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Immunophenotype

Quantitative multiparametric immunophenotyping in acute lymphoblastic leukemia: correlation with specific genotype. I. ETV6/AML1 ALLs identification

Abstract

The t(12;21)(p13;q22) fusion gene is the most frequent genetic lesion described in precursor B cell acute lymphoblastic leukemia (ALL) of childhood occurring in a quarter of cases. This gene rearrangement is associated with a good outcome presenting a high response rate to chemotherapy. In spite of its potential clinical relevance, the t(12;21) translocation usually goes undetected with conventional cytogenetic procedures. In the present study we utilized an objective flow cytometric approach (multiparametric quantitative analysis) for the phenotypic characterization of this type of ALL. We studied a total of 74 precursor B-ALL children, including 21 t(12;21)+ and 53 t(12;21) cases. Our results show that the t(12;21)(p13;q22)+ ALLs display a higher intensity of CD10 (P = 0.0016) and HLADR (P = 0.005) expression together with lower levels of the CD20 (P = 0.01), CD45 (P = 0.01), CD135 (P = 0.003) and CD34 (P = 0.03) antigens as compared to the t(12;21) cases. Moreover, as regards CD34 expression, we observed a more heterogeneous antigen expression within individual patients with higher coefficients of variation (median of 202 vs 88, P = 0.0001). A multivariate analysis disclosed that with the immunophenotypic approach used identification of t(12;21)+ cases can be achieved with a sensitivity of 86% and a specificity of 100%. We conclude that childhood precursor B-ALL carrying the t(12;21) translocation display characteristic phenotypic features which could provide a rapid, simple, sensitive and specific screening method to select for those cases that should undergo confirmatory molecular analysis.

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References

  1. McLean TW, Ringold S, Neuberg D, Stegmaier K, Tantravahi R, Ritz J, Koeffler HP, Takeuchi S, Janssen JWG, Seriu T, Bartram CR, Sallan SE, Gilliland DG, Golub TR . TEL/AML1 dimerizes and is associated with a favourable outcome in childhood acute lymphoblastic leukemia Blood 1996 88: 4252–4258

    CAS  PubMed  Google Scholar 

  2. Romana SP, Poirel H, Leconiat M, Flexor MA, Mauchauffé M, Jonveaux P, Macintyre EA, Berger R, Bernard OA . High frequency of t(12;21) in childhood B-lineage acute lymphoblastic leukemia Blood 1995 86: 4263–4269

    CAS  PubMed  Google Scholar 

  3. Shurtleff SA, Buijs A, Behm FG, Rubnitz JE, Raimondi SC, Hancock ML, Chan GC-F, Pui C-H, Grosveld G, Downing JR . TEL/AML1 fusion resulting from a cryptic t(12;21) is the most common genetic lesion in pediatric ALL and defines a subgroup of patients with an excellent prognosis Leukemia 1995 9: 1985–1989

    CAS  PubMed  Google Scholar 

  4. Rubnitz JE, Pui CH, Downing JR . The role of the TEL fusion gene in pediatric leukemias Leukemia 1999 13: 6–13

    Article  CAS  PubMed  Google Scholar 

  5. Golub TR, Barker GF, Bohlander SK, Hiebert SW, Ward DC, Bray-Ward P, Morgan E, Raimondi SC, Rowley JD, Gilliland DG . Fusion of the TEL gene on 12p13 to the AML1 gene on 21q22 in acute lymphoblastic leukemia Proc Natl Acad Sci USA 1995 92: 4917–4921

    Article  CAS  PubMed  Google Scholar 

  6. Romana SP, Mauchauffé M, Le Coniat M, Chumakov I, Le Paslier D, Berger R, Bernard OA . The t(12;21) of acute lymphoblastic leukemia results in a TEL-AML1 gene fusion Blood 1995 85: 3662–3670

    CAS  PubMed  Google Scholar 

  7. Raynaud S, Cavé H, Baens M, Bastard C, Cacheux V, Grosgeorge J, Guidal-Giroux C, Guo C, Vilmer E, Marynen P, Grandchamp B . The 12;21 translocation involving TEL and deletion of the other TEL allele: two frequently associated alterations found in childhood acute lymphoblastic leukemia Blood 1996 87: 2891–2899

