• Zaratulain Bashir National Institute of Blood Disease & Bone Marrow Transplantation, Karachi.
  • Jawad Hassan
  • Samra Waheed
  • Mahjabeen Imam
  • Naveena Fatima
  • Sidra Zafar
  • Saima Siddiqui
  • Tahir Shamsi



acute lymphoblastic leukemia, , cytogenetics, CD34 expression, BCR-ABL1 p190, hyperdiploidy


Background: This study was carried out to determine the frequency of CD34 positivity in acute lymphoblastic leukaemia (B-ALL) in our population and to report its association with the clinicopathological profilet the time of diagnosis. Methods: The cross-sectional study was conducted at National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan, from March 2020 till December 2020.Newly diagnosed patients were selected, from both genders and all age groups. Relevant history and findings of physical examination were recorded. Immunohistochemistry was done on trephine biopsy and molecular studies were carried on bone marrow aspirates or peripheral blood samples. Results: Out of 105 patients enrolled, 67(63.8%) were males, with a male to female ratio (M: F) 1.8:1. Of the total patients, 62 (59.04%) were above 15 years of age. CD34 was expressed in 73 (69.5%) cases. Lymphadenopathy, splenomegaly, and hepatomegaly were separately noted in context to CD 34 expression in 22 (66.6%), 24 (64.8%), and 14 (58.3%) patients, respectively. CNS disease was seen in a total of 3(2.75%) subjects, in which 2 (66.6%) of the patients had CD34 expression. Total 81 patients in our study fall into the high-risk group out of which CD 34 expression was seen in 58(71.6%) subjects. Cytogenetic analysis, BCR-ABL p190, and MLL gene rearrangement were investigated in all participants. Cytogenetic analysis revealed an abnormality in 20 (19%) cases out of which 13 (17.8%) cases were from CD34 positive group. Conclusion: Our study reported CD34 expression in more than two-thirds of cases. High-risk disease was significantly associated with CD34 expression.


Terwilliger T, Abdul-Hay MJ. Acute lymphoblastic leukemia: a comprehensive review and 2017 update. Blood Cancer J 2017;7(6):e577

Pastorczak A, Domka K, Fidyt K, Poprzeczko M, Firczuk M. Mechanisms of Immune Evasion in Acute Lymphoblastic Leukemia. Cancers (Basel) 2021;13(7):1536.

Snodgrass R, Nguyen LT, Guo M, Vaska M, Naugler C, Rashid-Kolvear F. Incidence of acute lymphocytic leukemia in Calgary, Alberta, Canada: a retrospective cohort study. BMC Res Notes 2018;11(1):104.

Hamed EO, El-Deen AF. Flow Cytometric Diagnosis of Acute Leukemia and Aberrant Antigen: Sohag University Experience. Open J Blood Dis 2018;8(2):37–48.

Sharma RK, Purohit A, Somasundaram V, Mishra PC, Kotru M, Ranjan R, et al. Aberrant myeloid antigen co-expression is correlated with high percentages of CD34-positive cells among blasts of acute lymphoblastic leukemia patients: an Indian tertiary care center perspective. Blood Res 2014;49(4):241.

Garg N, Gupta R, Kotru M. CD34 is not Expressed by Blasts in a Third of B-ALL Patients and its Negativity is associated with Aberrant Marker Expression: A Retrospective Analysis. Asian Pac J Cancer Prev 2021;22(3):919–25.

DeAngelo DJ, Jabbour E, Advani A. Recent advances in managing acute lymphoblastic leukemia. Am Soc Clin Oncol Educ Book 2020;40:330–42.

Gupta N, Pawar R, Banerjee S, Brahma S, Rath A, Shewale S, et al. Spectrum and immunophenotypic profile of acute leukemia: a tertiary center flow cytometry experience. Mediterr J Hematol Infect Dis 2019;11(1)e2019017.

Riley RS, Gandhi P, Harley SE, Garcia P, Dalton JB, Chesney A. A synoptic reporting system to monitor bone marrow aspirate and biopsy quality. J Pathol Inform 2021;12(1):23.

Shilina MA, Grinchuk TM, Anatskaya OV, Vinogradov AE, Alekseenko LL, Elmuratov AU, et al. Cytogenetic and transcriptomic analysis of human endometrial MSC retaining proliferative activity after sublethal heat shock. Cells 2018;7(11):184.

Huang FL, Liao EC, Li CL, Yen CY, Yu SJ. Pathogenesis of pediatric B cell acute lymphoblastic leukemia: Molecular pathways and disease treatments. Oncol Lett 2020;20(1):448–54.

Basso G, Lanza F, Orfao A, Moretti S, Castoldi G. Clinical and biological significance of CD34 expression in acute leukemia. J Biol Regul Homeost Agents 2001;15(1):68–78.

Birva R, Hemangini V, Pina T, Biren P. Flowcytometric analysis of leukemic blasts-as primary screening test

for BCR/ABL1 gene rearrangement in B-ALL. Eurasian J Med Oncol 2019;3:191–8.

Wimalachandra M, Prabashika M, Dissanayake M, de Silva R, Gooneratne L. Immunophenotypic characterization of acute lymphoblastic leukemia in a flowcytometry reference centre in Sri Lanka. Ceylon Med J 2020;65(1-2):23–7.

Jaafar FH, Kadhom AE. Expression of CD45, CD34, CD10, and human leukocyte antigen-DR in acute lymphoblastic leukemia. Iraqi J Hematol 2018;7(1):14.

Supriyadi E, Veerman AJ, Sutaryo S, van de Ven PM, Cloos J. Detection of CD10, CD34 and their combined expression on childhood acute lymphoblastic leukemia and the association with clinical outcome in Indonesia. J Cancer Ther Res 2012;1:1.

Cascavilla N, Musto P, D'Arena GI, Ladogana S, Matera R, Carotenuto M. Adult and childhood acute lymphoblastic leukemia: clinico-biological differences based on CD34 antigen expression. Haematologica 1997;82(1):31–7.

Blatt K, Menzl I, Eisenwort G, Cerny-Reiterer S, Herrmann H, Herndlhofer S, et al. Phenotyping and target expression profiling of CD34+/CD38− and CD34+/CD38+ stem-and progenitor cells in acute lymphoblastic leukemia. Neoplasia 2018;20(6):632–42.

Al-Bayaa IM, Al-Nidawy ZN, Al-Amiri YA, Hajem IM. Immunophenotyic profile of adult acute lymphoblastic leukaemia in Iraq, a one year experience. Iraqi J Cancer Med Genet 2018;8(2-20):164.