MORPHOLOGICAL, CYTOCHEMICAL AND IMMUNOPHENOTYPING PATTERN OF ACUTE MYELOID LEUKEMIA: A STUDY OF 95 CASES

Dr. Shruti Chauhan*, Dr. Mili Jain, Dr. Rashmi Kushwaha, Dr. Ashutosh Kumar and Dr. U.S. Singh

ABSTRACT

Aim: AML is a heterogenous disease characterized by arrest of normal hematopoetic maturation by dysregulated clonal expansion of karyotypically distinct neoplastic cells. The aim was to characterise clinical, morphological and cytochemical features of AML and corelate with the diagnosis provided by immunophenotyping method. Methods: A total of 95 patients of AML for a duration of one year(2014-2015) were included and immunophenotyping was done. Results: Majority cases (65.3%) were of pediatric age, with mean age of 27.2 years and male:female ratio of 1.3:1. Bleeding was raised in APML. Aleukemic cases were 1/4th(23.16%). AMLM6 was present in greater percentage as compared to literature. Mean Hb was 6.03g/dl) and Mean TLC was 37.87 X 109/L. CD33 was most common in AML(93.98%) followed by CD13, CD117, MPO, CD34 and HLADR. APML showed strong MPO, CD13 and CD33 positivity while CD34 and HLADR negativity. CD14, CD11b and CD64 positivity was seen in AMLM4. Auer rods were significant in identifying AMLM1, M2 and M3 subtypes with concordance of 54.74%. 100% concordance was seen between morphological and Immunophenotypic diagnoses while 76.19% between cytochemical and Immunophenotypic diagnoses. 33.68% showed aberrant markers, most common being CD19(31.43%) followed by CD7(18.18%) and CD2(9.09%) and were associated with worse hematological features. As per cytogenetic data, t(15;17) was most common in APML and t(8;21) in AMLM2. Conclusions: Aleukemic cases were significant(23%), hence, scrupulous PBS examination is recommended. We cannot trivialise the contribution of cytochemical studies where flowcytometry cannot be done. Immunophenotyping has become indispensable and is a boon to the diagnosis of AML.

Keywords: Acute Myeloid Leukemia, Immunophenotyping, Myeloperoxidase, Aberrant.