    CAS  PubMed  Google Scholar 

  8. Borkhardt A, Cazzaniga G, Viehmann S, Valsecchi MG, Ludwig WD, Burci L, Mangioni S, Schrappe M, Riehm H, Lampert F, Basso G, Masera G, Harbott J, Biondi A . Incidence and clinical relevance of TEL/AML1 fusion genes in children with acute lymphoblastic leukemia enrolled in the German and Italian multicenter therapy trials Blood 1997 90: 571–577

    CAS  PubMed  Google Scholar 

  9. Cayuela JM, Baruchel A, Orange C, Madani A, Auclerc MF, Daniel MT, Schaison G, Sigaux F . TEL/AML1 fusion RNA as a new target to detect minimal residual disease in pediatric B-cell precursor acute lymphoblastic leukemia Blood 1996 88: 302–308

    CAS  PubMed  Google Scholar 

  10. Bene MC, Castoldi G, Knapp W, Ludwig WD, Matutes E, Orfao A, van't Veer MB . Proposals for the immunological classification of acute leukemias Leukemia 1995 9: 1783–1786

    CAS  PubMed  Google Scholar 

  11. Jennings CD, Foon KA . Recent advances in flow cytometry: application to the diagnosis of hematologic malignancy Blood 1997 90: 2863–2892

    CAS  PubMed  Google Scholar 

  12. De Rossi G, Grossi C, Foa R, Tabilio A, Vegna L, Lo Coco F, Annino L, Camera A, Cascavilla N, Ciolli S, Del Poeta G, Liso V, Mandelli F . Immunophenotype of acute lymphoblastic leukemia cells: the experience of the Italian Cooperative Group (Gimena) Leuk Lymphoma 1993 9: 221–228

    Article  PubMed  Google Scholar 

  13. Ludwig WD, Reiter A, Loffler H, Gokbuget, Hoelzer D, Riehm H, Thiel E . Immunophenotypic features of childhood and adult acute lymphoblastic leukemia (ALL): experience of the German Multicentre Trials ALL-BFM and GMALL Leuk Lymphoma 1994 13: (Suppl. 1) 71–76

    Article  PubMed  Google Scholar 

  14. Foon KA, Tood RF III . Immunologic classification of leukemia and lymphoma Blood 1986 68: 1–31

    CAS  PubMed  Google Scholar 

  15. Paietta E . Proposal for the immunological classification of acute leukemias Leukemia 1995 9: 2147–2148

    CAS  PubMed  Google Scholar 

  16. Janossy G, Bollum FJ, Bradstock KF, Ashley J . Cellular phenotypes of normal and leukemic hemopoietic cells determined by analysis with selected antibody combinations Blood 1980 56: 430–441

    CAS  PubMed  Google Scholar 

  17. Ryan DH, Chapple C, Kossover SA, Sandberg AA, Cohen HJ . Phenotypic similarities and differences between cALLA-positive acute lymphoblastic leukemia cells and normal marrow cALLA-positive B cell precursors Blood 1987 70: 814–821

    CAS  PubMed  Google Scholar 

  18. Lamkin T, Brooks J, Annett G, Roberts W, Weinberg K . Immunophenotypic differences between putative hematopoietic stem cells and childhood B-cell precursor acute lymphoblastic leukemia cells Leukemia 1994 8: 1871–1878

    CAS  PubMed  Google Scholar 

  19. Hurwitz CA, Loken MR, Graham ML, Karp JE, Borowitz MJ, Pullen DJ, Civin CI . Asynchronous antigen expression in B lineage acute lymphoblastic leukemia Blood 1988 72: 299–307

    CAS  PubMed  Google Scholar 

  20. Ross CW, Stoolman LM, Schnitzer B, Schlegelmilch JA, Hanson CA . Immunophenotypic aberrancy in adult acute lymphoblastic leukemia Am J Clin Pathol 1990 94: 590–599

    Article  CAS  PubMed  Google Scholar 

  21. Drexler HG, Thiel E, Ludwig WD . Review of the incidence and clinical relevance of myeloid antigen-positive acute lymphoblastic leukemia Leukemia 1991 5: 637–645

