Evaluation of CD96 and CD123 in CD34+ leukemic stem cells in acute myeloid leukemia patients and their relation to response to induction therapy


BACKGROUND: Leukemic stem cells (LSCs) are thought to originate either from normal hematopoietic stem cellsor from more differentiated progenitor cells. LSCs are capable of self‑renewal, proliferation, and differentiationinto malignant blasts.OBJECTIVE: To evaluate the expression of the LSC markers CD96 and CD123 in de novo acute myeloidleukemia (AML) patients, and to explore the relationship between those markers and response to inductiontherapy and prognostic factors in AML.MATERIALS AND METHODS: A cross‑sectional study was conducted on 30 adults with newly diagnosed AMLpatients were prospectively tested for the expression of CD96 and CD123 using four‑color flow cytometer at thetime of diagnosis and re‑evaluated at day 28 from the start of chemotherapy for the response to 3 + 7 inductiontherapy regimen.RESULTS: Eight cases (26.7%) expressed CD96, and 12 cases (40%) expressed CD123; all the CD96 positivecases were also CD123 positive, however, four cases among the CD123 positive patients did not express CD96.CD96 and CD123 were expressed more on blast cells in the cases of M5 French–American–British subtype,whereas the least expression was in M3. Among the eight cases with CD96+ expression, only (37.5%) acquiredCR, whereas cases without CD96 expression, (77.3%) acquired CR. Among the 12 cases with CD123+ expression,only (33.3%) acquired CR, while cases without CD123 expression, (88.9%) acquired CR.CONCLUSION: The expressions of CD96 and CD123 were associated with a higher total white blood cell countand bone marrow blast cells at presentation, and a lower response rate to the induction therapy.