HLA-DR antigen-positive acute promyelocytic leukemia

Correlation Study on HLA-DR and CD117 (c-Kit) Expressions: Its Prognosis and Treatment Response in Acute Myeloid Leukemia Patients

Introduction

Acute myeloid leukemia (AML) is the most common type of acute leukemia in adults. HLA-DR and CD117 (c-Kit) are important diagnostic markers of AML. Our objective is to determine the prognostic significance of HLA-DR and CD117 expressions in newly diagnosed AML patients and determine the correlation between HLA-DR and CD117 expressions and other prognostic markers such as cytogenetic abnormalities, FLT3-ITD, response to treatment, and patient’s survival.

Methods

This study included 100 newly diagnosed AML patients. All patients were subjected to clinical, morphological, cytochemical, cytogenetic analysis, molecular genetic analysis to detect FLT3-ITD, and Flowcytometric detection of HLA-DR, CD117, and CD 34.

Results

The results showed that HLA-DR expression was found in 75 patients (77.3%), while CD117 expression was found in 63 patients (64.9%). Patients with HLA-DR expression showed significantly higher mean Hb concentration, significantly higher platelet count, associated with AML-FAB subtypes (M0, M1, and M2), CD34 expression, and favorable cytogenetic group. M3 subtype was significantly associated with HLA-DR-ve. While patients with CD117 expression showed significantly lower platelets count. Double positive patients (HLA-DR+ve/CD117+ve) showed significant association with the intermediate cytogenetic group, while double-negative patients (HLA-DR-ve/CD117-ve) were associated with the favorable and intermediate cytogenetic group and either positive (HLA-DR+ve /CD117-ve or HLA-DR-ve/CD117+ve) associated with poor cytogenetic groups. FLT3-ITD expression had significantly worse overall survival.

Conclusion

The current study suggested that the expression of CD117 and HLA-DR may be a prognostic marker in AML, as they are associated with M0, M1, and M2 FAB subtypes; moreover, patients with combined HLA-DR and CD117 positive expression are associated with CD34 expression and intermediate cytogenetic group.

The curious case of HLA-DR-positive APL

The triad of weak/absent CD34, negative HLA-DR expression, and positivity to CD117 is pathognomonic for the diagnosis of acute promyelocytic leukemia. However, in rare cases, strong positivity to HLD-DR and CD34 may be noted.

Successful Treatment With ATRA and Arsenic Trioxide for a Child With Down Syndrome and Acute Promyelocytic Leukemia

Acute promyelocytic leukemia (APL) is rare in patients with Down syndrome (DS). Cytotoxic chemotherapy combined with all-trans retinoic acid (ATRA) has been a standard treatment for APL, but is potentially intolerable for DS patients because of their vulnerability to cytotoxic agents. We report here a case of a 10-year-old girl with DS and APL successfully treated with a combination of ATRA and arsenic trioxide, a therapy emerging as a new standard for APL. She achieved molecular remission and completed the therapy without significant toxicities. ATRA/arsenic trioxide combination therapy would be a preferable option for DS patients with APL.

Exploring the Risks of Genetic Similarity Between Donor and Recipient in Human Leukocyte Antigen-Matched Transplantation

OBJECTIVE

Successful allogeneic hematopoietic stem cell transplantation (HSCT) relies on human leukocyte antigen (HLA) matching. However, whether HLA-matching between donors and recipients increases recipients' risk of genetic disease remains unclear.

METHODS

We investigated whether HLA-matched donor cells used for HSCT have similar microsatellite DNA polymorphisms to HSCT recipients at 19 randomly selected loci including CSF1PO, D12S391, D13S317, D16S539, D18S51, D19S433, D21S11, D2S1338, D3S1358, D5S818, D6S1043, D7S820, D8S1179, FGA, PentaD, PentaE, TH01, TPOX, and VWA. We analyzed allele matching at each short tandem repeat (STR) loci in HLA-matched and mismatched (control) groups using binary outcomes and a quantitative numerical method.

RESULTS

The frequencies were similar between the HLA-matched group and the mismatched group for D6S1043. However, the allele matching rate was higher in the HLA-matched group than that in the mismatched group at 14 of the 19 STR loci. Overall, a significant increase in the rate of STR matching was observed in the HLA-matched group compared to the mismatched group (P = .004).

CONCLUSION

It would be interesting to know if the HLA matched pairs came more often in question than their mismatched counterparts as candidates for fully HLA-matched unrelated HSCT. The actual risk for HSCT donors developing these diseases needs further evaluation.