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Al-Zubaidi HK, Hughes SF. The Use of CD200 in the Differential Diagnosis of B-Cell Lymphoproliferative Disorders. Br J Biomed Sci 2023; 80:11573. [PMID: 37822353 PMCID: PMC10563807 DOI: 10.3389/bjbs.2023.11573] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023]
Abstract
Background: B-Cell Lymphoproliferative Disorders (B-LPDs) are a group of heterogenous disorders characterised by the accumulation of B-cells in peripheral blood, bone marrow, lymph nodes and spleen. They have a variable disease course and outcome and many share similar features making differential diagnosis challenging. Therefore, accurate diagnosis is fundamental in particular for determining treatment options. Immunophenotyping by flow cytometry plays a crucial role in the diagnosis of B-LPDs. However, overlapping immunophenotyping patterns exist and the use of novel monoclonal antibodies has become increasingly important in immunophenotyping analysis. More recently differential expression of CD200 has been reported in various B-LPDs and that CD200 may improve the differentiation between chronic lymphocytic leukaemia (CLL) and mantle cell lymphoma (MCL). In this study CD200 expression is evaluated in different B-LPDs. Methods: A total of 100 samples were collected and analysed by immunophenotyping flow cytometry over a period of 1 year (2017-2018), by a panel of monoclonal antibodies including CD200. The percentage of CD200 and its expression intensity was evaluated and compared between different groups of B-LPDs. Results: All of the 50 cases of CLL expressed CD200 with moderate to bright intensity, 6 MCL cases lacked the expression of CD200. Furthermore, all 5 cases of hairy cell leukaemia (HCL) expressed CD200. Out of all B-LPDs evaluated, CD200 expression in HCL cases was noted to be the brightest. The other 39 cases were not found to be B-LPDs. Conclusion: CD200 has an important role in differentiating CLL from MCL, HCL has a consistent bright expression of CD200. By adding CD200 to the combinations of markers in routine testing panel, Immunophenotyping by flow cytometry can be an effective tool in the diagnosis of B-LPDs especially in cases with atypical immunophenotyping pattern. Our result support that CD200 can be added to routine testing panel as it is useful in differentiating them.
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MESH Headings
- Humans
- Antibodies, Monoclonal/metabolism
- B-Lymphocytes/metabolism
- B-Lymphocytes/pathology
- Diagnosis, Differential
- Flow Cytometry
- Immunophenotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Lymphoma, Mantle-Cell/diagnosis
- Lymphoma, Mantle-Cell/pathology
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Affiliation(s)
- Hanaan Kareem Al-Zubaidi
- Pathology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Stephen Fôn Hughes
- Maelor Academic Unite (MAU), Betsi Cadwaladr University Health Board, Wrexham, United Kingdom
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2
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Yu J, Zhao SS, Chen X, Qiao C, Wang R, Li JY, Wu YJ. [The value of CD200 in differential diagnosis of classic hairy cell leukemia and variant hairy cell leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:775-779. [PMID: 38049324 PMCID: PMC10630581 DOI: 10.3760/cma.j.issn.0253-2727.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 12/06/2023]
Affiliation(s)
- J Yu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - S S Zhao
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - X Chen
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - C Qiao
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - R Wang
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - J Y Li
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Y J Wu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
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Jin HM, Qiao C, Zhao SS, Qiu HR, Chen X, Yang H, Zhu LY, Li JY, Wu YJ. [Study of cytogenetics and molecular biology in typical and atypical immunophenotypic chronic lymphocytic leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:469-474. [PMID: 35968589 PMCID: PMC9800222 DOI: 10.3760/cma.j.issn.0253-2727.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Indexed: 01/01/2023]
Abstract
Objective: To analyze the differences in immunophenotype, cytogenetics, and molecular biology between typical and atypical immunophenotype chronic lymphocytic leukemia (CLL) , and explore the correlation of cytogenetic anomalies with gene mutations. Methods: This study included 488 patients diagnosed in the First Affiliated Hospital of Nanjing Medical University between November 2014 and May 2021. Of these, 382 patients scored 4-5 points, which was typical CLL (tCLL) , and 106 scored 3 points, which was atypical CLL (aCLL) as per the Royal Marsden Hospital Immunomarker Integral System. Peripheral blood cells were collected for immunophenotype by multiparameter flow cytometry in 488 patients, fluorescence in situ hybridization (FISH) was employed to detect cytogenetic anomalies in 359 patients, and gene mutations were detected by next-generation sequencing (NGS) in 330 patients. Results: The positive rates of CD10, CD22, CD49d, CD81, and FMC7 were significantly higher in the aCLL compared with the tCLL group (P=0.020, P<0.001, P<0.001, P=0.027, and P<0.001, respectively) , while the positive rates of CD5, CD23, CD148, and CD200 were lower in the former compared to the latter (P<0.001, P=0.017, P=0.041, and P<0.001, respectively) . aCLL exhibited a higher frequency of trisomy 12 and lower frequency of del (13q14) compared to the tCLL group (P<0.001 and P<0.001, respectively) . Moreover, aCLL patients also showed a higher incidence of NOTCH1 mutations than the tCLL patients (P=0.038) , while no statistically significant differences in other gene mutations occurred between the two groups. No significant differences in overall survival (OS) and treatment-free survival (TFS) occurred between aCLL and tCLL using Kaplan-Meier analysis (P>0.05) . Conclusion: aCLL has characteristic immunophenotype, cytogenetic, and somatic mutation that differ from tCLL, and this can provide reliable information for the diagnosis and differential diagnosis between the two groups.
