Abnormal immunophenotype provides a key diagnostic marker: a report of 29 cases of de novo aggressive natural killer cell leukemia

Aggressive natural killer (NK) cell leukemia (ANKL) is a systemic neoplastic proliferation of NK cells with an aggressive clinical course. Currently, the diagnosis of ANKL remains challenging. In the current study, we report the clinical, laboratory, immunophenotypic, and genetic findings from 29 cases of de novo ANKL in a single center and evaluate the relative contribution of these features to the diagnosis of ANKL. Clinical features, laboratory findings, morphologic, cytogenetic features, and Epstein-Barr virus status were important factors for diagnosing aggressive NK cell leukemia. On the other hand, ANKL displays a strikingly abnormal immunophenotype in contrast to nonneoplastic NK cells. The immunophenotype of ANKL cells may differ from reactive NK cells in 4 respects. First, the CD45/linear side scatter gating of flow cytometry allows the initial identification of neoplastic subpopulations for additional immunophenotypic analysis in half of ANKL cases. Second, unusual expression of surface antigens in ANKL cells was a prominent feature. Third, the clonality of ANKL cells could be identified using antibodies against CD158a/h, CD158b, or CD158e. Last, the positive rate of Ki-67 expression in ANKL cells was generally high. Based on these findings, we provide an objective marker based on clinical data for the definite diagnosis of ANKL.