BACKGROUND: The accurate and early diagnosis of acute myeloid leukemia (AML) is important to choose proper treatment option depending on the risk stratification. The delta neutrophil index (DNI) is a relatively new blood marker that indicates the proportion of immature granulocytes in peripheral blood circulation. This study aimed to evaluate the diagnostic value of the DNI for detecting AML in the early phase of acute leukemia. METHODS: We retrospectively analyzed laboratory tests and bone marrow study results of 163 pediatric patients with acute leukemia admitted to the emergency department, who were diagnosed with acute leukemia. An automatic analyzer (ADVIA 2120 Hematology System; Siemens Healthcare Diagnostics, Forchheim, Germany) was used to measure the DNI in the peripheral blood of each patient. RESULTS: The mean DNI was significantly different between the AML (N=39) and non-AML (N=124) groups (P < 0.05), and the DNI was the only significant marker for predicting AML in patients with acute leukemia (odds ratio, 1.328; P < 0.05). The DNI more than 4.4% has the highest predictability for distinguishing the patients with AML from the patients with acute leukemia. The mean DNI of the acute promyelocytic leukemia (APL, N=8) group was statistically higher than that of the non-APL group (N=31, P=0.019), but the DNI was not significant in the univariate logistic regression analysis. CONCLUSION: The DNI might be a promising peripheral blood marker for predicting AML in the early work-up of patients with acute leukemia.
Blood Circulation ; Bone Marrow ; Child ; Delivery of Health Care ; Early Diagnosis ; Emergency Service, Hospital ; Granulocytes ; Hematology ; Humans ; Leukemia* ; Leukemia, Myeloid, Acute ; Leukemia, Promyelocytic, Acute ; Logistic Models ; Neutrophils* ; Retrospective Studies

No abstract available.
Adult ; Aged ; Aged, 80 and over ; Area Under Curve ; Automation ; Blood Cell Count/instrumentation/*methods ; Female ; Humans ; Leukemia, Myeloid, Acute/*diagnosis ; Leukemia, Promyelocytic, Acute/*diagnosis ; Male ; Middle Aged ; Prospective Studies ; ROC Curve ; Young Adult

Cutaneous paraneoplastic syndromes comprise a broad spectrum of cutaneous reactions to an underlying malignancy. These dermatoses are not the result of metastatic spread to the skin, but rather a reaction to the presence of malignancy. Cutaneous paraneoplastic syndromes often precede the identification of a malignancy. We describe the case of a 79-year-old man with a six-month history of recalcitrant treatment- resistant dermatitis. A complete blood count test performed at the time of initial presentation was normal. The patient ultimately presented with erythroderma and was diagnosed with acute myeloid leukemia (AML). The evolution of the dermatitis to erythroderma coincided with the clinical presentation of AML, and was therefore considered to be a paraneoplastic syndrome. The patient decided against therapy and died seven weeks after diagnosis. Physicians should consider a cutaneous paraneoplastic syndrome when faced with dynamic recalcitrant dermatoses that are difficult to treat and decide on laboratory testing accordingly. Patients should be evaluated regularly for two to three years after initial diagnosis with a physical exam and review of systems to monitor for signs and symptoms of malignancy.
Aged ; Blood Cell Count ; Dermatitis ; Dermatitis, Exfoliative ; Diagnosis ; Humans ; Hypersensitivity* ; Leukemia ; Leukemia, Myeloid, Acute* ; Paraneoplastic Syndromes ; Skin ; Skin Diseases

The cytokines of acute leukemia (AL) patients have certain expression patterns, forming a complex network involved in diagnosis, progression, and prognosis. We collected the serum of different AL patients before and after complete remission (CR) for detection of cytokines by using an antibody chip. The expression patterns of cytokines were determined by using bioinformatics computational analysis. The results showed that there were significant differences in the cytokine expression patterns between AL patients and normal controls, as well as between acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). In confirmatory test, ELISA revealed the expression of uPAR in AL. Moreover, the bioinformatic analysis showed that the differentially expressed cytokines among the AL groups were involved in different biological behaviors and were closely related with the development of the disease. It was concluded that the cytokine expression pattern of AL patients is significantly different from that of healthy volunteers. Also, differences of cytokine expression patterns exist between AML and ALL, and between before and after CR in the same subtype of AL, which holds important clinical significance for revealing disease progression.
Cytokines ; biosynthesis ; blood ; Diagnosis, Differential ; Gene Expression Regulation, Leukemic ; Humans ; Leukemia, Myeloid, Acute ; blood ; Microarray Analysis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; blood ; Prognosis ; RNA, Messenger ; biosynthesis ; blood

