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Tomic Vujovic K, Ugrin M, Tosic N, Vukovic V, Marjanovic I, Kostic T, Stankovic S, Otasevic V, Sarac S, Antic D, Pavlovic S, Karan-Djurasevic T. Expression Pattern and Prognostic Significance of the Long Non-Coding RNA Metastasis-Associated Lung Adenocarcinoma Transcript 1 in Chronic Lymphocytic Leukemia. Int J Mol Sci 2024; 25:922. [PMID: 38255996 PMCID: PMC10815316 DOI: 10.3390/ijms25020922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/21/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Dysregulated expression of the long non-coding RNA MALAT1 has been implicated in the pathogenesis and progression of a variety of cancers, including hematological malignancies, but it has been poorly investigated in chronic lymphocytic leukemia (CLL). In this study, the expression of MALAT1 was measured using a quantitative reverse-transcriptase polymerase chain reaction in the peripheral blood mononuclear cells of 114 unselected, newly diagnosed CLL patients in order to analyze its association with clinical, laboratory, and molecular patients' characteristics at diagnosis, as well as its prognostic relevance. MALAT1 was found to be upregulated in CLL patients in comparison to healthy controls, and expression levels were not related to age, leukocyte, lymphocyte and platelet count, serum β2-microglobulin, and IGHV somatic hypermutational status. On the other hand, high MALAT1 expression was associated with several favorable prognostic markers (high hemoglobin, low serum lactate dehydrogenase, earlier clinical stages, CD38-negative status), but also with unfavorable cytogenetics. Furthermore, an association between high MALAT1 levels and longer time to first treatment and overall survival in IGHV-unmutated CLL subtype was observed. In summary, our results imply that high MALAT1 expression at diagnosis may be a predictor of better prognosis and point to MALAT1 expression profiling as a candidate biomarker potentially useful in clinical practice.
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Affiliation(s)
- Kristina Tomic Vujovic
- Clinic for Hematology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (K.T.V.); (V.V.); (V.O.); (S.S.); (D.A.)
| | - Milena Ugrin
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (M.U.); (N.T.); (I.M.); (T.K.); (S.P.)
| | - Natasa Tosic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (M.U.); (N.T.); (I.M.); (T.K.); (S.P.)
| | - Vojin Vukovic
- Clinic for Hematology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (K.T.V.); (V.V.); (V.O.); (S.S.); (D.A.)
| | - Irena Marjanovic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (M.U.); (N.T.); (I.M.); (T.K.); (S.P.)
| | - Tatjana Kostic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (M.U.); (N.T.); (I.M.); (T.K.); (S.P.)
| | - Sanja Stankovic
- Center for Medical Biochemistry, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
- Department of Biochemistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Vladimir Otasevic
- Clinic for Hematology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (K.T.V.); (V.V.); (V.O.); (S.S.); (D.A.)
| | - Sofija Sarac
- Clinic for Hematology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (K.T.V.); (V.V.); (V.O.); (S.S.); (D.A.)
| | - Darko Antic
- Clinic for Hematology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (K.T.V.); (V.V.); (V.O.); (S.S.); (D.A.)
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Sonja Pavlovic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (M.U.); (N.T.); (I.M.); (T.K.); (S.P.)
| | - Teodora Karan-Djurasevic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (M.U.); (N.T.); (I.M.); (T.K.); (S.P.)
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Brito Junior LCD, Fonseca MBDS, Paixão APS, Mendes NSLC, Parente JSC, Nascimento MH. Análise dos Critérios Imunofenotípicos por Citometria de Fluxo para Definição das Doenças Linfoproliferativas Crônicas de Células B. REVISTA BRASILEIRA DE CANCEROLOGIA 2023. [DOI: 10.32635/2176-9745.rbc.2023v69n1.2734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introdução: A citometria de fluxo é uma metodologia importante para o diagnóstico das doenças linfoproliferativas crônicas de células B (DLPCB), contudo, por vezes, o citometrista não encontra subsídios suficientes para a definição exata da entidade patológica envolvida. Objetivo: Analisar os laudos emitidos a pacientes com doenças linfoproliferativas crônicas (DLPC) atendidos em um laboratório particular de Belém-PA, segundo os critérios de classificação estabelecidos pelos estudos de Matutes et al. e Craig e Foon. Método: Estudo retrospectivo com laudos de pacientes que realizaram imunofenotipagem por citometria de fluxo para diagnóstico de DLPCB no período entre setembro de 2015 a dezembro de 2019. Resultados: Depois de aplicados os critérios de Matutes et al. e Craig e Foon para os laudos analisados, observou-se concordância em: 45,24% casos de leucemia linfoide crônica de células B/linfoma linfocítico de pequenas células B; 14,29% casos de linfoma folicular; 4,76% casos de leucemia de células pilosas; e 21,43% de casos definidos como “outras DLPCB não classificáveis por citometria de fluxo”. Entretanto, o teste de hipóteses de Hotelling (p=0,0409) mostrou haver diferença estatística para a definição das DLPCB segundo os critérios aplicados. Conclusão: Os resultados ressaltam que, mesmo sendo a citometria de fluxo importante para a caracterização das DLPCB, por vezes, o citometrista necessita incluir no laudo a categoria “outras doenças linfoproliferativas crônicas de células B não classificadas por citometria de fluxo” para induzir o prescritor a solicitar mais exames complementares.
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Glencross DK, Swart L, Pretorius M, Lawrie D. Evaluation of fixed-panel, multicolour ClearLLab 10C at an academic flow cytometry laboratory in Johannesburg, South Africa. Afr J Lab Med 2022; 11:1458. [PMID: 35937760 PMCID: PMC9350555 DOI: 10.4102/ajlm.v11i1.1458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background Flow cytometric immunophenotyping is well established for the diagnosis of haematological neoplasms. New commercially available systems offer fixed, pre-aliquoted multi-parameter analysis to simplify sample preparation and standardise data analysis. Objective The Beckman Coulter (BC) ClearLLab™ 10C (4-tube) system was evaluated against an existing laboratory developed test (LDT). Methods Peripheral blood and bone marrow aspirates (n = 101), tested between August 2019 and November 2019 at an academic pathology laboratory in Johannesburg, South Africa, were analysed. Following daily instrument quality control, samples were prepared for LDT (using > 20 2–4-colour in-house panels and an extensive liquid monoclonal reagent repertoire) or ClearLLab 10C, and respectively analysed using in-house protocols on a Becton Dickinson FACSCalibur, or manufacturer-directed protocols on a BC Navios. Becton Dickinson Paint-a-Gate or BC Kaluza C software facilitated data interpretation. Diagnostic accuracy (concordance) was established by calculating sensitivity and specificity outcomes. Results Excellent agreement (clinical diagnostic concordance) with 100% specificity and sensitivity was established between LDT and ClearLLab 10C in 67 patients with a haematological neoplasm and 34 participants with no haematological disease. Similar acceptable diagnostic concordance (97%) was noted when comparing ClearLLab 10C to clinicopathological outcomes. Additionally, the ClearLLab 10C panels, analysed with Kaluza C software, enabled simultaneous discrimination of disease and concurrent background myeloid and lymphoid haematological populations, including assessing stages of maturation or sub-populations. Conclusion ClearLLab 10C panels provide excellent agreement to existing LDTs and may reliably be used for immunophenotyping of haematological neoplasms, simplifying and standardising sample preparation and data acquisition.
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Affiliation(s)
- Deborah K Glencross
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, Charlotte Maxeke Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa
| | - Leanne Swart
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, Charlotte Maxeke Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa
| | - Melanie Pretorius
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, Charlotte Maxeke Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa
| | - Denise Lawrie
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, Charlotte Maxeke Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa
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Quirós C, Fonseca A, Alonso-Álvarez S, Moro-García MA, Alonso-Arias R, Morais LR, Álvarez-Menendez FV, Colado E. Development of an algorithm for the identification of leukemic hematolymphoid neoplasms in Primary Care patients. Diagnosis (Berl) 2021; 8:239-247. [PMID: 32284442 DOI: 10.1515/dx-2020-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/26/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diagnosis of hematolymphoid neoplasm (HLN) requires different technologies which are performed on a patient basis instead of per protocol. We hypothesize that integration of hematimetric and cytological analysis along with multiparametric flow cytometry (MFC) provides a framework to evaluate peripheral blood (PB) samples from Primary Care. METHODS Samples from patients with persistent (>3 months) lymphocytosis (>5 × 109/L) and/or monocytosis (>109/L) or the presence of atypical and/or blast cells upon the smear review were analyzed by MFC concurrent to cytological analysis. MFC studies were carried out following standardized procedures. RESULTS In a 3-year period, smear review and MFC were performed simultaneously in 350 samples, demonstrating HLN in 194 cases (55.4%). In 156 cases, reactive cell populations were found. The combination of age, absolute lymphocyte count (ALC), hemoglobin and platelets provided the best correlation with MFC for the presence of a chronic lymphoproliferative disorder (CLPD) in lymphocytosis [area under the curve (AUC) 0.891, p < 0.05]. A model evaluating the probability of CLPD has been proposed and validated in an independent cohort. CONCLUSIONS A strategy to perform MFC studies following standardized procedures has proven to be useful to evaluate samples from patients in Primary Care centers for HLN diagnosis or reactive conditions, providing a sensitive and rapid clinical orientation and avoiding unnecessary consultations in routine clinical practice. The probability for the presence of CLPD in PB can be calculated and help guide decision-making regarding further testing.
