The Significance Of Combination Of CD9/CD11b/HLA-DR In The Diagnosis Of APL

Objective: To investigate the immunophenotyping characteristics of acutepromyelocytic leukemia (APL) and explore the high sensitivity and specificityantibody combination for early, timely and accurate diagnosis of the APL and providethe basis for minimal residual disease(MRD) monitoring.Methods: Retrospective analysis was carried out on morphology, immunology,genetics and molecular biology data of the92patients diagnosed as APL in theSecond Hospital of Shanxi Medical University from September of2010to Decemberof2012;20patient controls diagnosed as non-APL-AML were compared and asummarize for phenotype characteristics of acute promyelocytic leukemia was made.Results:(1)The PML/RRAa fusion gene was detected in79patients,The PML/RRAa fusion gene was detected in78patients,positive rate is99%,results shows thatL-shaped50cases (64%), S-type,25cases (32%), V-type,3cases (4%).（2）SSC/CD45gating,92patients with newly diagnosed as APL, high SSC of75cases(82%), low SSC of14cases (15%), other types of3cases (3%).Immunophenotypicanalysis showed that the most APL express CD9(87/92;95%), CD33(92/92;100%),CD13(90/92;98%), CD33> CD13(89/92;97%), CD117(33/92;36%), CD64(84/92;91%), CD38(89/92;97%), cMPO (92/92;100%). the portion of APLexpressing CD15(22/92;24%), lack of expressing HLA-DR (92/92;100%), CD11b(86/92;93%), CD34(83/92;90%), CD14(92/92;100%), CD56(83/92;90%).(3) Inthe diagnose of APL,CD9/CD11b/HLA-DR antibody composition has the sensitivityof90%, specificity95%. DR/CD34/CD117combination has sensitivity of68%,specificity of85%. CD11b/HLA-DR combination has sensitivity of92%, specificity of70%. Significant difference (p <0.05) in the antibody combination can be found.Conclusion:(1)The majority of APLs with L-type, S-type followed and V-type israre..(2)The phenotyping characteristics of APL are stable expressing CD9, CD13,CD33(CD33> CD13), CD64, CD38, cMPO; part of expressing CD34, CD117;lacking of expressing CD14, CD15, CD11b, CD4, HLA-DR, CD56,cCD79a,cCD3.few of the APLs expressing CD16, CD10, CD2.(3) The new antibodycombination of CD9/CD11b/HLA-DR in the diagnosis of APL has higher sensitivityand specificity, and can be used as diagnosis of APL, and monitoring the MRD. Objective：To deep understand the clinical and biological characteristics of acutepanmyelosis and reduce the misdiagnosis.Methods：The clincal and biological characteristics of the patient who was diagnosedand treated as acute panmyelosis in our hospital were studied and the literatures werereviewed.Results：The clinical manifestations of the acute panmyelosis patient are similar toacute myeloid leukemia. The complete blood count was reducing with the diseaseprogress. The bone marrow (BM) examination showed hyperplasia and themyeloblasts Ⅰ+Ⅱ types accounted for10.0%(NEC26.9%); the percentage oferythrocyte is40.8%; the original megakaryocytes+immature megakaryocyteswere accounted for27.5%. The phenomenon of dysplasia of myeloid, monocytic,megakaryocytic and erythroid could be observed by flow cytometryimmunophenotyping (FCI).+8-7/7q-of karyotype could be detected by FISH. Thepatient was treated by CAG regimen (Acla20mg dl-7, Ara-c25mg dl-14, G-CSF200ug dl-14) and lung had serious fungal infection at the15th day. After onetreatment cycle, a complete remission in bone marrow was achieved.Conclusion： Acute panmyelosis is a rare type of leukemia. The clinicalmanifestations are similar to acute myeloid leukemia. The disease is characterizedby a multilineage proliferation involving in myeloid, monocytic, megakaryocytic,erythroid system, and has chromosomal abnormalities, prone to serious concurrentinfection, rapid progression, and poor prognosis.