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Flow cytometric identification of acute myeloid leukemia with limited differentiation and NPM1 type A mutation: a new biologically defined entity

Leukemia volume 23, pages 1361–1364 (2009)Cite this article

Many specific leukemia subtypes have been identified by characteristic and reproducible phenotypic features detected mainly by cytomorphology and immunophenotyping. Further research then led to unraveling recurring cytogenetic and molecular genetic aberrations forming the pathogenetic basis of the respective entities as exemplified by chronic myelogenous leukemia.1, 2 We here report on 20 cases with acute myeloid leukemia (AML) with limited differentiation as identified by their specific immunophenotype. All of these cases were shown to carry an NPM1 type A mutation.

This immunophenotype thus clearly differs from all other AML subtypes as defined by immunophenotype: (1) AML with minimal differentiation in general shows no or only a dim expression of MPO and in most cases, in addition to other myeloid markers, progenitor cell markers and HLA-DR are expressed; (2) the latter markers are mostly expressed in AML without maturation and AML with maturation, furthermore in these cases myeloid markers are expressed at higher numbers than in the present series; (3) myelomonocytic and monoblastic AML feature a coexpression of a variety of myeloid and monocytic markers and most often express HLA-DR. Interestingly, acute promyelocytic leukemia shares some of the immunophenotypic features with the present series (lack of HLA-DR expression, strong MPO expression) but shows additional ones which were not observed in the presented cohort (unspecific fluorescence signals in negative controls, strong expression of other myeloid markers). Furthermore, although there is a weak side-scatter signal in both the present series and in AML M3, it is stronger in the latter group.3 The present series thus features a distinct immunophenotype which was not described before.

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Authors and Affiliations

  1. MLL Munich Leukemia Laboratory, Munich, Germany

    W Kern, C Haferlach, T Haferlach & S Schnittger

  2. Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg (UCCH), Hamburg, Germany

    U Bacher

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  1. W Kern
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  2. C Haferlach
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  3. U Bacher
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  4. T Haferlach
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  5. S Schnittger
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Correspondence to W Kern.

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Kern, W., Haferlach, C., Bacher, U. et al. Flow cytometric identification of acute myeloid leukemia with limited differentiation and NPM1 type A mutation: a new biologically defined entity. Leukemia 23, 1361–1364 (2009). https://doi.org/10.1038/leu.2009.84

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