Acute Myelomonocytic AMML and Monocytic AMOL Leukemia

The two most informative markers for a monocytic component within a leukemia cell population are CD11b and CD14. Although CD14-positive leukemias are virtually always CD11b-positive, CD11b positivity does not predict for CD14 expression. CD11b+HLA-DR+CD14- leukemic cells may represent CD11b+ AML (see below); CD11b+HLA-DR-CD14- cells in all likelihood reflect normal maturing myeloid cells. Thus, combined testing for CD11b and HLA-DR will resolve this question. Occasionally, a CD11b+HLA-DR+ but CD14- and a CD14+ leukemic component can be observed side by side within the same leukemia cell population. Whether a minor CD14+ CD11b+HLA-DR+ cell component in a myeloblastic leukemia represents residual normal or leukemic monocytes may be difficult to establish because a major portion of acute monocytic leukemia (AMOL) cells lack CD34151,159,304 (Paietta et al., unpublished). Lack of MPO expression is another feature typical of many cases of AMOL.292,294 In such cases, differential expression of the CD24 antigen by normal and malignant myelomono-cytic cells can be useful. Normal mature myeloid cells are CD24-positive,62 whereas normal mature monocytes lack this antigen.207,208 The opposite is true for their leukemic counterparts in that the majority of AML cells lack CD24 and some AMOL are CD24-positive207,208 (Paietta et al., unpublished)

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