    CAS  PubMed  Google Scholar 

  22. Greaves MF, Chan LC, Furley AJW, Watt SM, Molgaard HV . Lineage promiscuity in hematopoietic differentiation and leukemia Blood 1986 67: 1–11

    CAS  PubMed  Google Scholar 

  23. Ciudad J, San Miguel JF, Lopez Berges MC, Vidriales B, Valverde B, Ocqueteau M, Mateos G, Cabellero MD, Hernendez J, Moro MJ, Mateos MV, Orfao A . Prognostic value of immunophenotypic detection of minimal residual disease in acute lymphoblastic leukemia J Clin Oncol 1998 16: 3774–3781

    Article  CAS  PubMed  Google Scholar 

  24. Pui CH, Williams DL, Roberson PK, Raimondi SC, Behm FG, Lewis SH, Rivera GK, Kalwinsky DK, Abromowitch M, Crist WM, Murphy SB . Correlation of karyotype and immunophenotype in childhood acute lymphoblastic leukemia J Clin Oncol 1988 6: 56–61

    Article  CAS  PubMed  Google Scholar 

  25. Van Denderen J, Van der Plas D, Meeuwsen T, Zegers N, Boersma W, Grosveld G, Van Ewijk W . Immunologic characterization of the tumor-specific bcr-abl junction in Philadelphia chromosome-positive acute lymphoblastic leukemia Blood 1990 76: 136–141

    CAS  PubMed  Google Scholar 

  26. Tien HF, Wang CH, Lee FY, Liu MC, Chuang SM, Chen YC, Shen MC, Lin DT, Lin KH, Chuu WM . Cytogenetic study of acute lymphoblastic leukemia and its correlation with immunophenotype and genotype Cancer Genet Cytogenet 1992 59: 191–198

    Article  CAS  PubMed  Google Scholar 

  27. Ludwig WD, Bartram CR, Harbott J, Koller U, Haas O, Hansen-Hagge T, Heil G, Seibt-Jung H, Teichmann J, Ritter J, Knapp W, Gadner H, Thiel E, Riehm H . Phenotypic and genotypic heterogeneity in infant acute leukemia. I. Acute lymphoblastic leukemia Leukemia 1989 3: 431–439

    CAS  PubMed  Google Scholar 

  28. Ludwig WD, Bartram CR, Thiel E, Teichmann JV, Harbott J, Reiter A, Riehm H . Childhood acute lymphoblastic leukemia with co-expression of myeloid antigens (My+ALL): incidence, genotype, and clinical significance Blood 1989 74: 197a (Abstr.)

    Google Scholar 

  29. Kita K, Nakase K, Miwa H, Masuya M, Nichii K, Morita N, Takalura N, Otsuij A, Shirakawa S, Ueda T, Nasu K, Kyo T, Dohy H, Kamada N . Phenotypical characteristics of acute myelocytic leukemia associated with the t(8;21)(q22;p22) chromosomal abnormality. Frequent expression of immature B-cell antigen CD19 together with stem cell antigen CD34 Blood 1992 80: 470–477

    CAS  PubMed  Google Scholar 

  30. Devaraj PE, Foroni L, Janossy G, Hoffbrand AV, Secker-Walker LM . Expression of the E2A-PBX1 fusion transcripts in t(1;19)(q23;p13) and der(19)t(1;19) at diagnosis and in remission of acute lymphoblastic leukemias with different B lineage immunophenotype Leukemia 1995 9: 821–825

    CAS  PubMed  Google Scholar 

  31. Pui CH, Raimondi SC, Hancock ML, Rivera GK, Ribeiro RC, Mahmoud HH, Sandlund JT, Crist WM, Behm FG . Immunologic, cytogenetic and clinical characterization of childhood acute lymphoblastic leukemia with the t(1;19)(q23;p13) or its derivative J Clin Oncol 1994 12: 2601–2606