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Affiliation(s)
- H M Jin
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Hematology Department, Nanjing 210029, China
| | - C Qiao
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Hematology Department, Nanjing 210029, China
| | - S S Zhao
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Hematology Department, Nanjing 210029, China
| | - H R Qiu
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Hematology Department, Nanjing 210029, China
| | - X Chen
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Hematology Department, Nanjing 210029, China
| | - H Yang
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Hematology Department, Nanjing 210029, China
| | - L Y Zhu
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Hematology Department, Nanjing 210029, China
| | - J Y Li
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Hematology Department, Nanjing 210029, China
| | - Y J Wu
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Hematology Department, Nanjing 210029, China
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4
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Sorigue M, Raya M, Vergara S, Junca J. Concordance between flow cytometry CLL scores. Int J Lab Hematol 2021; 43:743-751. [PMID: 33949096 DOI: 10.1111/ijlh.13567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/19/2021] [Accepted: 04/13/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Multiple flow cytometry scores/diagnostic systems for the classification of leukemic lymphoproliferative disorders (LPD) have been published but few have been compared between them. PATIENTS AND METHODS We classified a cohort of leukemic LPD based on eleven published flow cytometry scores/diagnostic systems and compared their classification as chronic lymphocytic leukemia (CLL) or non-CLL LPD. RESULTS 329 patients were included. Patients classified as CLL ranged from 46% to 73%, depending on the score/diagnostic system used. All eleven scores/diagnostic systems agreed in 184/324 (57%) of patients while in 58/324 (18%) at least two scores/diagnostic systems classified the patient differently (from the majority). Fleiss kappa was 0.74, but pairwise agreement was variable (Cohen's kappa: 0.48 to 0.87). CONCLUSION This study found a suboptimal agreement between published flow cytometry scores/diagnostic systems for the classification of LPD.
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Affiliation(s)
- Marc Sorigue
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol. Functional Cytomics- IJC, LUMN, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Minerva Raya
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol. Functional Cytomics- IJC, LUMN, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Sara Vergara
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol. Functional Cytomics- IJC, LUMN, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jordi Junca
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol. Functional Cytomics- IJC, LUMN, Universitat Autònoma de Barcelona, Badalona, Spain
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Jalal SD. The contribution of CD200 to the diagnostic accuracy of Matutes score in the diagnosis of chronic lymphocytic leukemia in limited resources laboratories. PLoS One 2021; 16:e0247491. [PMID: 33606850 PMCID: PMC7895405 DOI: 10.1371/journal.pone.0247491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/04/2021] [Indexed: 12/15/2022] Open
Abstract
Flow cytometry immunophenotyping has an essential role in distinguishing chronic lymphocytic leukemia from other B-chronic lymphoproliferative disorders. Recently, CD200 is considered as a relatively consistent marker in chronic lymphocytic leukemia. We retrospectively assessed CD200 expression in 252 patients with B chronic lymphoproliferative disorders with four-color flow cytometry. CD200 expression estimation included the proportion of positive cells (≥30%) and the mean fluorescence intensity ratio. Additionally, we have incorporated CD200 into Matutes score, also replaced FMC7 and CD79b in an attempt to improve the score discriminative power. Of 252 patients enrolled, 199(79%) patients were classified as chronic lymphocytic leukemia and 53 (21%) as other B-chronic lymphoproliferative disorders. All chronic lymphocytic leukemia cases and 20 of 53 (37.7%) of other B-chronic lymphoproliferative disorders demonstrated high CD200 expression (≥30%). Further, CD200 (≥30%) revealed a higher accuracy in comparison to other markers in Matutes score (range: 51%–92.5%). Also, CD200 addition to the Matutes score has correctly recognized all 199 chronic lymphocytic leukemia cases including 10 atypical chronic lymphocytic leukemia cases. As for non-CLL cases, 20 of 53 attained a higher score, yet keeping the original diagnosis. Moreover, CD200 enhanced the diagnostic accuracy of Matutes score to 100%, and when included in a simplified 4-markers score, showed an accuracy of 99.8% compared to 99.4% of Matutes score. In conclusion, CD200 is an accurate diagnostic marker for chronic lymphocytic leukemia, and can refine the modified Matutes score accuracy when added with other markers.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antigens, CD/blood
- Biomarkers, Tumor/blood
- Diagnosis, Differential
- Female
- Flow Cytometry
- Humans
- Immunophenotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Male
- Middle Aged
- Retrospective Studies
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Affiliation(s)
- Sana Dlawar Jalal
- Department of Pathology, College of Medicine, University of Sulaimani, Sulaimani, Iraq
- * E-mail:
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6
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Debord C, Wuillème S, Eveillard M, Theisen O, Godon C, Le Bris Y, Béné MC. Flow cytometry in the diagnosis of mature B-cell lymphoproliferative disorders. Int J Lab Hematol 2021; 42 Suppl 1:113-120. [PMID: 32543070 DOI: 10.1111/ijlh.13170] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/27/2020] [Accepted: 01/31/2020] [Indexed: 12/19/2022]
Abstract
B-lineage lymphoproliferative disorders (LPD) are rather frequent diseases, associated with specific clinical or biological features but also sometimes of fortuitous discovery. Multiparameter flow cytometry plays a major role for a rapid diagnostic indication, on peripheral blood or bone marrow samples in most instances, guiding complementary analyses and allowing for the proper therapeutic management of patients. After describing the important pre-analytical precautions required for an adequate assessment, the immunophenotypic features of small-cell and large-cell lymphomas are described in this review. The ubiquitous expression of CD19 is a first mandatory gating step. A possible clonal proliferation is then suspected by the demonstration of surface immunoglobulin light chain restriction. The aberrant presence of CD5 allows to segregate chronic lymphocytic leukemia and mantle cell lymphoma in most cases. Other LPD exhibit specific immunophenotypic features. A table of useful markers and a decision tree are provided. Of note, immunophenotypic data should as much as possible be interpreted in an integrated manner, involving the patient's clinical and other biological features, and be completed by further chromosomal and/or molecular investigations.