The purpose of this study was to detect the minimal residual disease (MRD) in peripheral blood of newly diagnosed patients with acute myeloid leukemia (AML) on day 8 of induction chemotherapy and analyze the correlation between day 8 MRD (D8RD) and therapeutic effectiveness. 29 adult patients (13 males and 16 females, aged 16 - 75 years, median 41 years) with AML diagnosed and treated in West China Hospital from September 2009 to June 2010 were analyzed and followed up in the study. The leukemia-associated aberrant immunophenotype (LAIP) of all the patients were detected by multiparameter flow cytometry (FCM) before therapy. The level of MRD in the peripheral blood at day 8 of induction chemotherapy was detected by FCM based on the LAIP. The overall survival curve was drawn by calculation using Kaplan-Meier method using, and the comparison between different groups was carried out by Log-rank test. The results indicated that after first course therapy, the levels of peripheral D8RD in 7 out of 29 AML cases were lower than 0.01% (negative group), and that in another 22 cases were higher than 0.01% (0.08% - 55%, positive group). The sex, age, WBC, LDH, percentage of bone marrow blasts at diagnosis in these groups were not statistically different. 6 cases achieved CR (86%) in D8RD negative group, and also 6 cases achieved CR (27%) in D8RD positive group, CR rate in D8RD negative group was higher than in D8RD positive group (86% vs 27%, P < 0.05). The median follow-up of 29 cases lasted for 15 months; the 1-year overall survival rate of D8RD negative and D8RD positive groups was 100% and 39.4%, respectively (P < 0.01). It is concluded that MRD level in peripheral blood at day 8 of induction chemotherapy is an early index to predict clinical efficacy of induction therapy in AML.
Adolescent ; Adult ; Aged ; Early Diagnosis ; Female ; Flow Cytometry ; Humans ; Leukemia, Myeloid, Acute ; blood ; drug therapy ; mortality ; Male ; Middle Aged ; Neoplasm, Residual ; diagnosis ; drug therapy ; mortality ; Prognosis ; Survival Rate ; Treatment Outcome ; Young Adult

Post-transplantation lymphoproliferative disorders (PTLDs) are a heterogeneous group of diseases that represent serious complications following immunosuppressive therapy for solid organ or hematopoietic-cell recipients. In contrast to B-cell PTLD, T-cell PTLD is less frequent and is not usually associated with Epstein Barr Virus infection. Moreover, to our knowledge, isolated T-cell PTLD involving the breast is extremely rare and this condition has never been reported previously in the literature. Herein, we report a rare case of isolated T-cell PTLD of the breast that occurred after a patient had been treated for allogeneic peripheral blood stem cell transplantation due to acute myeloblastic leukemia.
Allografts ; Axilla ; Breast Neoplasms/diagnosis/*etiology/immunology ; Diagnosis, Differential ; Fatal Outcome ; Female ; Humans ; Leukemia, Myeloid, Acute/surgery ; Lymph Nodes/pathology ; Lymphoma, T-Cell, Peripheral/*etiology/pathology/ultrasonography ; Peripheral Blood Stem Cell Transplantation/*adverse effects ; T-Lymphocytes/immunology/pathology ; Transplantation, Homologous ; Ultrasonography, Mammary/*methods ; Young Adult

An 87-yr-old woman was diagnosed with AML with myelodysplasia-related changes (AML-MRC). The initial complete blood count showed Hb level of 5.9 g/dL, platelet counts of 27x10(9)/L, and white blood cell counts of 85.33x10(9)/L with 55% blasts. Peripheral blood samples were used in all the tests, as bone marrow examination could not be performed because of the patient's extremely advanced age and poor general health condition. Flow cytometric analysis, chromosome analysis, FISH, and reverse transcriptase-PCR (RT-PCR) results indicated AML-MRC resulting from t(3;21) with the RUNX1-MECOM fusion gene. To our knowledge, this is the second most elderly de novo AML patient associated with t(3;21) to be reported.
Aged, 80 and over ; Blood Cells/pathology ; Chromosomes, Human, Pair 21 ; Chromosomes, Human, Pair 3 ; Female ; Humans ; Karyotyping ; Leukemia, Myeloid, Acute/complications/*diagnosis/genetics ; Multiplex Polymerase Chain Reaction ; Myelodysplastic Syndromes/complications/*diagnosis/genetics ; Oncogene Proteins, Fusion/*genetics ; Sequence Analysis, DNA ; *Translocation, Genetic

