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How can aberrant B lymphoblasts in B lymphoblastic leukemia (B-ALL) be distinguished from hematogones?
Hematogones are immature B-cell precursors that are found primarily in the bone marrow from which they arise. They are found in greatest abundance in infants and young children and decline with age. They are frequently increased in regenerating bone marrow after chemotherapy or bone marrow transplant, but also can be increased in other inflammatory, hematologic, oncologic, and inflammatory disorders. They are rarely detected in peripheral blood. It is particularly important to be able to differentiate hematogones from neoplastic B-cell precursors in the diagnosis and monitoring of B-ALL. B-lineage lymphoblasts and hematogones often share immunophenotypic characteristics. Thus, hematogone hyperplasia can be mistaken for B-ALL at diagnosis and regenerating hematogones can be mistaken for minimal residual disease after therapy. Figure 1A shows normal B-lineage maturation. All hematogones are positive for CD19 (not shown) and show variable expression of CD58. The earliest hematogones...
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