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Affiliation(s)
- Camille Debord
- Hematology Biology Department, Nantes University Hospital and CRCINA, Nantes, France
| | - Soraya Wuillème
- Hematology Biology Department, Nantes University Hospital and CRCINA, Nantes, France
| | - Marion Eveillard
- Hematology Biology Department, Nantes University Hospital and CRCINA, Nantes, France
| | - Olivier Theisen
- Hematology Biology Department, Nantes University Hospital and CRCINA, Nantes, France
| | - Catherine Godon
- Hematology Biology Department, Nantes University Hospital and CRCINA, Nantes, France
| | - Yanick Le Bris
- Hematology Biology Department, Nantes University Hospital and CRCINA, Nantes, France
| | - Marie C Béné
- Hematology Biology Department, Nantes University Hospital and CRCINA, Nantes, France
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7
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D'Arena G, De Feo V, Pietrantuono G, Seneca E, Mansueto G, Villani O, La Rocca F, D'Auria F, Statuto T, Valvano L, Arruga F, Deaglio S, Efremov DG, Sgambato A, Laurenti L. CD200 and Chronic Lymphocytic Leukemia: Biological and Clinical Relevance. Front Oncol 2020; 10:584427. [PMID: 33324560 PMCID: PMC7727446 DOI: 10.3389/fonc.2020.584427] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022] Open
Abstract
CD200, a transmembrane type Ia glycoprotein belonging to the immunoglobulin protein superfamily, is broadly expressed on a wide variety of cell types, such as B lymphocytes, a subset of T lymphocytes, dendritic cells, endothelial and neuronal cells. It delivers immunosuppressive signals through its receptor CD200R, which is expressed on monocytes/myeloid cells and T lymphocytes. Moreover, interaction of CD200 with CD200R has also been reported to play a role in the regulation of tumor immunity. Overexpression of CD200 has been reported in chronic lymphocytic leukemia (CLL) and hairy cell leukemia but not in mantle cell lymphoma, thus helping to better discriminate between these different B cell malignancies with different prognosis. In this review, we focus on the role of CD200 expression in the differential diagnosis of mature B-cell neoplasms and on the prognostic significance of CD200 expression in CLL, where conflicting results have been published so far. Of interest, increasing evidences indicate that anti-CD200 treatment might be therapeutically beneficial for treating CD200-expressing malignancies, such as CLL.
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Affiliation(s)
- Giovanni D'Arena
- Hematology, "S. Luca" Hospital, ASL Salerno, Vallo della Lucania, Italy
| | - Vincenzo De Feo
- Department of Pharmaceutical and Biomedical Sciences, University of Salerno, Salerno, Italy
| | - Giuseppe Pietrantuono
- Hematology and Stem Cell Transplantation Unit, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Elisa Seneca
- Hematology and Stem Cell Transplantation Unit, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Giovanna Mansueto
- Hematology and Stem Cell Transplantation Unit, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Oreste Villani
- Hematology and Stem Cell Transplantation Unit, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Francesco La Rocca
- Laboratory of Preclinical and Translational Diagnostics, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Fiorella D'Auria
- Laboratory of Clinical Research and Advanced Diagnostics, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Teodora Statuto
- Laboratory of Clinical Research and Advanced Diagnostics, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Luciana Valvano
- Laboratory of Clinical Research and Advanced Diagnostics, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Francesca Arruga
- Cancer Immunogenetics Unit, Department of Medical Sciences, Molecular Biotechnology Center, University of Turin, Turin, Italy
| | - Silvia Deaglio
- Cancer Immunogenetics Unit, Department of Medical Sciences, Molecular Biotechnology Center, University of Turin, Turin, Italy
| | - Dimitar G Efremov
- Molecular Hematology, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Alessandro Sgambato
- Scientific Direction, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Luca Laurenti
- Hematology Institute, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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8
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Soliman DS, Al-Kuwari E, Siveen KS, Al-Abdulla R, Chandra P, Yassin M, Nashwan A, Hilmi FA, Taha RY, Nawaz Z, El-Omri H, Mateo JM, Al-Sabbagh A. Downregulation of Lymphoid enhancer-binding factor 1 (LEF-1) expression (by immunohistochemistry and/ flow cytometry) in chronic Lymphocytic Leukemia with atypical immunophenotypic and cytologic features. Int J Lab Hematol 2020; 43:515-525. [PMID: 33314668 DOI: 10.1111/ijlh.13420] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/17/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Lymphoid enhancer-binding factor 1 (LEF-1) overexpression has been recently remarkably reported in chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and has shown utility in distinguishing CLL/SLL from other B-cell lymphomas. CLL has a well-defined immunophenotype, yet, some cases of CLL demonstrate atypical morphology/ phenotype reflected by low Matutes score (atypical CLL). Till date, LEF1 expression has not been systematically studied in cases of CLL with atypical features. METHODS In this study, LEF-1 expression was assessed by two different techniques, (immunohistochemistry and flow cytometry), to investigate the expression profile of LEF-1 in cases of CLL/SLL, in comparison with other low-grade B-lymphomas and CLL with atypical features, including atypical immunophenotype and CLL with increased prolymphocytes or morphologically atypical cells. RESULTS We found that LEF-1 expression is downregulated in CLL with atypical immunophenotype/features compared to classic CLL; Chi-Square P < .0001. The ratio for LEF-1 expression in malignant B-cells/NK (by flow cytometry) in CLL/SLL with classic immunophenotype was higher than atypical CLL and is significantly higher in other small B-cell lymphomas (P < .01). Absence of LEF-1 expression in CLL/SLL is correlated (P < .05) with downregulation of CD5, CD23, CD200, expression of FMC7, brighter expression of CD79b, brighter expression of surface light chain, increased prolymphocytes and lower Matutes score. CONCLUSION As downregulation of LEF-1 expression is well correlated with atypical CLL, we suggest adding LEF-1 to Matutes score as a beneficial marker to differentiate classic from atypical CLL LEF-1 could also serve as a potential prognostic indicator for CLL clinical course.
