A clinically relevant population of leukemic CD34+CD38− cells in acute myeloid leukemia
Jonathan M. GerberB. Douglas SmithBrownhilda NgwangHao ZhangMilada S. ValaLaura MorsbergerSteven GalkinMichael I. CollectorBrandy PerkinsMark J. LevisConstance A. GriffinSaul J. SharkisMichael J. BorowitzJudith E. KarpRichard J. Jones
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Minimal Residual Disease
A case of acute myeloid leukemia (AML) with an unusual phenotype which was negative for a panel of myeloid antigens determined by flow cytometry, but was strongly positive for myeloperoxidase has recently been reported. We herein describe a case of AML with this unusual phenotype at diagnosis; relapse occurred with the acquisition of CD13 and CD33 expressions. Morphological features of the blasts at relapse seemed to be more compatible with myeloblasts than those at diagnosis. These phenotypic and morphological changes are suggestive of asynchronous differentiation, clonal evolution or clonal change of leukemic cells.
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Immunophenotyping
Minimal Residual Disease
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To study the expression of L-selectin, Mac-1, LFA-1 on CML progenitor cells in relation to CML progression and therapeutic effect.The expression of adhesion molecules (LFA-1, Mac-1, L-selectin) on bone marrow CD34+ cells from 34 CML patients were analyzed by three-color flow cytometry.The mean percentage of expression of L-selectin, and LFA-1 on CD34+ CD38-(-)+ cells from untreated CML patients was significantly lower than that from normal controls. Among 8 CML patients treated with IFN-alpha, the expression of L-selectin and LFA-1 on CD34+ CD38- cell (37.6 +/- 5.3%, 42.1 +/- 13.1%) was comparable to that from normal controls (38.2 +/- 9.4%, 48.2 +/- 12.2%). L-selectin expression in CD34+ CD38- cells from CML patients was inversely correlated with the percentage of Ph'(+) cells. In 2 CML patients treated with allo-bone marrow transplantation, the expression rate of L-selectin, IFA-1 and Mac-1 on CD38+ CD38- cells was comparable to that from normal controls.The data suggest that decreased expression of L-selectin and LFA-1 in CML CD34+ cells reflects one of the features of malignant CML progenitors. IFN-alpha and allo-BMT restore the expression of Mac-1, L-selectin and LFA-1 to normal on CML CD34+ cells.
L-selectin
P-selectin
Alpha (finance)
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CD15
Precursor cell
Lineage (genetic)
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Objectives In myelodysplastic syndromes (MDS), neoplastic myeloblast (CD34+CD13+CD33+ cells) numbers often increase over time, leading to secondary acute myeloid leukemia (AML). In recent studies, blasts in some MDS patients have been found to express a megakaryocyte-lineage molecule, CD41, and such patients show extremely poor prognosis. This is the first study to evaluate whether myeloblasts transition to CD41+ blasts over time and to investigate the detailed immunophenotypic features of CD41+ blasts in MDS. Methods We performed a retrospective cohort study, in which time-dependent changes in blast immunophenotypes were analyzed using multidimensional flow cytometry (MDF) in 74 patients with MDS and AML (which progressed from MDS). Results CD41+ blasts (at least 20% of CD34+ blasts expressing CD41) were detected in 12 patients. In five of these 12 patients, blasts were CD41+ from the first MDF analysis. In the other seven patients, myeloblasts (CD34+CD33+CD41- cells) transitioned to megakaryoblasts (CD34+CD41+ cells) over time, which was often accompanied by disease progression (including leukemic transformation). These CD41+ patients were more frequently observed among patients with monosomal and complex karyotypes. CD41+ blasts were negative for the erythroid antigen, CD235a, and positive for CD33 in all cases, but CD33 expression levels were lower in three cases when compared with CD34+CD41- blasts. Among the five CD41+ patients who underwent extensive immunophenotyping, CD41+ blasts all expressed CD61, but two cases had reduced CD42b expression, three had reduced/absent CD13 expression, and three also expressed CD7. Conclusions Myeloblasts become megakaryoblastic over time in some MDS patients, and examining the megakaryocyte lineage (not only as a diagnostic work-up but also as follow-up) is needed to detect CD41+ MDS. The immunophenotypic features revealed in this study may have diagnostic relevance for CD41+ MDS patients.
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Acute megakaryoblastic leukemia
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CD34 and CD38 proteins are usually used as surface markers to identify HSCs and Leukemic stem cells. However, there have been cases that lacked CD34 or CD38 protein but still had leukemia initiating capacity in B-ALL suggesting the restrictive of these two markers. CD34 and CD38 expression were detected in most B-ALL and can serve as a specific biomarker for the prognosis of this subset of leukemia. Lack of CD34 or high CD38 expression is associated with favorable prognosis.
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Cord blood
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We previously showed that Aurora kinase A (AURKA) is aberrantly expressed in acute myelogenous leukemia (AML) cells when compared to bone marrow mononuclear cells isolated from healthy volunteers. We have also shown that CD34(+) /CD38(-) AML cells, one of compartments enriched for leukemia stem cells in most leukemia subgroups, were relatively resistant to cytarabine-mediated growth inhibition when compared to their CD34(+) /CD38(+) counterparts. Our study attempted to identify therapeutic targets in CD34(+) /CD38(-) AML cells and found that CD34(+) /CD38(-) AML cells isolated from patients (n = 26) expressed larger amounts of AURKA than their CD34(+) /CD38(+) counterparts and CD34(+) normal hematopoietic stem/progenitor cells isolated from healthy volunteers (n = 6), as measured by real-time reverse-transcriptase polymerase chain reaction. Blockade of AURKA by the specific inhibitor MLN8237 or a short hairpin RNA (shRNA) against AURKA significantly inhibited proliferation, impaired self-renewal capability and induced apoptosis of CD34(+) /CD38(-) AML cells, in association with modulation of levels of Bcl-2 family member proteins. Importantly, inhibition of AURKA in CD34(+) /CD38(-) AML cells by MLN8237 or an shRNA significantly impaired engraftment of these cells in severely immunocompromised mice and appeared to prolong their survival. These results suggest that AURKA is a promising molecular target to eliminate chemotherapy-resistant CD34(+) /CD38(-) AML cells.
Chronic myelogenous leukemia
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Chronic human immunodeficiency virus-1 (HIV-1) infection in patients leads to multi-lineage hematopoietic abnormalities or pancytopenia. The deficiency in hematopoietic progenitor cells (HPCs) induced by HIV-1 infection has been proposed, but the relevant mechanisms are poorly understood. We report here that both human CD34+CD38- early and CD34+CD38+ intermediate HPCs were maintained in the bone marrow (BM) of humanized mice. Chronic HIV-1 infection preferentially depleted CD34+CD38- early HPCs in the BM and reduced their proliferation potential in vivo in both HIV-1-infected patients and humanized mice, while CD34+CD38+ intermediate HSCs were relatively unaffected. Strikingly, depletion of plasmacytoid dendritic cells (pDCs) prevented human CD34+CD38- early HPCs from HIV-1 infection-induced depletion and functional impairment and restored the gene expression profile of purified CD34+ HPCs in humanized mice. These findings suggest that pDCs contribute to the early hematopoietic suppression induced by chronic HIV-1 infection and provide a novel therapeutic target for the hematopoiesis suppression in HIV-1 patients.
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