    Article  CAS  PubMed  Google Scholar 

  32. Borowitz MJ, Hunger SP, Carroll AJ, Shuster JJ, Pullen DJ, Steuber CP, Cleary ML . Predictability of the t(1;19)(q23;p13) from surface antigen phenotype: implications for screening cases of childhood acute lymphoblastic leukemia for molecular analysis: a Pediatric Oncology Group study Blood 1993 82: 1086–1091

    CAS  PubMed  Google Scholar 

  33. Pui CH, Frankel LS, Carroll AJ, Raimondi SC, Shuster JJ, Head DR, Crist WM, Land VJ, Pullen DJ, Steuber P, Behm FG, Borowitz MJ . Clinical characteristics and treatment outcome of childhood acute lymphoblastic leukemia with the t(4;11)(q21;q23): a collaborative study of 40 cases Blood 1991 77: 440–447

    CAS  PubMed  Google Scholar 

  34. Pui CH . Acute leukemias with the t(4;11)(q21;q23) Leuk Lymphoma 1992 7: 173–179

    Article  CAS  PubMed  Google Scholar 

  35. Baruchel A, Cayuela JM, Ballerini P, Landman-Parker J, Cezard V, Firat H, Haddad E, Auclerc MF, Valensi F, Cayre YE, Macintyre EA, Sigaux F . The majority of myeloid-antigen-positive (My+) childhood B-cell precursor acute lymphoblastic leukaemias express TEL/AML1 fusion transcripts Br J Haematol 1997 99: 101–106

    Article  CAS  PubMed  Google Scholar 

  36. Borowitz MJ, Rubnitz J, Nash M, Pullen DJ, Camitta B . Surface antigen phenotype can predict TEL-AML1 rearrangement in childhood B-precursor ALL: a Pediatric Oncology Group study Leukemia 1998 12: 1764–1770

    Article  CAS  PubMed  Google Scholar 

  37. Conter V, Aricò M, Valsecchi MG, Rizzari C, Testi A, Miniero R, Di Tullio MT, Lo Nigro L, Pession A, Rondelli R, Messina C, Santoro N, Mori PG, De Rossi G, Tamaro P, Silvestri D, Biondi A, Basso G, Masera G . Intensive BFM chemotherapy for childhood ALL: interim analysis of the AIEOP-ALL 91 study Haematologica 1998 83: 791–799

    CAS  PubMed  Google Scholar 

  38. Golub TR, Barker GF, Lovett M, Gilliland DG . Fusion of the PDGF receptor β to a novel ets-like gene, in chronic myelomonocytic leukemia with t(5;12) chromosomal translocation Cell 1994 77: 307–316

    Article  CAS  PubMed  Google Scholar 

  39. Janossy G, Bollum FJ, Bradstock KF, McMichael A, Rapson N, Greaves MF . Terminal transferase-positive human bone marrow cells exhibit the antigenic phenotype of common acute lymphoblastic leukemia J Immunol 1979 123: 1525–1529

    CAS  PubMed  Google Scholar 

  40. Borowitz MJ, Rubnitz J, Nash M, Pullen DJ, Camitta B . Replay: immunophenotypic prediction of TEL/AML1 rearrangement in childhood ALL (letter) Leukemia 1999 13: 983

    Article  Google Scholar 

  41. Orfao A, Chillon MC, Bortoluci AM, Lopez Berges MC, Garcia-Sanz R, Gonzalez M, Tabernero MD, Garcia Marcos MA, Rasillo AI, Hernendez-Rivas J, San Miguel JF . The flow cytometric pattern of CD34, CD15 and CD13 expression in acute myeloblastic leukemia is highly characteristic of the presence of PML-RARalfa gene rearrangements Haematologica 1999 84: 405–412

    CAS  PubMed  Google Scholar 

  42. Faraht N, Lens D, Zomas A, Morilla R, Matutes E, Catovsky D . Quantitative flow cytometry can distinguish between normal and leukemic B-cell precursors Br J Haematol 1995 10: 640–646

    Article  Google Scholar 

  43. Dworzak MN, Fritsch G, Fleischer C, Printz D, Froschl G, Buchinger P, Mann G, Gadner H . Comparative phenotype mapping of normal vs. malignant pediatric B-lymphopoiesis unveils leukemia-associated aberrations Exp Hematol 1998 26: 305–313