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Affiliation(s)
- Covadonga Quirós
- Clinical Biochemistry Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ariana Fonseca
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Hematology and Haemotherapy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Sara Alonso-Álvarez
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Hematology and Haemotherapy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Rebeca Alonso-Arias
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Immunology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Lucía-Rita Morais
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Hematology and Haemotherapy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Francisco V Álvarez-Menendez
- Clinical Biochemistry Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Enrique Colado
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Hematology and Haemotherapy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Avda. Roma s/n - 33011 Oviedo, Spain; Hematology and Haemotherapy Department, Hospital Universitario Central de Asturias, Avda. Roma s/n - 33011 Oviedo, Spain; and Hematology and Haemotherapy Department, Laboratory of Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain, Phone: +34 985 10 80 00, Ext 37138
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Hedley BD, Cheng G, Keeney M, Kern W, Padurean A, Luider J, Chin‐Yee I, Lowes LE, Rohrbach J, Ortega R, Smit A, Lo K, Magari R, Tejidor L. A multicenter study evaluation of the ClearLLab 10C panels. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2021; 100:225-234. [PMID: 32667744 PMCID: PMC8048967 DOI: 10.1002/cyto.b.21935] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/20/2020] [Accepted: 06/16/2020] [Indexed: 11/26/2022]
Abstract
Multiparameter flow cytometry plays an important role in the diagnosis, staging, and monitoring of patients with a suspected hematological malignancy. The ClearLLab 10C Panels consist of four reagent panels (B-Lineage Tube, T-Lineage Tube, and 2 Myeloid Lineage Tubes), each consisting of 10 color/10 antibody conjugates utilizing Beckman Coulters proprietary dry format optimized for investigating patients with suspected leukemia or lymphoma. A multicenter study was conducted to evaluate the performance of the ClearLLab 10C Panels for qualitative assessment of normal versus abnormal phenotype in peripheral blood, bone marrow, and lymph node samples with suspected hematological malignancies. ClearLLab 10C was compared to laboratory developed tests (LDTs) and final clinical diagnosis. Four clinical sites were used to enroll patient's spent specimens (n = 453); three laboratories in North America and one in Europe. Of the 453 specimens, 198 had no malignancy and 255 contained an abnormal population. The diagnostic accuracy of the ClearLLab 10C Panels was achieved with sensitivity of 96% and specificity of 95% with respect to patient final clinical diagnosis. The agreement of phenotyping between ClearLLab10C Panels and LDTs was 98%. Any differences noted between ClearLLab 10C and LDT were due to either the presence of populations below the level of detection, the lack of clinical information provided to the evaluators, or marker(s) not present in these panels. Overall, the ClearLLab 10C demonstrated excellent agreement to LDTs and diagnosis. These four reagent panels can be adopted by individual laboratories to assess the presence or absence of malignancy.
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Affiliation(s)
- Benjamin D. Hedley
- Department of Pathology and Laboratory MedicineLondon Health Sciences CenterLondonOntarioCanada
| | - Guoyan Cheng
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Michael Keeney
- Department of Pathology and Laboratory MedicineLondon Health Sciences CenterLondonOntarioCanada
| | - Wolfgang Kern
- MLL Munich Leukemia LaboratoryDepartment of ImmunophenotypingMunichGermany
| | - Adrian Padurean
- Neogenomics Laboratory, Inc.Department of Flow CytometryFort MyersFloridaUSA
| | - Joanne Luider
- Calgary Laboratory ServicesFlow Cytometry CalgaryAlbertaCanada
| | - Ian Chin‐Yee
- Department of Pathology and Laboratory MedicineLondon Health Sciences CenterLondonOntarioCanada
| | - Lori E. Lowes
- Department of Pathology and Laboratory MedicineLondon Health Sciences CenterLondonOntarioCanada
| | - Justin Rohrbach
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Robert Ortega
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Astrid Smit
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Ka‐Wai Lo
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Robert Magari
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Liliana Tejidor
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
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Meichner K, Stokol T, Tarigo J, Avery A, Burkhard MJ, Comazzi S, Fogle J, Stowe DM, Rütgen B, Seelig D, Wasserkrug-Naor A, Vernau W, Bienzle D. Multicenter flow cytometry proficiency testing of canine blood and lymph node samples. Vet Clin Pathol 2020; 49:249-257. [PMID: 32246538 DOI: 10.1111/vcp.12843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/22/2019] [Accepted: 09/20/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Flow cytometry (FC) is used increasingly in veterinary medicine for further characterization of hematolymphoid cells. Guidelines for optimizing assay performance and interpretation of results are limited, and concordance of results across laboratories is unknown. OBJECTIVES This study aimed to determine inter-investigator agreement on the interpretation of FC results from split samples analyzed in different laboratories using various protocols, cytometers, and software; and on the interpretation of archived FC standard (FCS) data files contributed by the different investigators. METHODS This was a multicenter observational cross-sectional study. Anticoagulated blood or lymph node aspirate samples from nine client-owned dogs were aliquoted and shipped to participating laboratories. Samples were analyzed with individual laboratory-developed protocols. In addition, FCS files from a set of separate samples from 11 client-owned dogs were analyzed by participating investigators. A person not associated with the study tabulated the results and interpretations. Agreement of interpretations was assessed with Fleiss' kappa statistic. RESULTS Prolonged transit times affected sample quality for some laboratories. Overall agreement among investigators regarding the FC sample interpretation was strong (κ = 0.86 ± 0.19, P < .001), and for specific categories, ranged from moderate to perfect. Agreement of the lymphoproliferation or other leukocyte sample category from the analysis of the FCS files was weak (κ = 0.58 ± 0.05, P < .001). CONCLUSIONS Lymphoproliferations were readily identified by FC, but identification of the categories of hematolymphoid neoplasia in fresh samples or archived files was variable. There is a need for a more standardized approach to maximize the enormous potential of FC in veterinary medicine.
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Affiliation(s)
- Kristina Meichner
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Tracy Stokol
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | - Jaime Tarigo
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Anne Avery
- Department of Microbiology, Immunology & Pathology, University of Colorado, Fort Collins, CO, USA
| | - Mary J Burkhard
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, USA
| | - Stefano Comazzi
- Department of Veterinary Medicine, University of Milan, Milan, Italy
| | - Jonathan Fogle
- Department of Population Health and Pathobiology, North Carolina State University, Raleigh, NC, USA
| | - Devorah Marks Stowe
- Department of Population Health and Pathobiology, North Carolina State University, Raleigh, NC, USA
| | | | - Davis Seelig
- Department of Veterinary Clinical Sciences, University of Minnesota, St Paul, MN, USA
| | - Adi Wasserkrug-Naor
- Department of Diagnostic Medicine/Pathobiology, Kansas State University, Manhattan, KS, USA
| | - William Vernau
- Department of Pathology, Microbiology & Immunology, University of California, Davis, Davis, CA, USA
| | - Dorothee Bienzle
- Department of Pathobiology, University of Guelph, Guelph, ON, Canada
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Hill AJ, Zhang C, Kusakabe M, Gowing K, Wang X, Brinkman RR, Weng AP, Craig JW. Occurrence of T-cell and NK-cell subsets with less well-recognized phenotypes in peripheral blood submitted for routine flow cytometry analysis. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 100:235-239. [PMID: 32222062 DOI: 10.1002/cyto.b.21876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/18/2020] [Accepted: 03/10/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Ainsleigh J Hill
- Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Chaoran Zhang
- Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Manabu Kusakabe
- Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Kevin Gowing
- Department of Pathology and Lab Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xuehai Wang
- Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Ryan R Brinkman
- Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Andrew P Weng
- Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada.,Department of Pathology and Lab Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Lab Medicine, BC Cancer Agency, Vancouver, British Columbia, Canada.,Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Jeffrey W Craig
- Department of Pathology and Lab Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Lab Medicine, BC Cancer Agency, Vancouver, British Columbia, Canada.,Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
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Rivas E, Plapp FV, Cui W. Flow Cytometric, Morphologic, and Laboratory Comparative Study in Patients With Leukocytosis and Cytopenia. Am J Clin Pathol 2020; 153:266-273. [PMID: 31608361 DOI: 10.1093/ajcp/aqz160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We wanted to evaluate the effectiveness of flow cytometry immunophenotyping (FCI) as a screening test for patients with leukocytosis and cytopenia. METHODS We identified 320 patients during August 2016 to December 2016 and evaluated FCI and morphology of peripheral blood smears (PBSs). RESULTS The most common indications for FCI included history of hematologic malignancy (HHM, n = 126), leukocytosis (n = 80), and cytopenia (n = 53). Positive FCI rate was low with a range of 4.4% to 12.5% in patients with absolute neutrophilia regardless of HHM, if cases with circulating blasts were excluded. Patients with absolute lymphocytosis had a 93% positive FCI rate. Patients with HHM and pancytopenia showed a higher incidence of positive FCI findings than patients without HHM and with isolated cytopenia. PBS morphology correlated strongly with FCI (P = .0001). CONCLUSION PBS evaluation is an accurate and cost-effective screening test. FCI for patients with mature neutrophilia and isolated cytopenia has a very low yield.
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Affiliation(s)
| | - Fred V Plapp
- University of Kansas Medical Center, Kansas City
| | - Wei Cui
- University of Kansas Medical Center, Kansas City
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9
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Zhang ML, Guo AX, Kadauke S, Dighe AS, Baron JM, Sohani AR. Machine Learning Models Improve the Diagnostic Yield of Peripheral Blood Flow Cytometry. Am J Clin Pathol 2020; 153:235-242. [PMID: 31603184 DOI: 10.1093/ajcp/aqz150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Peripheral blood flow cytometry (PBFC) is useful for evaluating circulating hematologic malignancies (HM) but has limited diagnostic value for screening. We used machine learning to evaluate whether clinical history and CBC/differential parameters could improve PBFC utilization. METHODS PBFC cases with concurrent/recent CBC/differential were split into training (n = 626) and test (n = 159) cohorts. We classified PBFC results with abnormal blast/lymphoid populations as positive and used two models to predict results. RESULTS Positive PBFC results were seen in 58% and 21% of training cases with and without prior HM (P < .001). % neutrophils, absolute lymphocyte count, and % blasts/other cells differed significantly between positive and negative PBFC groups (areas under the curve [AUC] > 0.7). Among test cases, a decision tree model achieved 98% sensitivity and 65% specificity (AUC = 0.906). A logistic regression model achieved 100% sensitivity and 54% specificity (AUC = 0.919). CONCLUSIONS We outline machine learning-based triaging strategies to decrease unnecessary utilization of PBFC by 35% to 40%.