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Affiliation(s)
- Dina S Soliman
- Department of Laboratory Medicine and Pathology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine - Qatar, Doha, Qatar.,Department of Clinical Pathology, National Cancer Institute, Cairo, Egypt
| | - Einas Al-Kuwari
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Kodappully S Siveen
- Flow Cytometry Core Facility, interim Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rajaa Al-Abdulla
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Academic Health Systems, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Yassin
- Department of Hematology and Medical Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Abdulqader Nashwan
- Nursing Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Feryal A Hilmi
- Department of Laboratory Medicine and Pathology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Ruba Y Taha
- Department of Hematology and Medical Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Zafar Nawaz
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Halima El-Omri
- Department of Hematology and Medical Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Jericha M Mateo
- Flow Cytometry Core Facility, interim Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Al-Sabbagh
- Department of Laboratory Medicine and Pathology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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9
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Jain A, Khunger JM, Prasad P, Chaudhry S, Sharma M, Gupta DK, Saluja S. An illustrative case of B-cell prolymphocytic leukemia. Blood Res 2020; 55:181-184. [PMID: 32883890 PMCID: PMC7536564 DOI: 10.5045/br.2020.2020079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/10/2020] [Accepted: 08/05/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ankur Jain
- Department of Hematology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - J M Khunger
- Department of Hematology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Pooja Prasad
- Department of Hematology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Sumita Chaudhry
- Department of Hematology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Monica Sharma
- Department of Hematology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Dipender Kumar Gupta
- Department of Hematology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Sumita Saluja
- Department of Hematology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
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10
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Hoffmann J, Rother M, Kaiser U, Thrun MC, Wilhelm C, Gruen A, Niebergall U, Meissauer U, Neubauer A, Brendel C. Determination of CD43 and CD200 surface expression improves accuracy of B-cell lymphoma immunophenotyping. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 98:476-482. [PMID: 32716606 DOI: 10.1002/cyto.b.21936] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND The Matutes score (MS) was proposed to differentiate chronic lymphocytic leukemia (CLL) from other B-cell non-Hodgkin lymphomas (B-NHLs). However, ambiguous immunophenotypes are common and remain a diagnostic challenge. Therefore, we evaluated the diagnostic benefit of measuring CD200 and CD43 expression together with the standard MS antigens. METHODS 138 lymphoma patient samples and a validation cohort of 138 additive samples were classified according to the standard MS and further assigned with one or two additional points, for high CD200 and/or CD43 expression levels. The "classical" MS and the "Matutes score-extended" (MS-e) were categorized as high (4-5/6-7), intermediate (2-3/4-5), and low (0-1/0-3). Samples were reclassified into the MS-e with focus on ambiguous cases with an intermediate "classical" MS. RESULTS A total of 35 of 138 (25.4%) patient samples were assigned to the intermediate MS group and confirmed by histopathological reports as CLL (14/40.0%) and B-NHLs other than CLL (21/60%). MS-e analysis identified 13 of 14 (92.9%) of CLL cases (MS-e 4-5) and 18/21 (85.7%) non-CLL cases (MS-e ≤ 3) correctly. Overall, the sensitivity of the CLL diagnosis was significantly increased by application of MS-e compared to the "classical" MS (98.8% vs. 82.7%; p = 0.0009), while specificity of both methods was almost equal (94.7% vs. 98.3%; p = 0.4795). Of note, sole measurement of CD43 and CD200 on B-cells sufficiently differentiated CLL from non-CLL with a test accuracy superior to the "classical" MS (F1 score 96.2 vs. 93.6). CONCLUSION CD200 and CD43 have a high informative value in diagnostic immunophenotyping and facilitate the separation of CLL from other B-NHLs particularly in ambiguous cases.
