p53 immunohistochemistry discriminates between pure erythroid leukemia and reactive erythroid hyperplasia

Christina Alexandres, Basma Basha, Rebecca L. King, Matthew T. Howard, Kaaren K. Reichard

Research output: Contribution to journalArticlepeer-review


Pure erythroid leukemia (PEL) is a rare, aggressive subtype of acute myeloid leukemia with a poor prognosis. The diagnosis of PEL is often medically urgent, quite challenging, and is typically a diagnosis of exclusion requiring meticulous distinction from non-neoplastic erythroid proliferations, particularly florid erythroid hyperplasia/regeneration. Given the frequency of TP53 mutations in the molecular signature of PEL, we hypothesize that differential p53 expression by immunohistochemistry (IHC) may be useful in distinguishing PEL versus non-neoplastic erythroid conditions. We performed p53 IHC on 5 normal bone marrow, 46 reactive erythroid proliferations, and 27 PEL cases. We assessed the positivity and intensity of nuclear staining in pronormoblasts and basophilic normoblasts using a 0–3+ scale with 0 being absent (with internal positive controls) and 3 being strong nuclear positivity. A total of 26/27 PEL cases showed strong, uniform, diffuse intense staining by the neoplastic pronormoblasts versus 0/5 and 0/46 normal and reactive controls, respectively. The control cases show various staining patterns ranging from 0 to 3+ in scattered erythroid precursor cells. Uniform, strong p53 positivity is unique to PEL and discriminates this entity from a benign erythroid mimic. Thus, p53 IHC may be a useful marker in urgent medical cases to assist in the confirmation of a malignant PEL diagnosis while awaiting the results of additional ancillary studies such as cytogenetics.

Original languageEnglish (US)
Pages (from-to)15-22
Number of pages8
JournalJournal of Hematopathology
Issue number1
StatePublished - Mar 2021


  • Erythroid
  • Erythroleukemia
  • Leukemia
  • M6
  • PEL
  • p53

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology
  • Hematology


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