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Affiliation(s)
- M Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston
| | - Alan X Guo
- Independent Researcher, Boston, MA, Philadelphia
| | - Stephan Kadauke
- Department of Pathology, University of Pennsylvania, Philadelphia
| | - Anand S Dighe
- Department of Pathology, Massachusetts General Hospital, Boston
| | - Jason M Baron
- Department of Pathology, Massachusetts General Hospital, Boston
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston
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10
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Del Principe MI, De Bellis E, Gurnari C, Buzzati E, Savi A, Consalvo MAI, Venditti A. Applications and efficiency of flow cytometry for leukemia diagnostics. Expert Rev Mol Diagn 2019; 19:1089-1097. [PMID: 31709836 DOI: 10.1080/14737159.2019.1691918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Multiparametric flow cytometry immunophenotype (MFCI) plays a crucial role in the diagnosis of acute leukemia (AL). Through the comprehensive assessment of surface and intracellular antigens expressed by blasts, MFCI permits to distinguish myeloid or B/T lymphoid AL, or AL of ambiguous lineages. By means of MFCI, the blasts can be characterized in bone marrow, peripheral blood, and body fluids, such as cerebrospinal fluid.Area covered: This review discusses how MFCI is currently applied in the diagnostic evaluation of AL; it also focuses on 'peculiar' issues such as the role of MFCI for the diagnosis of central nervous system leukemic involvement.Expert commentary: Despite the improved knowledge about the biology of AL, MFCI remains a fundamental tool to make a prompt and accurate diagnosis. MFCI also provides prognostic information for some antigens are associated with specific cytogenetic/genetic abnormalities and, recently, it became a powerful tool to evaluate the quality and depth of response (the so called 'measurable residual disease'). Its role as an efficient detector of residual disease paved the way to the investigation of tissues other than bone marrow and peripheral blood, demonstrating that even small amounts of AL appear to have a prognostic impact and may require personalized intervention.
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Affiliation(s)
- Maria Ilaria Del Principe
- Cattedra di Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italia.,Ematologia, Dipartimento di Onco-Ematologia, Fondazione Policlinico Tor Vergata, Roma, Italia
| | - Eleonora De Bellis
- Cattedra di Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italia.,Ematologia, Dipartimento di Onco-Ematologia, Fondazione Policlinico Tor Vergata, Roma, Italia
| | - Carmelo Gurnari
- Cattedra di Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italia.,Ematologia, Dipartimento di Onco-Ematologia, Fondazione Policlinico Tor Vergata, Roma, Italia
| | - Elisa Buzzati
- Cattedra di Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italia.,Ematologia, Dipartimento di Onco-Ematologia, Fondazione Policlinico Tor Vergata, Roma, Italia
| | - Arianna Savi
- Cattedra di Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italia.,Ematologia, Dipartimento di Onco-Ematologia, Fondazione Policlinico Tor Vergata, Roma, Italia
| | | | - Adriano Venditti
- Cattedra di Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italia.,Ematologia, Dipartimento di Onco-Ematologia, Fondazione Policlinico Tor Vergata, Roma, Italia
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11
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Gounari E, Tsavdaridou V, Ioakeimidou A, Haidich AB, Skoura L. Evaluation of a 10color protocol as part of a 2tube screening panel for flow cytometric assessment of peripheral blood leukocytic subsets. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:475-483. [PMID: 31497995 DOI: 10.1080/00365513.2019.1661007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Peripheral blood (PB) immunophenotyping is commonly required for initial evaluation of various suspected disease entities. Several approaches have been proposed. The objective of this work is to explore the value of a 10color protocol developed in our laboratory for flow cytometric assessment of PB leukocytic subsets, as part of a 2tube screening panel. A combination of CD16/CD56/CD34/CD33/CD19/CD4/CD8/CD3/CD20/CD45 antibodies in 1 tube was applied routinely during flow cytometric analysis of PB samples for diagnostic purposes. The protocol was systematically complemented by a 2nd tube with anti-kappa, anti-lambda, CD5, CD19, and CD45 antibodies for adults and selected pediatric patients, and specifically oriented panels when necessary. 25 samples with no detectable neoplastic PB involvement and 31 samples with a hematolymphoid disorder were investigated retrospectively. The contribution of CD33 in the separation of leukocytic populations, as well as the benefits from the simultaneous assessment of CD20/CD19/CD45, CD16/CD56 and the detection of CD34+ cells were examined. The gating strategy with the use of CD33 provided additional information in certain cases. The protocol enabled recognition of differential expression of CD20 and CD45 in CD19+ cells with chronic lymphocytic leukemia phenotype, overall evaluation of NK and NK like T cells, estimation of CD16- granulocytes and CD56/CD16 expression in monocytes, as well as identification of minor cell subsets, such as CD34+ cells. The proposed 10color combination of antibodies analyzed in a standardized manner can offer significant information in the initial evaluation of PB samples, thus, guiding subsequent investigation if needed.
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Affiliation(s)
- Evdoxia Gounari
- Department of Immunology, Microbiology Laboratory, AHEPA University Hospital , Thessaloniki , Greece
| | - Vasiliki Tsavdaridou
- Department of Immunology, Microbiology Laboratory, AHEPA University Hospital , Thessaloniki , Greece
| | - Aliki Ioakeimidou
- Department of Immunology, Microbiology Laboratory, AHEPA University Hospital , Thessaloniki , Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Faculty of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Lemonia Skoura
- Department of Immunology, Microbiology Laboratory, AHEPA University Hospital , Thessaloniki , Greece
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12
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Salem DA, Scott D, McCoy CS, Liewehr DJ, Venzon DJ, Arons E, Kreitman RJ, Stetler-Stevenson M, Yuan CM. Differential Expression of CD43, CD81, and CD200 in Classic Versus Variant Hairy Cell Leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019; 96:275-282. [PMID: 31077558 DOI: 10.1002/cyto.b.21785] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/05/2019] [Accepted: 04/19/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hairy cell leukemia (HCL) and hairy cell leukemia variant (HCLv) are rare diseases with overlapping clinicopathological features. Features distinguishing HCL from HCLv include expression of CD25, CD123, CD200, annexin-A1, and the presence of BRAF V600E mutation. HCLv typically lacks these markers, but they may occur in a subgroup of HCL patients with an aggressive clinical course. We examined CD43, CD81, CD79b, and CD200 expression in HCL and HCLv. METHODS Multiparametric flow cytometry (FCM) was performed on blood from 59 HCL and 15 HCLv patients for protocol entry. Mean fluorescent intensity (MFI) of CD43, CD79b, CD81, and CD200 was determined (for CD200, n = 17 and 7, respectively). RESULTS Median MFI of HCL vs HCLv was 545 vs 272 for CD43, 602 vs 2,450 for CD81, 4,962 vs 1,969 for CD79b, and 11,652 vs 1,405 for CD200, respectively. Analysis of the median differences, HCL minus HCLv (and their 95% confidence intervals and P-values) indicated that CD43 MFI (estimated median difference (95% CI): 212 [72-413; P = 0.0027) and CD200 MFI (9,883 [3,514-13,434]; P < 0.0001) were higher in HCL than in HCLv, while CD81 MFI (-1,858 [-2,604 to -1,365]; P < 0.0001) was lower in HCL than in HCLv. CD79b MFI HCL median was more than double that of HCLv, but the observed difference (1,571 [-739 to 4,417]) was consistent with the null hypothesis of no difference (P = 0.13). CONCLUSIONS CD200, CD43, and CD81 are likely differentially expressed between HCL and HCLv, reflecting their differing disease biology. Inclusion of these markers in FCM is potentially informative. © 2019 International Clinical Cytometry Society.
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Affiliation(s)
- Dalia A Salem
- Laboratory of Pathology, CCR, NCI, NIH, Bethesda, Maryland.,Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Drake Scott
- Laboratory of Pathology, CCR, NCI, NIH, Bethesda, Maryland
| | | | - David J Liewehr
- Biostatistics and Data Management Section, CCR, NCI, NIH, Bethesda, Maryland
| | - David J Venzon
- Biostatistics and Data Management Section, CCR, NCI, NIH, Bethesda, Maryland
| | - Evgeny Arons
- Laboratory of Molecular Biology, Clinical Immunotherapy Section, CCR, NCI, NIH, Bethesda, Maryland
| | - Robert J Kreitman
- Laboratory of Molecular Biology, Clinical Immunotherapy Section, CCR, NCI, NIH, Bethesda, Maryland
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13
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Vukovic V, Karan-Djurasevic T, Antic D, Tosic N, Kostic T, Marjanovic I, Dencic-Fekete M, Djurasinovic V, Pavlovic S, Mihaljevic B. Association of SLC28A3 Gene Expression and CYP2B6*6 Allele with the Response to Fludarabine Plus Cyclophosphamide in Chronic Lymphocytic Leukemia Patients. Pathol Oncol Res 2019; 26:743-752. [PMID: 30778771 DOI: 10.1007/s12253-019-00613-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/08/2019] [Indexed: 01/11/2023]
Abstract
Fludarabine plus cyclophosphamide (FC) chemotherapy is the basis of treatment protocols used in management of chronic lymphocytic leukemia (CLL). In some patients, response to therapy may be affected by aberrant function of genes involved in pharmacokinetics and pharmacodynamics of the drugs. The aim of this research was to assess the impact of pharmacogenetic variability, namely expression of SLC28A3 gene and the presence of CYP2B6*6 variant allele, on the FC treatment efficacy. Forty-four CLL patients with functional TP53 gene at the time of FC initiation were enrolled in this study. CYP2B6 genotyping was performed by polymerase chain reaction and direct sequencing. SLC28A3 expression was measured by quantitative reverse-transcriptase polymerase chain reaction. Significantly higher pretreatment levels of SLC28A3 mRNA were detected in patients who failed to respond to FC in comparison to patients who achieved complete and partial response (p = 0.01). SLC28A3 high-expressing cases were almost ten times more likely not to respond to FC than low-expressing cases (OR = 9.8; p = 0.046). However, association of SLC28A3 expression with progression-free survival (PFS) and overall survival (OS) was not observed. CYP2B6*6 allele, detected in 24 patients (54.6%), exerted no association with the attainment of response to FC, as well as with PFS and OS. The results of this study demonstrate that SLC28A3 expression is a significant predictor of FC efficacy in CLL patients with intact TP53. Elevated SLC28A3 mRNA levels are associated with inferior short-term response to FC, suggesting that, if validated on larger cohorts, SLC28A3 expression may become a biomarker useful for pretreatment stratification of patients.