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Affiliation(s)
- Joerg Hoffmann
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Marissa Rother
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | | | - Michael C Thrun
- Databionics, Mathematics and Computer Science, Philipps University Marburg, Marburg, Germany
| | - Christian Wilhelm
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Andrea Gruen
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Ute Niebergall
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Ute Meissauer
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Andreas Neubauer
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Cornelia Brendel
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
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Pattnaik SA, Padhi S, Chhabra G, Panigrahi MK, Das PK, Bhola RK, Mishra S. Atypical presentation of hairy cell leukemia: a report and comprehensive review. Blood Res 2020; 55:123-127. [PMID: 32408416 PMCID: PMC7343552 DOI: 10.5045/br.2020.2020069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sandeep Abhijit Pattnaik
- Departments of Pathology and Laboratory Medicine, IMS and Sum Hospital, S'O'A Deemed to be University, Bhubaneswar, India
| | - Somanath Padhi
- Departments of Pathology and Laboratory Medicine, IMS and Sum Hospital, S'O'A Deemed to be University, Bhubaneswar, India
| | - Gaurav Chhabra
- Departments of Pathology and Laboratory Medicine, IMS and Sum Hospital, S'O'A Deemed to be University, Bhubaneswar, India
| | - Manoj Kumar Panigrahi
- Departments of Pulmonary Medicine, IMS and Sum Hospital, S'O'A Deemed to be University, Bhubaneswar, India
| | - Prabodh Kumar Das
- Medical Oncology/Hematology, All India Institute of Medical Sciences, IMS and Sum Hospital, S'O'A Deemed to be University, Bhubaneswar, India
| | - Rajesh Kumar Bhola
- Department of Laboratory Hematology, IMS and Sum Hospital, S'O'A Deemed to be University, Bhubaneswar, India
| | - Shruti Mishra
- Departments of Pathology and Laboratory Medicine, IMS and Sum Hospital, S'O'A Deemed to be University, Bhubaneswar, India
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12
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Sorigue M, Junca J, Ferra C, Marce S, Ruiz-Xivillé N, Pinyol L, Cabezon M, Espasa A, Dominguez D, Lopez-Viaplana L, Ruiz R, Buch J, Plensa E, Mostacedo SZ, Aranda J, Vergara S, Raya M, Granada I, Tapia G, Navarro JT, Beà S, Zamora L. FMOD expression in whole blood aids in distinguishing between chronic lymphocytic leukemia and other leukemic lymphoproliferative disorders. A pilot study. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 98:421-428. [PMID: 32530577 DOI: 10.1002/cyto.b.21890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/25/2020] [Accepted: 05/04/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Within the hematopoietic compartment, fibromodulin (FMOD) is almost exclusively expressed in chronic lymphocytic leukemia (CLL) lymphocytes. We set out to determine whether FMOD could be of help in diagnosing borderline lymphoproliferative disorders (LPD). METHODS We established 3 flow cytometry-defined groups (CLL [n = 65], borderline LPD [n = 28], broadly defined as those with CLLflow score between 35 and -20 or discordant CD43 and CLLflow, and non-CLL LPD [n = 40]). FMOD expression levels were determined by standard RT-PCR in whole-blood samples. Patients were included regardless of lymphocyte count but with tumor burden ≥40%. RESULTS FMOD expression levels distinguished between CLL (median 98.5, interquartile range [IQR] 37.8-195.1) and non-CLL LPD (median 0.012, IQR 0.003-0.033) with a sensitivity and specificity of 1. Most borderline LPDs were CD5/CD23/CD200-positive with no loss of B-cell antigens and negative or partial expression of CD43. 16/22 patients with available cytogenetic analysis showed trisomy 12. In 25/28 (89%) of these patients, FMOD expression levels fell between CLL and non-CLL (median 3.58, IQR 1.06-6.21). DISCUSSION This study could suggest that borderline LPDs may constitute a distinct group laying in the biological spectrum of chronic leukemic LPDs. Future studies will have to confirm these results with other biological data. Quantification of FMOD can potentially be of help in the diagnosis of phenotypically complex LPDs.
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Affiliation(s)
- Marc Sorigue
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jordi Junca
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Christelle Ferra
- Department of Clinical Haematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Silvia Marce
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Neus Ruiz-Xivillé
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Laia Pinyol
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Marta Cabezon
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Andrea Espasa
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Diana Dominguez
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - Rocio Ruiz
- Institut Josep Carreres contra la leucemia, Badalona, Spain
| | - Joan Buch
- Department of Hematology, Hospital de Calella, Calella and ICO-Girona, Girona, Spain
| | | | | | - Jessica Aranda
- Institut Josep Carreres contra la leucemia, Badalona, Spain
| | - Sara Vergara
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Minerva Raya
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Isabel Granada
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Gustavo Tapia
- Department of Pathology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Jose-Tomas Navarro
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Silvia Beà
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,University of Barcelona, Barcelona, Spain
| | - Lurdes Zamora
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
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13
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Sorigue M, Magnano L, Miljkovic MD, Nieto‐Moragas J, Santos‐Gomez M, Villamor N, Junca J, Morales‐Indiano C. Positive predictive value of CD200 positivity in the differential diagnosis of chronic lymphocytic leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019; 98:441-448. [DOI: 10.1002/cyto.b.21849] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/25/2019] [Accepted: 10/02/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Marc Sorigue
