Re: Help!

From: Ierachmiel Daskal (DASKALI@einstein.edu)
Date: Mon Aug 20 2001 - 16:27:01 EST


Your question is not totally clear.With 54% blasts in the bone marrow , there is
persistence/recurrence of disease in the marrow. The above notwithstanding, in many
cases leukemic cells will have a dimmer CD45  expression which can help distinguish
the two populations. Not infrequently, CD45 in ALL will be negative of quite dim as you
experienced the first time. Please remember that you must be able also to differentiate
also hematogones which would be somewhat dimmer than your blasts. In addition, from
my experience ALL cells which are CD10 (+) are brighter  than any other CD10(+) cells.


>>> "Saldivar, Victor" <victor_saldivar@srhc.iwhs.org> 08/17/01 02:10PM >>>

Dear Anna: I would appreciate your help. I've got this morning another of
those very rare cases of pedi ALL with only 17% (dim) positive CD45 (BD Ab).
I  would like to know if you could share your views about the above with me
and the FLOW audience at large, for further discussion. We have seen this in
our lab, but rarely. Everytime something unusual comes, I jump and get
nervous.
I know it's not technical error in this case.
Patient is 14 years, diagnosed with L1ALL in Sept'99, 76 % blasts; could'nt
do FLOW, but cytospins showed Tdt+, CD10+, CD19 equivocal. The MPO, double
esterase and Sudan Black were negative. BM chromies showed
47,XY,+X,add(21)(q22). The CFS has shown blasts on/off. He's received
chemotherapy.
Yesterday he returned for chek-up and shows pancytopenia without blasts, but
the BM sohws 54% blasts. We could do BM FLOW that discloses CD45 17%
(only!!), HLADR 91%,CD10 87%, CD19 82% and CD34 77%. The CD5 and Glycophorin
are 5 and 16%.
So, I'm looking for supportive evidence/experience  that there are some
CD45-ALLs, and if so, ?how many/how often.
Thank you Anja and to those that may respond.
Victor A. Saldivar-- San Antonio, TX



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