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Affiliation(s)
- Vojin Vukovic
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia.
| | - Teodora Karan-Djurasevic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Darko Antic
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Natasa Tosic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Tatjana Kostic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Irena Marjanovic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Marija Dencic-Fekete
- Institute of Pathology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladislava Djurasinovic
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sonja Pavlovic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Biljana Mihaljevic
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
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14
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Lim HY, Hong FS. Maximising yield of peripheral blood flow cytometry for chronic lymphoproliferative disorders. Int J Lab Hematol 2018; 40:556-560. [PMID: 29790655 DOI: 10.1111/ijlh.12861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/18/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Flow cytometry is used in the diagnosis of haematological diseases including chronic lymphoproliferative disorders. This audit aims to ascertain the real-world indications for peripheral blood (PB) flow cytometry and which of these are associated with higher diagnostic yields. METHODS All PB flow cytometry requests for chronic lymphoproliferative disorders from 1 January 2014 to 31 December 2014 were identified using the laboratory information system. Data including patient demographics, specialty of requestor, lymphocyte count and blood film report (if available), indications for tests and subsequent diagnosis were collected. RESULTS A total of 185 requests with median patient age of 60 years were analysed. The main requestor was the Haematology Unit (n = 109; 58.9%) although the diagnostic yield of their requests was not significantly better than other units combined (16.5% vs 13.2%, P = .49). Factors that significantly improved the diagnostic yield of testing were older age, the presence of atypical lymphocytes on the blood film and lymphocytosis (P < .01). Constitutional symptoms and cytopenias were not found to influence the diagnostic yield. CONCLUSION PB flow cytometry is a useful tool when used in the appropriate clinical setting. Rationalisation of testing is important to reduce the futility of testing and unnecessary health costs.
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Affiliation(s)
- H Y Lim
- Department of Laboratory Haematology, Austin Health, Heidelberg, Vic., Australia
| | - F S Hong
- Department of Laboratory Haematology, Austin Health, Heidelberg, Vic., Australia
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15
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16
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Scheuermann RH, Bui J, Wang HY, Qian Y. Automated Analysis of Clinical Flow Cytometry Data: A Chronic Lymphocytic Leukemia Illustration. Clin Lab Med 2017; 37:931-944. [PMID: 29128077 PMCID: PMC5766345 DOI: 10.1016/j.cll.2017.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Flow cytometry is used in cell-based diagnostic evaluation for blood-borne malignancies including leukemia and lymphoma. The current practice for cytometry data analysis relies on manual gating to identify cell subsets in complex mixtures, which is subjective, labor-intensive, and poorly reproducible. This article reviews recent efforts to develop, validate, and disseminate automated computational methods and pipelines for cytometry data analysis that could help overcome the limitations of manual analysis and provide for efficient and data-driven diagnostic applications. It demonstrates the performance of an optimized computational pipeline in a pilot study of chronic lymphocytic leukemia data from the authors' clinical diagnostic laboratory.
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Affiliation(s)
- Richard H Scheuermann
- Department of Informatics, J. Craig Venter Institute, 4120 Capricorn Lane, La Jolla, CA 92037, USA.
| | - Jack Bui
- Department of Pathology, University of California, San Diego, Biomedical Sciences Building Room 1028, 9500 Gilman Drive, La Jolla, CA 92093-0612, USA
| | - Huan-You Wang
- Department of Pathology, School of Medicine, University of California, San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0987, USA
| | - Yu Qian
- Department of Informatics, J. Craig Venter Institute, 4120 Capricorn Lane, La Jolla, CA 92037, USA
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17
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18
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Arber DA, Borowitz MJ, Cessna M, Etzell J, Foucar K, Hasserjian RP, Rizzo JD, Theil K, Wang SA, Smith AT, Rumble RB, Thomas NE, Vardiman JW. Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology. Arch Pathol Lab Med 2017; 141:1342-1393. [PMID: 28225303 DOI: 10.5858/arpa.2016-0504-cp] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - A complete diagnosis of acute leukemia requires knowledge of clinical information combined with morphologic evaluation, immunophenotyping and karyotype analysis, and often, molecular genetic testing. Although many aspects of the workup for acute leukemia are well accepted, few guidelines have addressed the different aspects of the diagnostic evaluation of samples from patients suspected to have acute leukemia. OBJECTIVE - To develop a guideline for treating physicians and pathologists involved in the diagnostic and prognostic evaluation of new acute leukemia samples, including acute lymphoblastic leukemia, acute myeloid leukemia, and acute leukemias of ambiguous lineage. DESIGN - The College of American Pathologists and the American Society of Hematology convened a panel of experts in hematology and hematopathology to develop recommendations. A systematic evidence review was conducted to address 6 key questions. Recommendations were derived from strength of evidence, feedback received during the public comment period, and expert panel consensus. RESULTS - Twenty-seven guideline statements were established, which ranged from recommendations on what clinical and laboratory information should be available as part of the diagnostic and prognostic evaluation of acute leukemia samples to what types of testing should be performed routinely, with recommendations on where such testing should be performed and how the results should be reported. CONCLUSIONS - The guideline provides a framework for the multiple steps, including laboratory testing, in the evaluation of acute leukemia samples. Some aspects of the guideline, especially molecular genetic testing in acute leukemia, are rapidly changing with new supportive literature, which will require on-going updates for the guideline to remain relevant.
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19
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Craig FE. The utility of peripheral blood smear review for identifying specimens for flow cytometric immunophenotyping. Int J Lab Hematol 2017; 39 Suppl 1:41-46. [DOI: 10.1111/ijlh.12651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/07/2017] [Indexed: 01/19/2023]
Affiliation(s)
- F. E. Craig
- Department of Laboratory Medicine and Pathology; Mayo Clinic Arizona; Phoenix AZ USA
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20
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Rajab A, Axler O, Leung J, Wozniak M, Porwit A. Ten-color 15-antibody flow cytometry panel for immunophenotyping of lymphocyte population. Int J Lab Hematol 2017; 39 Suppl 1:76-85. [DOI: 10.1111/ijlh.12678] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 03/08/2017] [Indexed: 01/13/2023]
Affiliation(s)
- A. Rajab
- Hematology Department; LifeLabs; Toronto ON Canada
| | - O. Axler
- Klinisk patologi, Labmedicin; Medicinsk Service, Region Skåne; Lunds Universitetsjukhus; Lund Sweden
| | - J. Leung
- Flow Cytometry Laboratory; Laboratory Medicine Program; University Health Network; Toronto ON Canada
| | - M. Wozniak
- Hematology Department; LifeLabs; Toronto ON Canada
| | - A. Porwit
- Division for Oncology and Pathology; Department of Clinical Sciences Lund; Faculty of Medicine; Lund University; Lund Sweden
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21
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Jafari K, Tierens A, Rajab A, Musani R, Schuh A, Porwit A. Visualization of Cell Composition and Maturation in the Bone Marrow Using 10-Color Flow Cytometry and Radar Plots. CYTOMETRY PART B-CLINICAL CYTOMETRY 2017; 94:219-229. [DOI: 10.1002/cyto.b.21519] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 01/31/2017] [Accepted: 02/27/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Katayoon Jafari
- Department of Pathology; Cross Cancer Institute; Edmonton Alberta Canada
| | - Anne Tierens
- Department of Laboratory Medicine; Toronto General Hospital; Toronto Canada
| | | | - Rumina Musani
- Department of Laboratory Medicine; Toronto General Hospital; Toronto Canada
| | - André Schuh
- Department of Medical Oncology and Hematology; Princess Margaret Cancer Center; Toronto Canada
| | - Anna Porwit
- Division of Oncology and Pathology; Department of Clinical Sciences, Faculty of Medicine, Lund University; Lund Sweden
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22
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Ahmad IN, Assad S, Rahman M, Ghazanfar H. Flow Cytometric Analysis: Four-Year Experience in a Tertiary Care Centre of Pakistan. Cureus 2016; 8:e764. [PMID: 27725920 PMCID: PMC5045332 DOI: 10.7759/cureus.764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: This study summarizes a four-year experience from the analysis of hematolymphoid malignancies in Pakistani population using a database of six-colored flow cytometry. Methods: A cross-sectional survey of 323 specimens of hematolymphoid malignancies using six-colored flow cytometry (FC) was carried out in Shifa International Hospital, Islamabad, Pakistan from June 2012 to June 2016. The criterion for specimen adequacy was that the cases have abnormal populations by FC, and the specimen age (time from biopsy to being examined by the six-color FC tube) of three days or less was to be included in the study. Clinical follow-up of greater than six months was required for a negative flow cytometric study without a subsequent biopsy. Data analysis was done using Statistical Package for the Social Sciences (SPSS) version 21. One-way analysis of variance (ANOVA) was used to compare diagnosis with some antibodies used. Results: The number of specimen within certain age groups included were: 0-15 years; 111 (34.3%), 16-30 years; 65 (20.12%), 31-45 years; 47 (14.5%), 46-60 years; 46 (14.2%) and ≥ 60 years; 54 (16.7%). Hematological malignancies were documented in descending order of sequence with B-cell acute lymphoblastic leukemia (27.9%), acute myeloid leukemia (26.3%), chronic lymphocytic leukemia (13.3%), T cell acute lymphoblastic leukemia (7.7%), non-Hodgkin's lymphomas (5%), hairy cell leukemia (1.9%), chronic myeloid leukemia (0.3%), paroxysmal nocturnal hemoglobinuria (0.6%) and plasma cell dyscrasias (0.6%). The mean number of antibodies used were 12.68 ± 2.97. One-way ANOVA was used to compare diagnosis with some antibodies used. Statistical significance was found between diagnosis and number of antibodies used (F= 5.23 p<0.001). Conclusion: B cell acute lymphoblastic leukemia is most commonly diagnosed at tertiary care units in Pakistan using six-colored flow cytometry. Adoption of these complicated techniques has reinforced the need for optimization and further enhancement of flow cytometric procedures.