- Hematology Laboratory, ICO‐Hospital Germans Trias i Pujol. IJC Universitat Autònoma de Barcelona Badalona Spain
| | - Laura Magnano
- Hematopathology Unit, Department of Pathology Hospital Clinic de Barcelona Barcelona Spain
| | - Milos D. Miljkovic
- Lymphoid Malignancies Branch National Cancer Institute Bethesda Maryland
| | | | - Mireia Santos‐Gomez
- Hematology Laboratory, ICO‐Hospital Germans Trias i Pujol. IJC Universitat Autònoma de Barcelona Badalona Spain
| | - Neus Villamor
- Hematopathology Unit, Department of Pathology Hospital Clinic de Barcelona Barcelona Spain
| | - Jordi Junca
- Hematology Laboratory, ICO‐Hospital Germans Trias i Pujol. IJC Universitat Autònoma de Barcelona Badalona Spain
| | - Cristian Morales‐Indiano
- Clinical Laboratory ICS‐Metropolitana Nord, Core‐hematology Department Hospital Germans Trias i Pujol Badalona Spain
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14
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Elsaid A, Omran A, Abd Elrhman H. Expression and diagnostic utility of single and combined CD200, CD148 and CD160 markers in mature B‑cell neoplasms as revealed by ROC and SVM analyses. WORLD ACADEMY OF SCIENCES JOURNAL 2019. [DOI: 10.3892/wasj.2019.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Ahmed Elsaid
- Department of Public Health and Community Medicine, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Alaa Omran
- Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Heba Abd Elrhman
- Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
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15
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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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16
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El Din Fouad NB, Ibrahim NY, Abdel Aziz RS, Ibrahim SK. CD200 Expression in Diagnostic and Prognostic Assessment of Mature B Cell Lymphophoproliferative Neoplasms. Asian Pac J Cancer Prev 2018; 19:3383-3392. [PMID: 30583344 PMCID: PMC6428547 DOI: 10.31557/apjcp.2018.19.12.3383] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/04/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Multiparameter flow cytometry is a useful tool for diagnostic evaluation of mature B-cell neoplasms (MBN). Recently, it has been shown that assessment of CD200 expression may improve the distinction between chronic lymphocytic leukemia (CLL; CD200 positive) and mantle cell lymphoma (MCL; CD200 negative), but any potential as a prognostic marker for CLL remains to be established. Materials and methods: This cross sectional study was conducted on sixty-seven patients newly diagnosed as having mature B-cell lymphoproliferative disorders Levels of CD 200 in lymphoma cells were assessed. Results: CD200 was consistently expressed in CLL and hairy cell leukemia B cells, but not in MCL cells. Heterogeneous expression was noted in other CD5 positive Non-Hodgkin lymphomas. High CD200 expression (≥50%) was associated with a higher CD5, 19 and CD23 expression, older age, higher TLC and absolute lymphocyte count, hepatomegaly, splenomegaly and a higher Rai stage. There were no significant correlations between CD200 expression and response to treatment. Conclusion: CD200 could be of high value in distinguishing CLL, MCL, and atypical CLL. CD200 expression can also be of prognostic and therapeutic value in CLL cases.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antigens, CD/metabolism
- B-Lymphocytes/metabolism
- B-Lymphocytes/pathology
- Biomarkers, Tumor/metabolism
- Cross-Sectional Studies
- Diagnosis, Differential
- Female
- Humans
- Immunophenotyping/methods
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Lymphoma, Mantle-Cell/diagnosis
- Lymphoma, Mantle-Cell/metabolism
- Lymphoma, Mantle-Cell/pathology
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/metabolism
- Lymphoma, Non-Hodgkin/pathology
- Lymphoproliferative Disorders/diagnosis
- Lymphoproliferative Disorders/metabolism
- Lymphoproliferative Disorders/pathology
- Male
- Middle Aged
- Prognosis
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17
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Mora A, Bosch R, Cuellar C, Vicente EP, Blanco L, Martino R, Ubeda JM, Sierra J, Moreno C, Nomdedeu J. CD200 is a useful marker in the diagnosis of chronic lymphocytic leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 96:143-148. [DOI: 10.1002/cyto.b.21722] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/25/2018] [Accepted: 06/26/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Alba Mora
- Laboratory of Oncology/Hematology and TransplantationInstitute of Biomedical Research Barcelona Spain
- Department of Hematology, Hospital de la Santa Creu i Sant PauAutonomous University of Barcelona Spain
- Department of MedicineAutonomous University of Barcelona Barcelona Spain
- Biomedical Research Institute (IIB‐Sant Pau) and José Carreras Leukemia Research Institute
| | - Rosa Bosch
- Laboratory of Oncology/Hematology and TransplantationInstitute of Biomedical Research Barcelona Spain
- Department of Hematology, Hospital de la Santa Creu i Sant PauAutonomous University of Barcelona Spain
- Biomedical Research Institute (IIB‐Sant Pau) and José Carreras Leukemia Research Institute
| | - Carolina Cuellar
- Laboratory of Oncology/Hematology and TransplantationInstitute of Biomedical Research Barcelona Spain
- Department of Hematology, Hospital de la Santa Creu i Sant PauAutonomous University of Barcelona Spain
- Biomedical Research Institute (IIB‐Sant Pau) and José Carreras Leukemia Research Institute
| | - Eva Puy Vicente
- Laboratory of Oncology/Hematology and TransplantationInstitute of Biomedical Research Barcelona Spain
- Department of Hematology, Hospital de la Santa Creu i Sant PauAutonomous University of Barcelona Spain
| | - Laura Blanco
- Laboratory of HematologyHospital de la Santa Creu i Sant Pau Barcelona Spain
| | - Rodrigo Martino
- Department of Hematology, Hospital de la Santa Creu i Sant PauAutonomous University of Barcelona Spain
| | - José M. Ubeda
- Laboratory of HematologyHospital de la Santa Creu i Sant Pau Barcelona Spain
| | - Jorge Sierra
- Laboratory of Oncology/Hematology and TransplantationInstitute of Biomedical Research Barcelona Spain
