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  • Title: Diagnostic immunophenotype of acute promyelocytic leukemia before and early during therapy with all-trans retinoic acid.
    Author: Horna P, Zhang L, Sotomayor EM, Lancet JE, Moscinski LC.
    Journal: Am J Clin Pathol; 2014 Oct; 142(4):546-52. PubMed ID: 25239423.
    Abstract:
    OBJECTIVES: To study the immunophenotypic changes of acute promyelocytic leukemia (APL) in patients who recently received all-trans retinoic acid (ATRA) and to assess the diagnostic utility of flow cytometry in this setting. METHODS: Flow cytometry was performed on 29 newly diagnosed APLs and 93 other acute myeloid leukemias, including 25 HLA-DR- or CD34- cases. Clinical notes from referring institutions were reviewed to assess for recent ATRA administration. RESULTS: Recent ATRA therapy was documented in 17 (59%) of 29 patients with APL. The main features of untreated APL were preserved with ATRA therapy, including CD34- (83% vs 82%), HLA-DR- (83% vs 100%), and CD117+ (100% vs 77%). CD11b and CD11c were negative in all untreated APLs but positive in 76% and 88% of ATRA-treated APLs, respectively. Optimal diagnostic criteria for untreated APL (CD34- or HLA-DR- and CD11b- and CD11c-) showed 100% sensitivity and 98% specificity but were not useful after ATRA administration. The best interpretative approach to ATRA-treated APL (CD34- or HLA-DR-) showed 100% sensitivity but limited specificity (73%). CONCLUSIONS: Information about recent ATRA administration is critical for adequate interpretation of the flow cytometric findings in patients with suspected APL.
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