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Affiliation(s)
- Imran N Ahmad
- Shifa International Hospital, Shifa College Of Medicine, Islamabad, Pakistan
| | - Salman Assad
- Department of Neurology & Neurosurgery, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | - Haider Ghazanfar
- Department of Pathology, Shifa College Of Medicine, Islamabad, Pakistan
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Wolniak K, Goolsby C, Choi S, Ali A, Serdy N, Stetler-Stevenson M. Report of the results of the International Clinical Cytometry Society and American Society for Clinical Pathology workload survey of clinical flow cytometry laboratories. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 92:525-533. [PMID: 27363814 DOI: 10.1002/cyto.b.21398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 06/17/2016] [Accepted: 06/29/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Thorough review of current workload, staffing, and testing practices in clinical laboratories allows for optimization of laboratory efficiency and quality. This information is largely missing with regard to clinical flow cytometry laboratories. The purpose of this survey is to provide comprehensive, current, and accurate data on testing practices and laboratory staffing in clinical laboratories performing flow cytometric studies. METHODS Survey data was collected from flow cytometry laboratories through the ASCP website. Data was collected on the workload during a 1-year time period of full-time and part-time technical and professional (M.D./D.O./Ph.D. or equivalent) flow cytometry employees. Workload was examined as number of specimens and tubes per full time equivalent (FTE) technical and professional staff. Test complexity, test result interpretation, and reporting practices were also evaluated. RESULTS There were 205 respondent laboratories affiliated predominantly with academic and health system institutions. Overall, 1,132 FTE employees were reported with 29% professional FTE employees and 71% technical. Fifty-one percent of the testing performed was considered high complexity and 49% was low complexity. The average number of tubes per FTE technologist was 1,194 per year and the average number of specimens per FTE professional was 1,659 per year. The flow cytometry reports were predominantly written by pathologists (57%) and were typically written as a separate report (58%). CONCLUSIONS This survey evaluates the overall status of the current practice of clinical flow cytometry and provides a comprehensive dataset as a framework to help laboratory departments, directors, and managers make appropriate, cost-effective staffing decisions. © 2016 International Clinical Cytometry Society.
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Affiliation(s)
- Kristy Wolniak
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Charles Goolsby
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Sarah Choi
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Asma Ali
- Department of Evaluation, Measurement and Assessment, American Society for Clinical Pathology, Chicago, Illinois
| | - Nina Serdy
- Department of Evaluation, Measurement and Assessment, American Society for Clinical Pathology, Chicago, Illinois
| | - Maryalice Stetler-Stevenson
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Stepwise discriminant function analysis for rapid identification of acute promyelocytic leukemia from acute myeloid leukemia with multiparameter flow cytometry. Int J Hematol 2016; 103:306-15. [DOI: 10.1007/s12185-015-1923-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/08/2015] [Accepted: 12/11/2015] [Indexed: 01/27/2023]
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25
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26
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Rajab A, Porwit A. Screening bone marrow samples for abnormal lymphoid populations and myelodysplasia-related features with one 10-color 14-antibody screening tube. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 88:253-60. [PMID: 25664445 DOI: 10.1002/cyto.b.21233] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 01/08/2015] [Accepted: 01/30/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND We have designed one-tube 14-antibody 10-color flow cytometry (FCM) panel that would provide maximum information on lymphoid and myeloid cell subsets in bone marrow aspirates (BMA) from patients with cytopenia(s). SAMPLES AND METHODS BMA from 8 normal donors, from 286 non-malignant hospital controls, 92 myelodysplastic syndromes (MDS), 47 myeloproliferative neoplasms (MPN), and from 14 MDS/MPN patients were investigated. One tube 14-monoclonal antibody (MAb) 10-fluorochrome panel included: kappa+CD4 FITC, Lambda+CD8 PE, CD3 + CD14 ECD, CD34 APC, CD20+CD56 PC7, CD10 APC-A750, CD19 APC-A700, CD33 PC5.5, CD5 PB, and CD45 KO. Kappa/lambda expression was evaluated separately in CD19+, CD10+ and CD5+ B-cells. CD4+CD3+, CD8+CD3+, CD5+CD3+ T-lymphocyte subsets were enumerated. Blasts were evaluated using CD45/SSC and CD34 gating. The FCM score for MDS (sc. Ogata score) included CD34+ myeloblast and B-progenitor cluster size, myeloblast/lymphocyte CD45 expression, and granulocyte/lymphocyte SSC ratio. RESULTS Abnormal lymphoid populations or increased plasma cells were found in 18 patients (4%). A 43/92 BMA from MDS and 7/14 from MDS/MPN patients had score >2. Score >2 had 92.5% positive predictive value for MDS/MDS-MPN diagnosis. Negative predictive value for MDS/MDS-MPN was 83% for scores under 3 and 88% for scores under 2. All but two of normal/hospital control samples had FCM score <3 (99%). Differences in scores between MDS & MDS/MPN and the control groups were statistically significant (P < 0.0001). CONCLUSIONS Our one-tube FCM panel can be easily applied to screening for aberrant lymphoid populations and myelodysplasia-related features. MDS scores >2 are highly indicative of MDS or MDS-MPN.
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Affiliation(s)
- Amr Rajab
- Flow Cytometry Laboratory, Department of Laboratory Hematology, Laboratory Medicine Program, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Anna Porwit
- Flow Cytometry Laboratory, Department of Laboratory Hematology, Laboratory Medicine Program, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
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Morales BP, Junior IN, Trilles L, Bertho AL, Oliveira RDVCD, Nishikawa MM, Elias MDS, Wanke B, Lazéra MDS. Determination of the minimum inhibitory concentration of Cryptococcus neoformans and Cryptococcus gattii against fluconazole by flow cytometry. Med Mycol 2014; 52:90-8. [PMID: 23808405 DOI: 10.3109/13693786.2013.806827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recent studies have used flow cytometry (FCM) as an important alternative method to determine the antifungal susceptibility of yeasts compared to the broth microdilution Clinical and Laboratory Standards Institute (CLSI) reference procedure. We present a comparative study of the broth microdilution method and flow cytometry to assess the in vitro antifungal susceptibility of Cryptococcus neoformans (n = 16) and C. gattii (n = 24) to fluconazole. The minimum inhibitory concentration (MIC) assays by flow cytometry were defined as the lowest drug concentration that showed ∼50% of the count of acridine orange negative cells compared to that of the growth control. Categorical classification showed all C. neoformans isolates were susceptible to fluconazole. Three isolates of C. gattii were susceptible dose-dependent and the remaining 21 isolates were classified as susceptible. MICs comparison of both methodologies demonstrated 100% categorical agreement of the results obtained for C. neoformans and C. gattii. The MICs obtained with the CLSI-approved method and flow cytometry were compared by the Spearman correlation test and a significant Pv = 0.001. The flow cytometric method has the advantage of analyzing a large and constant number of cells in less time, i.e., 9 h incubation for fluconazole using acridine orange versus 72 h for broth microdilution method. In conclusion, the two methods were comparable and flow cytometry method can expedite and improve the results of in vitro susceptibility tests of C. neoformans and C. gattii against fluconazole and also allows comparative studies in vitro/in vivo more rapidly, which along with clinical data, could assist in selecting the most appropriate treatment choice.
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Zini G, Kern W, Brereton M, Stephens AD. ICSH: on board for new projects. Int J Lab Hematol 2014; 36:306-12. [PMID: 24750677 DOI: 10.1111/ijlh.12232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/11/2014] [Indexed: 12/19/2022]
Abstract
The International Council for Standardization in Hematology (ICSH) is a not-for-profit organization aimed at improving global quality and harmonization of analytical methods, and achieving reliable and reproducible results in diagnostic hematology. ICSH co-ordinates Working Groups of experts to examine laboratory methods and instruments for hematological analyses, and co-operates with different international organizations which have similar scientific goals. Among seven ongoing approved projects, three ICSH projects have been selected and will be presented in the ICSH session at the XXVIIth ISLH International Symposium on Technological Innovations in Laboratory Hematology in The Hague, on May 2014. The project on 'Guideline for flow cytometric evaluation of patients with suspected acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS)' covers different aspects of the application of immunophenotyping by multiparameter flow cytometry (MFC) in the diagnosis of AML and MDS including integration into multimodal diagnostic workflow, quality control, antibody selection, interpretation of findings, reporting, and personnel. Data from the pilot study of the project for 'International Standardization of Hematology Reporting Units' suggest that there is a wide variation in reporting units for the routine blood cell count and highlights the areas of nomenclature and units of measurement where standardization is necessary and feasible, such as units for cell counts, white cell differentials, and hemoglobin concentration. The project on 'Standardization of HbA2 measurement and its implications for clinical practice' starts from the observation that different instruments give different results for hemoglobin A2; it is aimed at producing recommendations as to how instrument manufacturers and laboratories should assess their equipment before using it to analyze patient samples. These projects are examples of how the ICSH represents a great opportunity for scientists involved in hematology laboratory to participate in a process of expert collaboration and discussion all around the world.
