N. Immunophenotyping of acute lymphoblastic leukemia

J Ayub Med Coll Abbottabad 2005;17(4)

in Mexican children. Sangre (Barc) 1999;44(3):188-94

(Article in Spanish)

Paul B, Mukiibi JM, Mandisodza A, Levy L, Nkrumah

FK. A three-year prospective study of 137 cases of acute

leukaemia in Zimbabwe. Cent Afr J Med 1992;38(3):95-9

Kamel AM, Ghaleb FM, Assem MM. Phenotypic analysis

of T-cell acute lymphoblastic leukemia in Egypt. Leuk

Res 1990;14(7):601-9

Bhurgi Y, Bhurgi A, Rahim A. Comparability and quality

control at Karachi cancer registry. Karachi Cancer

Registry Technical Report. No.4, 1999.

Tiensiwakul P, Lertlum T, Nuchprayoon I, Seksarn P.

Immunophenotyping of acute lymphoblastic leukemia in

pediatric patients by three-color flow cytometric analysis.

Asian Pacific Journal of Allergy & Immunology

;17(1):17-21

Menon BS, Dasgupta A, Jackson N. Immunophenotyping

pediatric leukemias in Kelantan, Malaysia. Pediatr

Hematol Oncol 1998;15(2):175-8

Kamel AM, Assem MM, Jaffe ES. Immunological

phenotypic pattern of acute lymphoblastic leukaemia in

Egypt Leuk Res 1989;13(7):519-25

Consolini R, Legitimo A, Rondelli R. Clinical relevance

of CD10 expression in childhood ALL. The Italian

Association for Pediatric Hematology and Oncology

(AIEOP). Haematologica 1998;83(11):967-73

Pui CH, Behm FG, Crist MW. Clinical and biological

relevance of immunologic marker studies in childhood

leukemias. Blood 1993; 82:343-62

van't Veer MB, van Putten WL, Verdonck LF. Acute

lymphoblastic leukaemia in adults: immunological

subtypes and clinical features at presentation. Ann

Hematol 1993;66(6):277-82

Cabrera ME, Labra S, Ugarte S, Matutes E, Greaves MF.

Immunophenotype. Clinical and laboratory features of

acute lymphoblastic leukemia in Chile. Study of 500

children and 131 adults. Rev Med Chil 1996;124(3):293-9

Roberts GT, Aur RJ, Sheth KV. Immunophenotypic and

age patterns of childhood acute lymphoblastic leukemia in

Saudi Arabia. Leuk Res 1990;14(7):667-72

Knox-Macaulay HH, Brown LC. Descriptive

epidemiology of de novo acute leukaemia in the Sultanate

of Oman. Leuk Res 2000;24(7):589-94

Ludwig WD, Teichmann JV, Sperling C, Komischke B,

Ritter J, Reiter A. Incidence, clinical markers and

prognostic significance of immunologic subtypes of acute

lymphoblastic leukemia (ALL) in children: experiences of

the ALL-BFM 83 and 86 studies. [Article in German].

Klin Padiatr 1990;202(4):243-52

Sauerbrey A, Hafer R, Zintl F. Acute lymphatic leukemia

with pre-B-cell characteristics. Folia Haematol Int Mag

Klin Morphol Blutforsch 1989;116(2):219-26.(Article in

German)

Rajalekshmy KR, Abitha AR, Pramila R, Gnanasagar T,

Shanta V. Immunophenotypic analysis of T-cell acute

lymphoblastic leukemia in Madras, India. Indian J Cancer

;38(2-4):85-91

Landary L, Auer R, Bach B. Clinical application of flow

cytometry: Quality assurance and immunophenotyping of

peripheral blood lymphocytes. NCCLS Document H42T.

;12:23-30

Pizzolo G, Vincenzi C, Nadali G. Detection of membrane

and intracellular antigens by flow cytometry following

ORTHO permeal: ix fixation. Leukemia 1994; 8:672-6

Chuang SS, Lui CY. Useful panel of antibodies for the

classification of acute leukemia by immunohistochemical

methods in the bone marrow trephine biopsy specimen.

Am J Clin Pathol 1997;107:410-8

Rego EM, Garcia AB, Viana SR, Falcao RP.

Characterization of acute lymphoblastic leukemia

subtypes in Brazilian patients. Leuk Res 1996;20(4):349-

Ludwig WD, Thiel E, Bartman CR. Clinical importance of

TALL sub classification according to thymic and

prethymic maturation stage. In: Buchner T, Schellong G,

Hiddemann W, editors. Acute Leukemia vol. 2,

Hematology and Blood Transfusion Series. Berlin:

Springer; 1990. p. 419

Kuerbitz SJ, Civin CI, Krischer JP. Expression of

myeloid-associated and lymphoid-associated cell surface

antigens in acute myeloid leukemia of childhood. J Clin

Oncol 1992;10:1419-29

Smith Lj, Curtis JE, Messner HA, Senn JS, Furthmayr,

McCulloch EA. Lineage infidelity in acute leukemia.

Blood 1983;61(6):1138-45

Deque RE. Flow cytometric analysis of lymphomas and

acute leukemias. N Y Acad Sci 1993;677:309-25

Orfao A, Cuidad J, Cronzalez M. Flow cytometry in

diagnosis of cancer. Scand J Clin Lab Invest. Supplement.

;221:145-52

Pui CH, Rivera GK, Hancock ML.Clinical significance of

CD10 expression in childhood acute lymphoblastic

leukemia. Leukemia 1993;7(1):35-40

Batinic D, Boranic M, Tiefenbach A, Rajic L, FemenicKes R, Konja. Subsets of childhood acute lymphoblastic

leukemia in Croatia. Biomed Pharmacother

;42(2):133-4