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Myeloblastic and Lymphoblastic Markers in Acute Undifferentiated Leukemia and Chronic Myelogenous Leukemia in Blast Crisis¹

Department of Medicine, Toronto General [K. H. S.] and Toronto Western [M. A. B.] Hospitals, University of Toronto, Toronto, Ontario M5G 1L7, Canada; Department of Medicine, Medical College of Virginia, Richmond, Virginia 23298 [R. N. T.]; and the Department of Biochemistry, University of Kentucky, Lexington, Kentucky 40508 [M. S. C.]

Blast cells were obtained from 17 patients with acute undifferentiated leukemia and 13 patients with chronic myelogenous leukemia in blast crisis. The blasts were tested with anti-i serum in cytotoxicity tests and with antisera to myeloblastic leukemia-associated antigens in immunofluorescence tests. The terminal deoxynucleotidyl transferase (TDT) content of the blasts was also measured. Lymphoblasts react strongly with anti-i, do not react with anti-myeloblast serum, and have high levels of TDT; myeloblasts react weakly with anti-i, do react with anti-myeloblast serum, and have very low levels of TDT. Of the 17 patients with acute undifferentiated leukemia, there were six with blasts which reacted like lymphoblasts, six with blasts which reacted like myeloblasts, and five with blasts bearing different combinations of these lymphoblastic and myeloblastic markers. Eight of the 11 patients with lymphoblastic or mixed lymphoblastic-myeloblastic markers, but only one of the six with myeloblastic markers, achieved complete or partial remission in response to therapy. Thus, in acute undifferentiated leukemia, classification of blasts with these markers may be of prognostic value.

Of the 13 patients with chronic myelogenous leukemia in blast crisis, the markers were concordant (for myeloblasts) in only two cases. Three of the 13 patients had TDT-positive blasts, but the reactions of these cells with anti-i and with anti-myeloblast serum differed from those seen with lymphoblasts from patients with acute lymphoblastic leukemia. Although the cell involved in "lymphoid" blast crisis of chronic myelogenous leukemia is similar in many respects to that involved in acute lymphoblastic leukemia, these cells are not identical.

¹ Supported by Grant MA-5069 from the Medical Research Council of Canada; Grant 285 from the Ontario Cancer Treatment and Research Foundation, the National Cancer Institute of Canada; Grant CA 19492 from the NIH, and Grant CM 67038 from the National Cancer Institute.

² To whom requests for reprints should be addressed, at Division of Hematology, Toronto General Hospital, 101 College St., Toronto, Ontario, Canada M5G 1L7.

³ Recipient of Research Cancer Award K04 CA 00494.

⁴ The following are contributing members of the Toronto Leukemia Study Group: Doctors Hospital, Dr. Harvey Silver; Mississauga Hospital, Dr. Michael King; Mount Sinai Hospital, Dr. Dominic Amato; Oshawa General Hospital, Dr. Hak Chiu; St. Michael's Hospital, Dr. Bernadette Garvey; St. Joseph's Hospital, Dr. Murray Davidson, Dr. H. James Watt; Toronto General Hospital, Dr. John Crookston, Dr. William Francombe, Dr. Gerald Scott, Dr. Kenneth Shumak; Toronto Western Hospital, Dr. Michael Baker, Dr. David Sutton, Dr. James G. Watt; York Finch Hospital, Dr. Sam Berger.

Received 3/19/80. Accepted 8/12/80.