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Affiliation(s)
- G Zini
- Catholic University of Sacred Heart, Rome, Italy
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Souza Melo CP, Campos CB, Dutra ÁP, Neto JCA, Fenelon AJS, Neto AH, Carbone EK, Pianovski MAD, Ferreira ACDS, Assumpcão JG. Correlation between FLT3-ITD status and clinical, cellular and molecular profiles in promyelocytic acute leukemias. Leuk Res 2014; 39:131-7. [PMID: 25530565 DOI: 10.1016/j.leukres.2014.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/11/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
Abstract
Internal tandem duplications (ITD) of FLT3 gene occur in about a third of acute promyelocytic leukemias (APL). We investigated the patterns of blood count, surface antigen, expression, chromosome aberrations, PML-RARa isoform, gene expression profile (GEP) and survival in 34 APL patients according to FLT3-ITD status. 97% had a t(15;17) and all of them carried PML-RARa gene fusion, 8 (23.5%) had a FLT3-ITD mutation. Presence of ITD was associated with higher Hb and WBC levels, bcr3 isoform, CD34 expression, CD2 or CD2/CD34 expression. In a multivariate analysis, Hb>9.6g/dL and WBC≥20 × 10(9)/L were important factors for predicting ITD presence. GEP showed that FLT3-ITD carriers clustered separately, even when as few as 5 genes were considered. This study provides further evidence that FLT3-ITDs carriers constitute a biologically distinct group of APL patients.
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Affiliation(s)
- Carolina Pereira Souza Melo
- Laboratório BIOCOD Biotecnologia Ltda., Av. das Nações 2448, Portaria A, Vespasiano CEP 33200-000, MG, Brazil.
| | - Catharina Brant Campos
- Laboratório BIOCOD Biotecnologia Ltda., Av. das Nações 2448, Portaria A, Vespasiano CEP 33200-000, MG, Brazil.
| | - Álvaro Pimenta Dutra
- Hospital Santa Casa de Misericórdia de Belo Horizonte, Av. Francisco Sales 1111, Belo Horizonte CEP 30150-221, MG, Brazil.
| | - Joaquim Caetano Aguirre Neto
- Hospital Santa Casa de Misericórdia de Belo Horizonte, Av. Francisco Sales 1111, Belo Horizonte CEP 30150-221, MG, Brazil.
| | - Alexandre José Silva Fenelon
- Hospital Santa Casa de Misericórdia de Belo Horizonte, Av. Francisco Sales 1111, Belo Horizonte CEP 30150-221, MG, Brazil.
| | - Abrahão Hallack Neto
- Hospital Universitário da Universidade Federal de Juiz de Fora, Rua Catulo Breviglieri s/n, Juiz de Fora CEP 36036-110, MG, Brazil.
| | - Edna Kakitani Carbone
- Hospital Pequeno Príncipe, Rua Desembargador Motta 1070, Curitiba CEP 80250-060, PR, Brazil.
| | | | | | - Juliana Godoy Assumpcão
- Laboratório BIOCOD Biotecnologia Ltda., Av. das Nações 2448, Portaria A, Vespasiano CEP 33200-000, MG, Brazil; Setor de Pesquisa e Desenvolvimento-Instituto Hermes Pardini, Av. das Nações 2448, Portaria A, Vespasiano CEP 33200-000, MG, Brazil.
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Oberley MJ, Fitzgerald S, Yang DT, Morgan A, Johnson J, Leith C. Value-based flow testing of chronic lymphoproliferative disorders: a quality improvement project to develop an algorithm to streamline testing and reduce costs. Am J Clin Pathol 2014; 142:411-8. [PMID: 25125633 DOI: 10.1309/ajcp0swzj6gbdhpf] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Flow cytometry is essential for the evaluation of lymphoproliferative disorders (LPDs) and their classification. Flow panels routinely incorporate a large array of antibodies, making testing complex and expensive; such panels are likely unnecessary in benign cases or those with straightforward diagnoses. Our aim was to develop a more cost-effective testing strategy based on a retrospective analysis of flow studies for possible LPDs in blood. METHODS We identified LPD frequencies and types, as well as associated results with patient age and absolute lymphocyte count. RESULTS We found that the likelihood of LPDs increased with patient age and absolute lymphocyte count and that CD5-positive LPD was the most common LPD diagnosed in our institution (71% of LPDs). Using these data, we devised flow-testing algorithms with a screening test for patients at low risk of disease and a focus on CD5-positive LPD detection, with reflexing as needed. CONCLUSIONS We project this approach will result in a 40% decrease in antibody utilization.
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Affiliation(s)
- Matthew J. Oberley
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | - Sean Fitzgerald
- Department of Pathology, University of Texas Medical Branch, Galveston
| | - David T. Yang
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | - Adam Morgan
- Department of Pathology, St Mary’s Hospital, Madison, WI
| | - Joyce Johnson
- Flow Cytometry Laboratory, University of Wisconsin Hospital and Clinics, Madison
| | - Catherine Leith
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison
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Semanaj V, Pecani A, Dedej T, Barbullushi A, Ylli Z, Curaj T, Pulluqi P, Caja T, Perolla A, Ivanaj A, Xhumari P, Sulcebe G. The Diagnostic Value of Flow Cytometry Imunophenotyping in an Albanian Patient Population with a Preliminary Clinical Diagnosis of Chronic Lymphocytic Leukemia. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: Based on the flow cytometry multiparametric immunophenotyping methodology we studied some useful cell marker criteria needed for the practical differentiation of the chronic lymphocytic leukemia from other chronic limphoproliferative diseases with a leukemic component.Materials and Methods: The applied methodology is a four color flow cytometry multiparametric immunophenotyping technique using EDTA blood samples taken from 84 consecutive patients diagnosed with CLL through a preliminary clinical and white blood cell examination. The following fluorescent stained monoclonal antibodies were used: CD3, CD4, CD5, CD8, CD11c, CD19, CD20, CD23, CD25, FMC7 and kappa/lambda light chains.Results: From the 84 individuals tested, 2 out of them (2.4%) resulted with a abnormal T-cell population while 82 (97.6%) showed a pathological B cell line. 58 (69.1%) patients resulted with typical CLL markers (CD19+CD5+CD23+) while 5 (5.9%) of them presented a non typical chronic lymphocytic leukemia profile (CD19+CD5+CD23-). 19 (22.6%) out of patients displayed an abnormal CD19+CD5- B cell population. A statistically significant correlation was found between the clinical stage of CLL and the positivity for the CD38 marker (p=0.04).Conclusion: Flow cytometry immunophenotyping is a fundamental examination for the final diagnosis of chronic lymphocytic leukemia. The expression of CD38+ in CLL patients stands for a more advanced clinical stage.
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Barnett D, Louzao R, Gambell P, De J, Oldaker T, Hanson CA. Validation of cell-based fluorescence assays: Practice guidelines from the ICSH and ICCS - part IV - postanalytic considerations. CYTOMETRY PART B-CLINICAL CYTOMETRY 2013; 84:309-14. [DOI: 10.1002/cyto.b.21107] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 05/20/2013] [Accepted: 06/14/2013] [Indexed: 11/08/2022]
Affiliation(s)
- David Barnett
- UK NEQAS for Leucocyte Immunophenotyping; Department of Haematology, Royal Hallamshire Hospital; Sheffield England
| | - Raaul Louzao
- Immunology Quality Assessment, Duke University; Durham, North Carolina USA
| | - Peter Gambell
- Department of Pathology, Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
| | - Jitakshi De
- DeePath Medical Inc.; Palo Alto CA 94301 USA
| | - Teri Oldaker
- Genoptix Medical Laboratory; Rutherford Carlsbad California USA
| | - Curtis A. Hanson
- Mayo Clinic College of Medicine, Department of Laboratory Medicine and Pathology; Rochester Minnesota
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Davis BH, Dasgupta A, Kussick S, Han JY, Estrellado A. Validation of cell-based fluorescence assays: practice guidelines from the ICSH and ICCS - part II - preanalytical issues. CYTOMETRY PART B-CLINICAL CYTOMETRY 2013; 84:286-90. [DOI: 10.1002/cyto.b.21105] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 05/20/2013] [Accepted: 06/14/2013] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | - Jin-Yeong Han
- Dong-A University College of Medicine; Busan South Korea
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Discrimination of malignant neutrophils of chronic myelogenous leukemia from normal neutrophils by support vector machine. Comput Biol Med 2013; 43:1192-5. [DOI: 10.1016/j.compbiomed.2013.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/06/2013] [Accepted: 06/09/2013] [Indexed: 11/20/2022]
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Liu Q, Wang M, Hu Y, Xing H, Chen X, Zhang Y, Zhu P. Significance of CD71 expression by flow cytometry in diagnosis of acute leukemia. Leuk Lymphoma 2013; 55:892-8. [PMID: 23962073 DOI: 10.3109/10428194.2013.819100] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In this study we investigated the significance of CD71 (transferrin receptor 1, TfR-1) as a flow cytometric marker in the diagnosis of acute leukemia (AL). A total of 105 patients with AL were enrolled. Poorly differentiated acute myeloid leukemias (AMLs) (including minimally differentiated AML, AML without maturation, AML with maturation, acute myelomonocytic leukemia) tended to express high levels of CD71 on leukemic cells, while partially differentiated AML (including acute promyelocytic leukemia and acute monocytic leukemia) often expressed low levels of CD71 on leukemic cells (p < 0.05, compared to poorly differentiated AML). B-cell acute lymphoblastic leukemia (B-ALL) expressed low levels of CD71 on leukemic cells, significantly lower than AML, mixed phenotype acute leukemia (MPAL) and normal bone marrow blasts (p < 0.05). In the seven cases of acute erythroid leukemia (AEL), leukemic cells rarely expressed CD71, with the mean CD71 expression level significantly lower than that of acute megakaryocytic leukemia (p < 0.05), and also lower than that of poorly differentiated AML and normal blasts but without statistical significance. CD71 may not be a specific marker for AEL leukemic cells. During the process from myeloid dysplasia to apparent leukemic cells, both CD71 and CD34 gradually increased. Consequently, the presence of leukemic cell subsets with variable levels of CD71 and CD34 may be useful for understanding the dynamic processes involved in the clonal development seen in leukemias.