The translocation t(10;11)(p13;q14q21) has been found to be recurrent in acute lymphoblastic and myeloid leukemias, and results in the fusion of the clathrin assembly lymphoid myeloid leukemia (CALM) gene with the AF10 gene; these genes are present on chromosomes 11 and 10, respectively. Because the CALM-AF10 rearrangement is a rare chromosomal abnormality, it is not included in routine molecular tests for acute leukemia. Here, we describe the cases of 2 patients with the CALM-AF10 fusion gene. The first patient (case 1) was diagnosed with T-cell ALL, and the second patient (case 2) was diagnosed with AML. Both patient samples showed expression of the homeobox A gene cluster and the histone methyltransferase hDOT1L, which suggests that they mediate leukemic transformation in CALM-AF10-positive and mixed-lineage leukemia-AF10-positive leukemias. Both patients achieved complete remission after induction chemotherapy. The first patient (case 1) relapsed after double-unit cord blood transplantation; there was no evidence of relapse in the second patient (case 2) after allogenic peripheral blood stem cell transplantation. Since CALM-AF10- positive leukemias have been shown to have poor prognosis with conventional therapy, molecular tests for CALM-AF10 rearrangement would be necessary to detect minimal residual disease during follow-up.
Adolescent ; Adult ; Bone Marrow/pathology ; Chromosomes, Human, Pair 10 ; Chromosomes, Human, Pair 11 ; Cord Blood Stem Cell Transplantation ; Female ; Histone-Lysine N-Methyltransferase/genetics/metabolism ; Homeodomain Proteins/genetics/metabolism ; Humans ; Leukemia, Myeloid, Acute/diagnosis/*genetics/therapy ; Male ; Monomeric Clathrin Assembly Proteins/*genetics ; Oncogene Proteins, Fusion/*genetics ; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/diagnosis/*genetics/therapy ; Recurrence ; Transcription Factors/*genetics ; Translocation, Genetic

BACKGROUND: Automated blood cell analyzers often read leukemic blasts as normal cells. In this study, we evaluated the 5-part differential patterns of blasts using automated analyzers to determine if they can differentiate among blast types. METHODS: Blood samples containing 10% or more blasts were collected from patients with acute leukemia (N=175). The 5-part differential count was conducted using DxH 800 (Beckman Coulter, USA) and XE-2100 analyzers (Sysmex Co., Japan), and the results were compared with manual differential counts, which was used as a reference method. RESULTS: The DxH 800 reported the 5-part white blood cell differential count in 98.9% of the cases. The XE-2100 provided an invalid automated differential count in 72% of the cases. Both analyzers counted most lymphoblasts as lymphocytes and most myeloblasts as monocytes. In 11 cases, the DxH 800 reported a 5-part differential count without a blast flag. CONCLUSIONS: Some automated analyzers are able to recognize and count blasts according to their characteristic cell types. Therefore, complete blood counts obtained automatically can provide valuable data for making provisional decisions regarding the lineage of leukemia cells before further investigation.
Acute Disease ; Automation ; Blood Cell Count/*instrumentation/methods ; Humans ; Leukemia/blood/*diagnosis ; Leukemia, Monocytic, Acute/blood/diagnosis ; Leukemia, Myeloid, Acute/blood/diagnosis ; Leukemia, Promyelocytic, Acute/blood/diagnosis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/blood/diagnosis

This study was purposed to preliminarily screen characteristic tumor markers of acute myeloid leukemia (AML) and to investigate the serum proteomics characteristics of patients with AML and their significance in pathogenesis. 14 patients with AML and 28 healthy controls were enrolled in this study. The serum protein components were captured by weak cation exchange nanometer magnetic beads, the protein mass-spectra of all samples were detected by Autoflex II matrix-assisted laser desorption/ionization time of flight mass spectrometer, and the detection data were analyzed by means of CliprotoolsTM2.2 software, then the differential protein molecules were screened and the diagnostic model was established. Sera of 7 AML patients and 14 healthy controls were selected to verify the established model by using blind test. The results indicated that about 69 protein peaks could be detected within the range of 0.7-10 kD in protein spectra of serum samples from AML patients and controls. Compared with healthy controls, there were 44 statistically differential expression peaks in AML group (p<0.0001). Among them, 10 protein peaks were upregulated protein peaks and 34 protein peaks were downregulated. Diagnostic model was established on the basis of Quick Classifier Algorithm (QC), and the three mass peaks had the strongest power for software to automatically distinguish AML group from control group. Mass charge ratios (m/z) were 3216.57, 4089.7, and 7762.87 respectively. Sensitivity was expected as 86.4% while 82.8% in this established model group. Category validation showed that this diagnostic model correctly identified all 6 cases out of AML and 12 cases out of 14 healthy controls. In cross validation, the model sensitivity and specificity both were 85.7%. It is concluded that the AML QC model is composed of three protein peaks, which can effectively distinguish AML patients from healthy controls. Owing to higher sensitivity and specificity, they may act as serum tumor markers of AML. Among the three proteins, the one with m/z 7762.87 is the platelet-derived protein chemokine (PF4) protein. This finding will probably provide significant experimental evidence for understanding pathogenesis, molecular type, prognosis and treatment effect of AML.
Adult ; Aged ; Biomarkers ; Biomarkers, Tumor ; blood ; Case-Control Studies ; Female ; Humans ; Leukemia, Myeloid, Acute ; blood ; diagnosis ; Male ; Middle Aged ; Prognosis ; Protein Array Analysis ; methods ; Proteomics ; Sensitivity and Specificity ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; methods ; Young Adult