Undifferentiated Lin Acute Leukemia

Immunologically undifferentiated (lin-) acute leukemias are currently characterized as CD34+TdT±HLA-DR+CD7±, lacking intracytoplasmic and membrane lymphoid or myeloid antigens, including CD117.309 These cases must not be confused with leukemias classified as FAB AML-M0, which, although morphologically and cytochemically undifferenti-ated, by definition10,310 express at least one myeloid lineage-affiliated antigen (e.g., CD33, CD13, CD14), have variable antigenic profiles that frequently include stem cell features, and account for 2 to 7 percent of AML cases. Lin- acute leukemia must also not be mistaken for Null-ALL, the most immature B-cell precursor ALL, which expresses CD19 and/or cCD22 but lacks CD10. True lin- leukemia is exceedingly rare when all currently available tools for immunophenotyping are applied. Campana et al. reported an incidence of less than 1 percent among 750 cases of acute leukemia.311 However, even this figure may be an overestimation in that MPO protein was detectable in three of the seven cases, albeit in a small percentage of cells possibly reflecting normal myeloid precursor cells. In my laboratory's unpublished experience, we have never seen a case of acute leukemia in which lineage affiliation could not be deduced from the antigen expression pattern. The detection of somatic gene rearrangements in MPO antibody-negative cells311 or the induction of myeloid antigens by in vitro culture309,312 can help in the lineage assignment of leukemic phe-notypes in question.

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