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Affiliation(s)
- Qian Liu
- Department of Hematology, Peking University First Hospital , Beijing , China
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Heel K, Tabone T, Röhrig KJ, Maslen PG, Meehan K, Grimwade LF, Erber WN. Developments in the immunophenotypic analysis of haematological malignancies. Blood Rev 2013; 27:193-207. [PMID: 23845589 DOI: 10.1016/j.blre.2013.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Immunophenotyping is the method by which antibodies are used to detect cellular antigens in clinical samples. Although the major role is in the diagnosis and classification of haematological malignancies, applications have expanded over the past decade. Immunophenotyping is now used extensively for disease staging and monitoring, to detect surrogate markers of genetic aberrations, to identify potential immuno-therapeutic targets and to aid prognostic prediction. This expansion in applications has resulted from developments in antibodies, methodology, automation and data handling. In this review we describe recent advances in both the technology and applications for the analysis of haematological malignancies. We highlight the importance of the expanding repertoire of testing capability for diagnostic, prognostic and therapeutic applications. The impact and significance of immunophenotyping in the assessment of haematological neoplasms are evident.
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Affiliation(s)
- Kathy Heel
- Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA 6009, Australia.
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37
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Sack U, Barnett D, Demirel GY, Fossat C, Fricke S, Kafassi N, Nebe T, Psarra K, Steinmann J, Lambert C. Accreditation of flow cytometry in Europe. CYTOMETRY PART B-CLINICAL CYTOMETRY 2013; 84:135-42. [DOI: 10.1002/cyto.b.21079] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 01/13/2013] [Accepted: 01/16/2013] [Indexed: 11/06/2022]
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Kalina T, Flores-Montero J, van der Velden VHJ, Martin-Ayuso M, Böttcher S, Ritgen M, Almeida J, Lhermitte L, Asnafi V, Mendonça A, de Tute R, Cullen M, Sedek L, Vidriales MB, Pérez JJ, te Marvelde JG, Mejstrikova E, Hrusak O, Szczepański T, van Dongen JJM, Orfao A. EuroFlow standardization of flow cytometer instrument settings and immunophenotyping protocols. Leukemia 2012; 26:1986-2010. [PMID: 22948490 PMCID: PMC3437409 DOI: 10.1038/leu.2012.122] [Citation(s) in RCA: 521] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The EU-supported EuroFlow Consortium aimed at innovation and standardization of immunophenotyping for diagnosis and classification of hematological malignancies by introducing 8-color flow cytometry with fully standardized laboratory procedures and antibody panels in order to achieve maximally comparable results among different laboratories. This required the selection of optimal combinations of compatible fluorochromes and the design and evaluation of adequate standard operating procedures (SOPs) for instrument setup, fluorescence compensation and sample preparation. Additionally, we developed software tools for the evaluation of individual antibody reagents and antibody panels. Each section describes what has been evaluated experimentally versus adopted based on existing data and experience. Multicentric evaluation demonstrated high levels of reproducibility based on strict implementation of the EuroFlow SOPs and antibody panels. Overall, the 6 years of extensive collaborative experiments and the analysis of hundreds of cell samples of patients and healthy controls in the EuroFlow centers have provided for the first time laboratory protocols and software tools for fully standardized 8-color flow cytometric immunophenotyping of normal and malignant leukocytes in bone marrow and blood; this has yielded highly comparable data sets, which can be integrated in a single database.
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Affiliation(s)
- T Kalina
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University (DPH/O), Prague, Czech Republic
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van Dongen JJM, Orfao A. EuroFlow: Resetting leukemia and lymphoma immunophenotyping. Basis for companion diagnostics and personalized medicine. Leukemia 2012; 26:1899-907. [PMID: 22948488 PMCID: PMC3437406 DOI: 10.1038/leu.2012.121] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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van Dongen JJM, Lhermitte L, Böttcher S, Almeida J, van der Velden VHJ, Flores-Montero J, Rawstron A, Asnafi V, Lécrevisse Q, Lucio P, Mejstrikova E, Szczepański T, Kalina T, de Tute R, Brüggemann M, Sedek L, Cullen M, Langerak AW, Mendonça A, Macintyre E, Martin-Ayuso M, Hrusak O, Vidriales MB, Orfao A. EuroFlow antibody panels for standardized n-dimensional flow cytometric immunophenotyping of normal, reactive and malignant leukocytes. Leukemia 2012; 26:1908-75. [PMID: 22552007 PMCID: PMC3437410 DOI: 10.1038/leu.2012.120] [Citation(s) in RCA: 656] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 02/14/2012] [Accepted: 04/19/2012] [Indexed: 12/21/2022]
Abstract
Most consensus leukemia & lymphoma antibody panels consist of lists of markers based on expert opinions, but they have not been validated. Here we present the validated EuroFlow 8-color antibody panels for immunophenotyping of hematological malignancies. The single-tube screening panels and multi-tube classification panels fit into the EuroFlow diagnostic algorithm with entries defined by clinical and laboratory parameters. The panels were constructed in 2-7 sequential design-evaluation-redesign rounds, using novel Infinicyt software tools for multivariate data analysis. Two groups of markers are combined in each 8-color tube: (i) backbone markers to identify distinct cell populations in a sample, and (ii) markers for characterization of specific cell populations. In multi-tube panels, the backbone markers were optimally placed at the same fluorochrome position in every tube, to provide identical multidimensional localization of the target cell population(s). The characterization markers were positioned according to the diagnostic utility of the combined markers. Each proposed antibody combination was tested against reference databases of normal and malignant cells from healthy subjects and WHO-based disease entities, respectively. The EuroFlow studies resulted in validated and flexible 8-color antibody panels for multidimensional identification and characterization of normal and aberrant cells, optimally suited for immunophenotypic screening and classification of hematological malignancies.
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Affiliation(s)
- J J M van Dongen
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam (Erasmus MC), Rotterdam, The Netherlands.
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Song JY, Filie AC, Venzon D, tevenson MSS, Yuan CM. Flow cytometry increases the sensitivity of detection of leukemia and lymphoma cells in bronchoalveolar lavage specimens. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2012; 82:305-12. [PMID: 22837143 PMCID: PMC3598592 DOI: 10.1002/cyto.b.21033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 05/08/2012] [Accepted: 05/31/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Recent studies have definitively determined that flow cytometry (FC) is significantly more sensitive than cytomorphology (CM) in detection of hematolymphoid neoplasms (HLNs). However, its utility in paucicellular bronchoalveolar lavage (BAL) specimens has not been established. METHODS FC was performed on BAL specimens submitted from 44 patients with a prior diagnosis of HLN. Panels chosen were based upon cellularity of specimen and patient history. FC results were compared with concurrent CM evaluations. RESULTS All 44 BALs were deemed satisfactory for FC and yielded informative results that assisted in diagnosis. Diagnoses included 22/44 B-cell neoplasms, 16/44 T-cell neoplasms, four/44 myeloid neoplasms, and two/44 plasma cell neoplasms. Overall concordance was demonstrated between FC and CM in 77% (34/44) of cases. In nine/44 cases (20%), one technique (FC or CM) clearly detected malignant cells when the other did not. FC was more sensitive than CM in detecting a HLN in eight/nine discordant cases. In only one case (one/44, 2%) were malignant HLN cells suspected by CM, but not identified by FC (one/44, 2%). CONCLUSION We demonstrate, in the largest series published to date, that FC can be performed on BAL specimens. FC is indicated in evaluation of BAL for HLN and improves sensitivity of detection of HLN over CM alone. An integrated FC and CM approach is superior to either technique alone in diagnostic evaluation of BAL.
