Early Preb All Prob

100 r

TdT CD10 CD20 CD33 CD11b CD34 CD13

Furthermore, changes in antigen expression at relapse are often predictable from the antigen constellation at presentation, for example, moderate expression levels of antigens that are subsequently almost or completely lost.

The overall stability of expression patterns of lineage-foreign antigens, that is, myeloid antigen expression in ALL or lymphoid antigen expression in AML, has not yet been established, mainly because of a lack of comprehensive, technically adequate studies. Some data suggest significant changes in the level of "aberrant" antigen expression in most patients with either AML or ALL studied at relapse when compared with their initial diagnoses.102 The two ALL patients represented in Figure 15-3 demonstrate a robustness in foreign antigen expression, which in our experience is not uncommon. To account for all possible changes, even a complete lineage switch such as may occur in secondary AML following treatment with topoisomerase II targeting reagents of ALL,103 immunophenotyping at the time of morphologically suspected or established relapse must be as comprehensive as that performed at the time of initial presentation.

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