- Department of Hematology, Hospital de la Santa Creu i Sant PauAutonomous University of Barcelona Spain
- Biomedical Research Institute (IIB‐Sant Pau) and José Carreras Leukemia Research Institute
| | - Carol Moreno
- Laboratory of Oncology/Hematology and TransplantationInstitute of Biomedical Research Barcelona Spain
- Department of Hematology, Hospital de la Santa Creu i Sant PauAutonomous University of Barcelona Spain
- Department of MedicineAutonomous University of Barcelona Barcelona Spain
- Biomedical Research Institute (IIB‐Sant Pau) and José Carreras Leukemia Research Institute
| | - Josep Nomdedeu
- Laboratory of HematologyHospital de la Santa Creu i Sant Pau Barcelona Spain
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18
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Sorigue M, Junca J. Atypical chronic lymphocytic leukemia: Brief historical overview and current usage of an equivocal concept. Int J Lab Hematol 2018; 41:e17-e19. [DOI: 10.1111/ijlh.12930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Marc Sorigue
- Hematology Laboratory ICO‐Hospital Germans Trias i Pujol Josep Carreras Leukemia Research Institute Universitat Autònoma de Barcelona Badalona Spain
| | - Jordi Junca
- Hematology Laboratory ICO‐Hospital Germans Trias i Pujol Josep Carreras Leukemia Research Institute Universitat Autònoma de Barcelona Badalona Spain
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D'Arena G, Vitale C, Coscia M, D'Auria F, Bellesi S, Topini G, Panichi V, Valvano L, Statuto T, Corrente F, Laurenti L. External validation of the accuracy of 'CLLflow score'. J Investig Med 2018; 66:e6. [PMID: 30217834 DOI: 10.1136/jim-2018-000832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Giovanni D'Arena
- Hematology and Stem Cell Transplantation Unit, IRCCS Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
| | - Candida Vitale
- Division of Hematology, University of Turin, Turin, Italy
| | - Marta Coscia
- Division of Hematology, University of Turin, Turin, Italy
| | - Fiorella D'Auria
- Laboratory of Clinical Research and Advanced Diagnostics, IRCCS Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
| | - Silvia Bellesi
- Hematology Unit, Catholic University of "Sacred Hearth", Roma, Italy
| | - Giuseppe Topini
- Department of Onco-Hematology, "Belcolle" Hospital, Viterbo, Italy
| | | | - Luciana Valvano
- Laboratory of Clinical Research and Advanced Diagnostics, IRCCS Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
| | - Teodora Statuto
- Laboratory of Clinical Research and Advanced Diagnostics, IRCCS Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
| | | | - Luca Laurenti
- Hematology Unit, Catholic University of "Sacred Hearth", Roma, Italy
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20
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McCoy JP. Issue Highlights - September 2016. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 90:401-3. [PMID: 27638251 DOI: 10.1002/cyto.b.21477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Mandy F. Issue Highlights - November 2016. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 90:480-482. [PMID: 27788287 DOI: 10.1002/cyto.b.21489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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22
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Roider T, Falini B, Dietrich S. Recent advances in understanding and managing hairy cell leukemia. F1000Res 2018; 7:F1000 Faculty Rev-509. [PMID: 29770206 PMCID: PMC5931274 DOI: 10.12688/f1000research.13265.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 01/15/2023] Open
Abstract
Hairy cell leukemia is a rare B-cell malignancy that is characterized by an indolent course. It was initially described as a distinct entity in 1958. Before the establishment of modern treatment, median survival was only 4 years. Since then, major advances in the treatment and understanding of the biology and genomic landscape of hairy cell leukemia have been made. This review summarizes the present understanding of hairy cell leukemia with particular focus on the development of novel and targeted approaches to treatment.
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Affiliation(s)
- Tobias Roider
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Brunangelo Falini
- Institute of Hematology and Center for Hemato-Oncology Research (CREO), University and Hospital of Perugia, Perugia, Italy
| | - Sascha Dietrich
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
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CD200 expression in mantle cell lymphoma identifies a unique subgroup of patients with frequent IGHV mutations, absence of SOX11 expression, and an indolent clinical course. Mod Pathol 2018; 31:327-336. [PMID: 28984300 DOI: 10.1038/modpathol.2017.135] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/31/2017] [Accepted: 08/31/2017] [Indexed: 01/20/2023]
Abstract
CD200, a marker currently utilized in the diagnosis of B-cell lymphoma, is uniformly positive in chronic lymphocytic leukemia/chronic lymphocytic leukemia, and is usually absent in mantle cell lymphoma. Over a 6 year-period, of 668 mantle cell lymphoma assessed by flow cytometry, CD200 expression was detected in 25 patients (~4%). All 25 patients had bone marrow involvement; however, 11 (44%) patients had no nodal or extranodal disease and belonged to non-nodal leukemic variant mantle cell lymphoma. Morphologically, bone marrow showed an unusual interstitial infiltrative pattern in 14/25 (56%) and small round cells resembling chronic lymphocytic leukemia in 9/25 (36%). CD23 was positive in 19/25 (76%) patients; and SOX11 was only positive in 5/21(24%). All 4 patients tested showed IGHV mutations. With a median follow-up of 23 months, 12/24 (50%) patients were not treated. These clinicopathological features were significantly different from 154 randomly chosen CD200-negative mantle cell lymphoma patients, in SOX11 positivity (24% versus 74%, P<0.0001), CD23 expression (76% versus 8%, P<0.0001), a non-nodal leukemic presentation (44% versus 2%, P<0.001), and therapy requirement (50% versus 92%, P<0.0001). This is the first study to show that CD200 expression in mantle cell lymphoma, though uncommon, identifies a subgroup of mantle cell lymphoma patients with characteristic pathological features, frequent non-nodal leukemic variant, and an indolent clinical course.