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Affiliation(s)
- Joo Y. Song
- Hematopathology section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Armando C. Filie
- Cytopathology section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - David Venzon
- Biostatistics and Data Management Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Constance M. Yuan
- Hematopathology section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Patkar N, Nair S, Alex AA, Parihar M, Manipadam MT, Arora N, Ahmed R, Abraham A, George B, Viswabandya A, Srivastava V, Srivastava A, Mathews V. Clinicopathological features of hepatosplenic T cell lymphoma: a single centre experience from India. Leuk Lymphoma 2012; 53:609-15. [DOI: 10.3109/10428194.2011.622421] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Technological advances in flow cytometry include increasingly sophisticated instruments and an expanding range of fluorochromes. These advances are making it possible to detect an increasing number of markers on a single cell. The term polychromatic flow cytometry applies to such systems that detect five or more markers simultaneously. This review provides an overview of the current and future impact of polychromatic flow cytometry in the clinical laboratory. The use of multiple markers has several advantages in the diagnosis and monitoring of haematological malignancies. Cell populations can be analysed more comprehensively and efficiently, and abnormal populations can be distinguished more readily when normal counterparts are present. Polychromatic flow cytometry is particularly useful in the evaluation of plasma cells, and the role of flow cytometry in the assessment of plasma cell disorders is reviewed in depth. There is improved sensitivity in the assessment of small populations, which is critical in the evaluation of minimal residual disease. Flow cytometry can also play a role in assessment of circulating tumour cells in carcinoma. Introduction of polychromatic flow cytometry is a complex process with many challenges including design of antibody panels and instrument compensation. Developments in data analysis are required to realise the full benefits of the other technical advances. Standardisation of protocols may reduce inter-laboratory variation. While the complexity of polychromatic flow cytometry creates challenges, it has substantial potential to improve clinical analysis.
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Giraldo PC, de Carvalho JBJ, do Amaral RLG, da Silveira Gonçalves AK, Eleutério J, Guimarães F. Identification of immune cells by flow cytometry in vaginal lavages from women with vulvovaginitis and normal microflora. Am J Reprod Immunol 2011; 67:198-205. [PMID: 22151521 DOI: 10.1111/j.1600-0897.2011.01093.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PROBLEM The extent of the vaginal immune response is not fully determined. The purpose of this study was to evaluate the vaginal immune cells from women with vulvovaginitis (VV). METHOD OF STUDY A total of 142 volunteers diagnosed with bacterial vaginosis (BV), vulvovaginal candidiasis (VC), and BV associated with VC or normal microflora were sampled to evaluate the immune cells by flow cytometry. The immune cells were obtained by vaginal lavage and labeled with fluorochrome-conjugated monoclonal antibodies to identify neutrophil granulocytes, macrophages, CD4(+) and CD8(+) T lymphocytes, B lymphocytes, and NK lymphocytes. RESULTS Neutrophil granulocytes were present in 84.6% of samples among the leukocyte populations. Considering samples in which neutrophils were present, the mean percentage of neutrophil granulocytes was significantly higher in women with VC than BV and normal microflora and was significantly lower in women with BV than normal microflora. Macrophages and lymphocytes were present in a lower percentage of samples. The mean percentage of CD4(+) T lymphocytes in vaginal lavages was significantly higher in VC and BV compared with women with normal microflora. CONCLUSIONS Neutrophils were the predominant leukocytes and were associated with VC and inversely with BV. CD4(+) T lymphocytes were associated with both VC and BV.
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Durrieu F, Geneviève F, Arnoulet C, Brumpt C, Capiod JC, Degenne M, Feuillard J, Garand R, Kara-Terki A, Kulhein E, Maynadié M, Ochoa-Noguera ME, Plesa A, Roussel M, Eghbali H, Truchan-Graczyk M, de Carvalho Bittencourt M, Feugier P, Béné MC. Normal levels of peripheral CD19+CD5+ CLL-like cells: Toward a defined threshold for CLL follow-up-A GEIL-GOELAMS study. CYTOMETRY PART B-CLINICAL CYTOMETRY 2011; 80:346-53. [DOI: 10.1002/cyto.b.20613] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Revised: 07/02/2011] [Accepted: 07/08/2011] [Indexed: 11/08/2022]
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Varma N, Naseem S. Application of flow cytometry in pediatric hematology-oncology. Pediatr Blood Cancer 2011; 57:18-29. [PMID: 21462301 DOI: 10.1002/pbc.22954] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 11/09/2010] [Indexed: 11/08/2022]
Abstract
Applications of flow cytometry in pediatric cancers have expanded substantially in recent years. In acute leukemias, the commonest childhood cancer, flow cytometry can now define complex antigenic profiles that are associated with specific cytogenetic/molecular defects and can also directly identify BCR-ABL fusion protein. Flow cytometry based scoring system has been described for diagnosis of myelodysplastic syndromes. In solid tumors, flow cytometry was previously used mainly to determine DNA content for prognosis; however, recent studies in children with neuroblastoma and Ewing sarcoma have identified its diagnostic utility. In this review, we will discuss the current and future applications of flow cytometry in pediatric hematology-oncology.
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Affiliation(s)
- Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, India.
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Yuan CM, Stetler-Stevenson M. Role of flow cytometry of peripheral blood and bone marrow aspirates in early myeloma. Semin Hematol 2011; 48:32-8. [PMID: 21232656 DOI: 10.1053/j.seminhematol.2010.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Flow cytometric immunophenotyping (FCM) of multiple myeloma (MM) is commonly accepted in academic centers as providing clinically significant information and is becoming increasingly utilized in the private setting. FCM has established clinical relevance in the following: (1) differential diagnosis of MM from other plasma cell dyscrasias; (2) differentiating MM from lymphoplasmacytic lymphoma (LPL) and other non-Hodgkin lymphomas; (3) diagnosis of unusual cases of myeloma (eg, to confirm the diagnosis of rare cases of IgM MM); (4) determining the risk of progression of monoclonal gammopathy of uncertain significance (MGUS) and smoldering MM; (5) prognostication in MM; and (6) minimal residual disease detection (MRD) post therapy. FCM may have an emerging role in the enumeration of abnormal plasma cells in diagnosis of MM, but further studies are needed. We review the clinical value of FCM in evaluation of peripheral blood and bone marrow in early myeloma.
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Affiliation(s)
- Constance M Yuan
- Flow Cytometry Unit, Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Della Porta MG, Lanza F, Del Vecchio L. Flow cytometry immunophenotyping for the evaluation of bone marrow dysplasia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2011; 80:201-11. [PMID: 21674774 DOI: 10.1002/cyto.b.20607] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 05/06/2011] [Accepted: 05/17/2011] [Indexed: 01/28/2023]
Abstract
The pathological hallmark of myelodysplastic syndromes (MDS) is marrow dysplasia, which represents the basis of the WHO classification of these disorders. This classification provides clinicians with a useful tool for defining the different subtypes of MDS and determining individual prognosis. The WHO proposal has raised some concern regarding minimal diagnostic criteria particularly in patients with normal karyotype without robust morphological markers of dysplasia (such as ring sideroblasts or excess of blasts). Therefore, there is clearly a need to refine the accuracy to detect marrow dysplasia. Flow cytometry (FCM) immunophenotyping has been proposed as a tool to improve the evaluation of marrow dysplasia. Rationale for the application of FCM in the diagnostic work up of MDS is that immunophenotyping is an accurate method for quantitative and qualitative evaluation of hematopoietic cells and that MDS have been found to have abnormal expression of several cellular antigens. To become clinically applicable, FCM analysis should be based on parameters with sufficient specificity and sensitivity, data should be reproducible between different operators and the results should be easily understood by clinicians. In this report, we reviewed the most relevant progresses in detection of marrow dysplasia by FCM in MDS as defined by WHO criteria.
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Affiliation(s)
- Matteo Giovanni Della Porta
- Department of Hematology Oncology, University of Pavia Medical School and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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Flow cytometry as a diagnostic tool in the early diagnosis of aggressive lymphomas mimicking life-threatening infection. Case Rep Med 2011; 2011:743817. [PMID: 21687548 PMCID: PMC3114563 DOI: 10.1155/2011/743817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 03/08/2011] [Accepted: 04/12/2011] [Indexed: 11/18/2022] Open
Abstract
Aggressive lymphomas can present with symptoms mimicking life-threatening infection. Flow cytometry (FC) is usually recommended for the classification and staging of lymphomas in patients with organomegaly and atypical cells in effusions and blood, after the exclusion of other possible diagnoses. FC may also have a place in the initial diagnostic investigation of aggressive lymphoma. Three cases are presented here of highly aggressive lymphomas in young adults, which presented with the clinical picture of fever of unknown origin (FUO) in patients severely ill. All followed a life-threatening clinical course, and two developed the hemophagocytic syndrome (HPS), but microbiological, immunological, and morphological evaluation and immunohistochemistry (IHC) failed to substantiate an early diagnosis. FC was the technique that provided conclusive diagnostic evidence of lymphoma, subsequently verified by IHC. Our experience with these three cases highlights the potential role of FC as an adjunct methodology in the initial assessment of possible highly aggressive lymphoma presenting with the signs and symptoms of life-threatening infection, although the definitive diagnosis should be established by biopsy. In such cases, FC can contribute to the diagnosis of lymphoma, independently of the presence of HPS.
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Calvo KR, McCoy CS, Stetler-Stevenson M. Flow cytometry immunophenotyping of hematolymphoid neoplasia. Methods Mol Biol 2011; 699:295-316. [PMID: 21116989 DOI: 10.1007/978-1-61737-950-5_14] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Flow cytometry immunophenotyping (FCI) of hematolymphoid specimens is a powerful tool in clinical medicine aiding in the accurate diagnosis and subclassification of acute and chronic leukemias, non-Hodgkin lymphomas, myelodysplasia, and other hematolymphoid neoplastic processes. Multiple flow cytometric strategies are used to evaluate hematolymphoid populations, including identification of neoplastic populations with aberrant immunophenotypes, abnormal maturation patterns, monotypic kappa/lambda light chain expression, restricted V-beta expression, and abnormal light scatter properties. In this chapter, we present a general approach to analyze hematolymphoid populations. Specimen handling, gating strategies, and appropriate antibody panels for flow cytometric detection of abnormal hematologic populations are presented.
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Affiliation(s)
- Katherine R Calvo
- Department of Laboratory Medicine, Hematology Section, National Institutes of Health Clinical Center, Bethesda, MD, USA
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