Frequency of Nucleophosmin 1 Expression by Immunohistochemistry in Acute Myeloid Leukemia

Abstract

Nucleophosmin (NPM1) mutation is one of the most common recurring genetic abnormalities seen in acute myeloid leukemia (AML). Immunohistochemistry serves as a cost effective and simple surrogate testing method for detection of NPM1 mutation. This study was conducted to evaluate the frequency of aberrant cytoplasmic nucleophosmin 1 expression in leukemic blast cells on formalin fixed bone marrow trephine biopsy (BMB) sections and also to correlate this data with the reference molecular method (reverse transcriptase-polymerase chain reaction; RT-PCR and gene sequencing), where available. Immunostains were performed using mouse anti-NPM1 monoclonal antibody on 71 paraffin embedded bone marrow biopsies (BMB) of patients with AML of any French-American-British (FAB) subtype. Results of immunohistochemistry (IHC) were then compared with the reference molecular method. The proportion of NPM1 expression by immunostaining in AML cases was found to be 17%. Twelve of the total 71 cases demonstrated cytoplasmic nucleophosmin (NPMc+) on immunostaining. Eleven of the positive cases that were correlated with the molecular standard demonstrated mutation in exon 12 of NPM1 gene. Cytoplasmic nucleophosmin expression by immunostaining was found to be in complete agreement with the standard molecular method. In a resource restricted setup, the information from this study might help in providing an inexpensive and accurate detection method to facilitate introduction of this marker in diagnostic and prognostic workup of AML especially in patients showing normal karyotype and no common recurrent translocations.

Keywords: Acute myeloid leukemia; Bone marrow trephine; Immunohistochemistry; NPM1.

Fig. 1

a Leishman 400X; Peripheral blood in a case of AML. Arrow indicates cup-like nuclear invagination of blast morphology. b BMBx H&E 1000X; demonstrate sheets of myeloblast. c IHC Anti NPM1,100X; Leukemic blast cells showing nucleus restricted staining pattern (negative NPMc−) d IHC Anti NPM, 400X; Leukemic blast cells showing cytoplasmic staining patterns (positive NPMc+)