ANKL cells primarily proliferate in the liver. (A) The percentage of leukemic cells in each organ of PDX mice analyzed by flow cytometry at days 7 and 14 and 3 to 4 weeks when mice already became weak (late) after splenic ANKL1 cell injection at a dose of 1 × 103 cells (n = 4-5). (B) IVIS imaging of an ANKL1 PDX mouse at an early (1-2 weeks after transplantation) and late (3-4 weeks when mice already got weakened) phase. (C) IVIS imaging at days 0, 7, and 21 after hepatic ANKL1 cell subcutaneous injection at a dose of 1 × 107 cells. Representative image from 3 biological replicates. (D) Expression of CD31, hCD45, F4/80, and desmin in the liver of an ANKL1 PDX mouse. Data are representative of 2 experiments. Scale bar, 100 μm. (E) H&E staining (left) and EBER-ISH (right) for a liver section from a biopsy sample of a patient with newly diagnosed ANKL. Upper and lower images show the ×10 and ×80 original magnification, respectively. Scale bar, 300 μm (×10) and 50 μm (×80). (F) Comparison of liver function between patients with chronic NK-cell lymphocytosis (CNKL) and those with ANKL. Clinical data of alanine transaminase (ALT, left), alkaline phosphatase (ALP, middle), and total bilirubin (T-Bil, right) from the previous study were reanalyzed.22 ∗P < .05; ∗∗P < .01; ∗∗∗P < .001; ∗∗∗∗P < .0001.