    CAS  PubMed  Google Scholar 

  44. Lavabre-Bertrand T, Duperray C, Brunet C, Poncelet P, Exbrayat C, Bourquard P, Lavabre-Bertrand C, Brochier J, Navarro M, Janossy G . Quantification of CD24 and CD45 antigens in parallel allows a precise determination of B-cell maturation stages: relevance for the study of B-cell neoplasias Leukemia 1994 8: 402–408

    CAS  PubMed  Google Scholar 

  45. Weir EG, Cowan K, LeBeau P, Borowitz MJ . A limited panel can distinguish B-precursor acute lymphoblastic leukemia from normal B precursors with four color flow cytometry: implication for residual disease detection Leukemia 1999 13: 558–567

    Article  CAS  PubMed  Google Scholar 

  46. Hrusak O, Trka J, Zuna J, Bartunkova J, Stary J . Are we ready to curtail testing for TEL/AML1 fusion (letter)? Leukemia 1999 13: 981–982

    Article  CAS  PubMed  Google Scholar 

  47. Ginaldi L, Matutes E, Farahat N, De Martinis M; Morilla R, Catovsky D . Differential expression of CD3 and CD7 in T-cell malignancies: a quantitative study by flow cytometry Br J Haematol 1996 93: 921–927

    Article  CAS  PubMed  Google Scholar 

  48. Putti MC, Rondelli R, Cocito MG, Aricò M, Sainati L, Conter V, Guglielmi C, Cantù-Rajnoldi A, Consolini R, Pession A, Zanesco L, Masera G, Biondi A, Basso G . Expression of myeloid markers lack prognostic impact in children treated for acute lymphoblastic leukemia: Italian experience in AIEOP-ALL 88–91 studies Blood 1998 92: 795–801

    CAS  PubMed  Google Scholar 

  49. Borowitz MJ, Shuster J, Carroll AJ, Nash M, Look AT, Camitta B, Mahoney D, Lauer SJ, Pullen DJ . Prognostic significance of fluorescence intensity of surface marker expression in childhood B-precursor acute lymphoblastic leukemia. A Pediatric Oncology Group Study Blood 1997 89: 3960–3966

    CAS  PubMed  Google Scholar 

  50. Lavabre-Bertrand T, Janossy G, Ivory K, Peters R, Secker-Walker L, Porwit-MacDonald A . Leukemia-associated changes identified by quantitative flow cytometry: I. CD10 expression Cytometry 1994 18: 209–217

    Article  CAS  PubMed  Google Scholar 

  51. Behm FG, Raimondi SC, Schell MJ, Look AT, Rivera GK, Pui C-H . Lack of CD45 antigen on blast cells in childhood acute lymphoblastic leukemia is associated with chromosomal hyperdiploidy and other favorable prognostic features Blood 1992 79: 1011–1016

    CAS  PubMed  Google Scholar 

  52. Borowitz MJ, Guenter KL, Shults KE, Stelzer GT . Immunophenotyping of acute lymphoblastic leukemia by flow cytometric analysis: use of CD45 as right-angle light scatter to gate on leukemic blasts in three-color analysis Am J Clin Pathol 1993 100: 534–540

    Article  CAS  PubMed  Google Scholar 

  53. Raynaud SD, Dastugue N, Zoccola D, Shurtleff SA, Mathew S and Raimondi SC . Cytogenetic abnormalities associated with the t(12;21): a collaborative study of 169 children with t(12;21)-positive acute lymphoblastic leukemia Leukemia 1999 13: 1325–1330

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank all the investigators from AIEOP Institutions for their collaboration; Maurizio Aricò, MD for helpful discussion and Mr Denis Swift for the editorial scrutiny. This work was supported by AIRC (Associazione Italiana per la Ricerca sul Cancro), MURST ex 40% and 60%; Fondazione Città della Speranza.

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De Zen, L., Orfao, A., Cazzaniga, G. et al. Quantitative multiparametric immunophenotyping in acute lymphoblastic leukemia: correlation with specific genotype. I. ETV6/AML1 ALLs identification. Leukemia 14, 1225–1231 (2000). https://doi.org/10.1038/sj.leu.2401824

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