The immunologic fingerprint established at the time of presentation may be found to have undergone slight or significant changes when a patient is retested at the time of relapse. In the majority of cases, however, the overall immunophenotypic interpretation will remain the same. A trend toward the development of a less or more mature phenotype may be observed, as reflected by a decrease or increase in the expression of selected maturation antigens (e.g., CD15 in AML or CD10 and CD20 in ALL).98-101

Figure 15-3 gives three examples of changes in antigen expression patterns from our experience. In the patient with differentiated AML at presentation, initial diagnosis was based on the expression of CD65s in 60 percent of blast cells positive for myeloperoxidase (partially), CD33, and CD13, which is above our threshold level for this marker in the distinction between differentiated and undifferentiated AML.2 At the time

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