Eren GUNDUZ, Hava USKUDAR TEKE, Neslihan ANDİC

Akut Miyeloid Lösemili Hastaların Tanı ve Relaps Dönemindeki Akım Sitometri Sonuçlarının Karşılaştırılması

Akut miyeloid lösemi (AML)li çoğu hastada lösemik hücreler kemoterapi sonrası kaybolur. Ancak minimal kalıntı hastalık (MKH) nedeniyle lösemi nüksü gözlenebilir. MKH’nin akım sitometrik olarak takibi prognostik açıdan bilgi sağlar. Fakat relaps anında immünfenotipik kaymalar olabilir ve akım sitometri ile MKH değerlendirilmesini kısıtlayabilir. Bu çalışmada AML hastalarındaki antijen değişikliklerinin saptanması amaçlanmıştır. Çalışmada Eylül 2002 ve Kasım 2016 arasında AML tanısı alan 19-77 yaş arası geriye dönük olarak değerlendirildi. Kemik iliği örnekleri tanı ve relaps anında elde edildi. Hastaların 34’ü de novo, 6’sı sekonder AML idi. Kemik iliği örnekleri K3EDTA içeren tüplere alındı. Phycoerhtyrine (PE) ve fluorescein isothiocyanate (FITC) (eBioscience and BD Bioscience, San Jose, California) yüzey antijenleri laboratuvarımızda kullanılan rutin panele göre kullanıldı. Analizler CD45 kapılama stratejisine göre Becton Dickinson FACSCalibur cihazı ile yapıldı. Kırk hastanın 34’ünde (%85) en az 1 antijende değişiklik (antijen kazanımı ve/veya kaybı) mevcuttu (n=10). Antijen değişiklikleri 2 (n=7), 3 (n=6), 4 (n=6), 5 (n=4) ya da 6 (n=1) antijende gözlendi. Antijen değişiklikleri 18 antijenin 16’sında (%88.9) saptandı. Hiçbir hastada değişiklik gözlenmeyen antijenler sadece CD20 ve CD45’ti. AML’li hastalarda relaps sırasında immünfenotipik kayma sıklığı yüksektir. MKH değerlendirilirken relapsta gelişen antigen değişiklikleri göz önünde bulundurulmalıdır.

Anahtar Kelimeler:

Acute myeloid leukemia, flow cytometry, relapse

Comparıson of Flow Cytometry Results of Acute Myeloid Leukemia Patients at Diagnosis and Relapse

In most patients with acute myeloid leukemia (AML), leukemic cells become undetectable after chemotherapy. Nevertheless, leukemia may subsequently relapse due to minimal residual disease (MRD). Flow cytometric monitoring of MRD is prognostically informative. However immunophenotypic shifts at relapse is possible and may limit flow cytometric MRD-testing. Our objective was to evaluate the antigen changes in our AML patients. Patients diagnosed between September 2002 and November 2016 were analyzed retrospectively. Bone marrow samples were collected at diagnosis and relapse from 40 patients with de novo (n=34) or secondary (n=6) AML, aged 19 to 77 years. Bone marrow samples were collected into tubes containing K3EDTA. Phycoerhtyrine (PE) and fluorescein isothiocyanate (FITC) (eBioscience and BD Bioscience, San Jose, California) surface antigens were used according to the routine panel used in our laboratory. Analyses were done according to CD45 SSC gating strategy by Becton Dickinson FACSCalibur device. Overall, 34 of 40 (85%) cases showed changes (gain and/or loss of antigen) of at least one marker (n=10). Antigen changes were observed in 2 (n=7), 3 (n=6), 4 (n=6), 5 (n=4) or 6 (n=1) antigens in other patients. Antigen changes were found in 16 of 18 antigens (88.9%) totally. CD20 and CD45 were the only antigens with no change. Patients with AML demonstrate a high frequency of immunophenotypic shift at relapse. Antigen changes at relapse should be kept in mind in the minimal residual disease era.

Keywords:

acute myeloid leukemia; flow cytometry; relapse; minimal residual disease,

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