A distinctive nuclear morphology in acute myeloid leukemia is strongly associated with loss of HLA-DR expression and FLT3 internal tandem duplication

SJ Kussick, DL Stirewalt, HS Yi, KM Sheets… - Leukemia, 2004 - nature.com
SJ Kussick, DL Stirewalt, HS Yi, KM Sheets, E Pogosova-Agadjanyan, S Braswell…
Leukemia, 2004nature.com
In a 5-year survey of nonpromyelocytic/nonmonocytic acute myeloid leukemias (AMLs)
diagnosed in the University of Washington Hematopathology Laboratory, we identified 19
cases containing distinctive, cup-like nuclear indentation in 10% or more of the blasts ('AML-
cuplike'). Fourteen of these cases (74%) demonstrated near-complete loss of HLA-DR
expression, while the other five cases showed partial loss of HLA-DR. A total of 16 of the
cases (84%) demonstrated internal tandem duplication (ITD) of the Flt3 gene. When …
Abstract
In a 5-year survey of nonpromyelocytic/nonmonocytic acute myeloid leukemias (AMLs) diagnosed in the University of Washington Hematopathology Laboratory, we identified 19 cases containing distinctive, cup-like nuclear indentation in 10% or more of the blasts (‘AML-cuplike’). Fourteen of these cases (74%) demonstrated near-complete loss of HLA-DR expression, while the other five cases showed partial loss of HLA-DR. A total of 16 of the cases (84%) demonstrated internal tandem duplication (ITD) of the Flt3 gene. When compared to a selected set of AMLs lacking this nuclear morphology, AML-cuplike was significantly more likely to lack HLA-DR and CD34 expression, to express CD123 without CD133, to have a normal karyotype, and to harbor the Flt3 ITD. To characterize AML-cuplike in an unselected series of AMLs, we analyzed 42 consecutive nonpromyelocytic/nonmonocytic AMLs diagnosed in our laboratory during a 6-month period in 2002. Strikingly, in this unselected series, there was a statistically significant coincidence of invaginated nuclear morphology, loss of HLA-DR, and presence of the Flt3 ITD beyond that expected if these three features were unrelated, suggesting that AMLs with these three features may represent a distinct AML subset.
nature.com