Çiğdem ÖZDEMİR, Yeter DÜZENLİ KAR, Nilgün EROĞLU, Yiğit ŞENOL, İbrahim EKER, Merve ŞAHİN

Yeni Tanı Pediatrik Akut Lenfoblastik Lösemide, Kemik İliği Biyopsisinde İmmünohistokimyasal Bulguların Akım Sitometrik Bulgular ile İlişkisinin Değerlendirilmesi

Amaç: Lösemiyi tedavi etmek için yeni terapötik seçeneklerin geliştirilmesi (kimerik antijen reseptörü [CAR] T hücrelerini hedefleyen tedaviler), hücre yüzeyinde eksprese edilen belirteçlerin down regülasyonuna neden olmaktadır. Bu nedenle, geleneksel immünofenotipleme panelleri artık bu antijenleri bir B hücresi immünofenotipinin tanımlanması için güvenilmez hale getirmektedir. Çalışmamızda, çocukluk çağı akut lenfoblastik lösemisinde (ALL) kemik iliği aspirasyonunda multiparametrik akım sitometrisi (AS) ile kemik iliği biyopsisinde immünohistokimyasal (İHK) analizi metodolojik olarak karşılaştırdık. Lösemi tanısında bu iki yöntemin birbirine alternatif olup olamayacağını yanıtlamaya çalıştık. Gereç-Yöntem: ALL tanısı alan 28 hasta çalışmaya dahil edildi. İlk tanı sırasında yapılan kemik iliği aspirasyonu ve biyopsi örneklerinde eş zamanlı AS ve İHK çalışmalarında kullanılan antikorların ekspresyonları arasındaki uyum için Kappa testi yapıldı. Bulgular: Hastaların 23'ü pre-B ALL (BCP-ALL) ve 5'i T-ALL idi. BCP-ALL'li hastaların AS ve İHK'da kullanılan MPO, CD79A, CD14, CD3 antikorlarında ekspresyonlar aynı iken, CD19, CD7, CD117, CD33, CD 56, CD34 antikor ekspresyonları arasında çok iyi, CD20 antikor ekspresyonunda iyi ve CD10 ekspresyonunda ise orta düzeyde uyum mevcuttu. T-ALL tanılı hastaların AS ve İHK'da kullanılan CD20, CD19, CD14, CD79a, MPO, CD22 antikorlarının ekspresyonları aynıydı, CD2, CD10, CD34 antikorlarının ekspresyonları açısından çok iyi uyum mevcuttu. Tartışma: İmmünfenotiplemeyi etkileyen tedavilerin olduğu, AS gibi maliyetli yöntemlerin bulunmadığı veya kemik iliği aspirasyonunun yeterince alınamadığı durumlarda, kemik iliği biyopsisinde pediatrik ALL tanısında İHK ile immünfenotipleme güvenle yapılabilir.

Anahtar Kelimeler:

Akut lenfoblastik lösemi, İmmünohistokimya, Akım sitometri, İmmünofenatiplendirme

Evaluation of the Correlation of Immunohistochemical Findings with Flow Cytometric Findings in Newly Diagnosed Pediatric Acute Lymphoblastic Leukemia Patients

Background and objectives: The development of new therapeutic options to treat leukemia (therapies targeting chimeric antigen receptor [CAR] T cells) down-regulates markers expressed on the cell surface. Therefore, conventional immunophenotyping panels no longer make these antigens unreliable for identifying a B cell immunophenotype. In our study, we methodically compared multiparametric flow cytometry (FC) in bone marrow aspiration and immunohistochemical (IHC) analysis in bone marrow biopsy in childhood acute lymphoblastic leukemia (ALL). We sought to answer whether these two methods could be alternatives to each other in the diagnosis of leukemia. Material-Method: Twenty-eight patients diagnosed with ALL were included in the study. A Kappa test was performed between the expression rates of the antibodies studied in simultaneous FC and IHC studies in bone marrow aspiration and biopsy samples performed at the initial diagnosis. Results: Twenty-three of the patients were precursor B-ALL (BCP-ALL) and 5 were T-ALL. In the immunophenotyping of patients with BCP-ALL using FC and IHC, MPO, CD79A, CD14, CD3 expressions were the same, while CD19, CD7, CD117, CD33, CD 56, CD34 expressions were very good, good concordance for CD20 expressions and moderate for CD10 expressions. In immunophenotyping of patients diagnosed with T-ALL using FC and IHC, CD20, CD19, CD14, CD79a, MPO, CD22 expressions were the same and excellent agreement was found in terms of CD2, CD10, CD34 expressions. Conclusion: In cases where there are treatments that affect immunophenotyping, costly methods such as FC are not available, or bone marrow aspiration cannot be taken adequately, immunophenotyping with IHC can be safely performed in the diagnosis of pediatric ALL in bone marrow biopsy.

Keywords:

Acute Lymphoblastic Leukemia, immunohistochemical, flow cytometry, immunophenotyping,

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