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24
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Sorigue M, Franch‐Sarto M, Sarrate E, Junca J. Usefulness of the CLLflow score. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 94:950-952. [DOI: 10.1002/cyto.b.21623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Marc Sorigue
- Hematology LaboratoryICO‐Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Josep Carreras Leukemia Research InstituteBadalona Spain
| | - Mireia Franch‐Sarto
- Hematology LaboratoryICO‐Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Josep Carreras Leukemia Research InstituteBadalona Spain
| | - Edurne Sarrate
- Hematology LaboratoryICO‐Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Josep Carreras Leukemia Research InstituteBadalona Spain
| | - Jordi Junca
- Hematology LaboratoryICO‐Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Josep Carreras Leukemia Research InstituteBadalona Spain
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25
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Sorigue M, Sarrate E, Franch-Sarto M, Feliu E, Junca J. Consistency of the Moreau CLL score. J Clin Lab Anal 2017; 32:e22376. [PMID: 29282771 DOI: 10.1002/jcla.22376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/05/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The Moreau score is essential for the diagnosis of B-cell lymphoproliferative disorders (B-LPD). METHODS We assessed the consistency of the Moreau score in a series of 138 patients with at least two samples involved by a B-LPD (316 samples) other than germinal center-derived malignancies, hairy cell leukemia, and mantle cell lymphomas. Patients with evidence of two distinct B-LPDs were also excluded. RESULTS We found 53 inconsistencies in 44 of 138 (32%) patients. FMC7 was the most inconsistent (18 cases) and CD5 the least (5 cases). CD200 was inconsistent in 6 of 67 (9%) cases. The most important predictive factor for the finding of antigenic inconsistencies was sampling of a different anatomic site. Other factors, including number of samples, time between samples, or cytogenetic group, were not predictive. For the most part, these inconsistencies did not appear to be clinically relevant. CONCLUSION Inconsistencies in the Moreau score are common, supporting the importance of integrated laboratory diagnosis. However, the practical implications of these antigenic inconsistencies are probably limited.
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Affiliation(s)
- Marc Sorigue
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Edurne Sarrate
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Mireia Franch-Sarto
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Evarist Feliu
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jordi Junca
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
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Miao Y, Fan L, Wu YJ, Xia Y, Qiao C, Wang Y, Wang L, Hong M, Zhu HY, Xu W, Li JY. Low expression of CD200 predicts shorter time-to-treatment in chronic lymphocytic leukemia. Oncotarget 2017; 7:13551-62. [PMID: 26910908 PMCID: PMC4924660 DOI: 10.18632/oncotarget.6948] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 12/26/2015] [Indexed: 11/25/2022] Open
Abstract
CD200, formerly known as OX-2, is a type I glycoprotein that is expressed on a variety of cell types. CD200 has been shown to be overexpressed in chronic lymphocytic leukemia (CLL). Although previous studies have confirmed the diagnostic value of CD200 in differentiating CLL from to other B-cell chronic lymphoproliferative disorders especially mantle cell lymphoma, whether CD200 has prognostic significance in CLL remains to be determined. We evaluated the mean fluorescence intensity (MFI) of CD200 in 307 consecutive, untreated patients with CLL in our center using flow cytometry. Using a CD200 MFI cutoff of 189.5, these cases could be divided into two groups. Patients with lower CD200 MFI (< 189.5) had a significantly shorter time-to-treatment (TTT) than those with higher CD200 MFI (≥ 189.5) (median TTT: 2 months vs 28 months, p = 0.0008). However, the effect of CD200 MFI on overall survival was not significant (CD200 MFI < 189.5: undefined vs CD200 MFI ≥ 189.5: undefined, P = 0.2379). In subgroup analysis, CD200 MFI retained its prognostic value in patients with favourable characteristics such as Binet stage A disease, mutated IGHV status, normal TP53 or negative CD38 expression. In conclusion, our study identified CD200 MFI as a potential prognostic factor in CLL.
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Affiliation(s)
- Yi Miao
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Lei Fan
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Yu-Jie Wu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Yi Xia
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Chun Qiao
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Yan Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Li Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Min Hong
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Hua-Yuan Zhu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Jian-Yong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing 210029, China
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Soldarini M, Farina L, Genderini A, Bolli N. A rare case of atypical chronic lymphocytic leukaemia presenting as nephrotic syndrome. BMJ Case Rep 2017; 2017:bcr-2016-218850. [PMID: 28710302 DOI: 10.1136/bcr-2016-218850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Chronic lymphocytic leukaemia (CLL) is characterised by a lymphocytosis of mature-appearing clonal CD5+, CD23+ B lymphocytes. CLL cells arise from the bone marrow and infiltrate lymphoid tissues such as lymph nodes and spleen. Presentation is usually through discovery of lymphocytosis or lymphadenopathy. Unusual presentations, especially paraneoplastic syndromes are rare. Here, we describe a rare case presenting with severe nephrotic syndrome associated with the presence of a monoclonal protein in serum. Workup for suspected plasma cell dyscrasia led instead to the diagnosis of bone marrow infiltration by atypical CLL without lymphocytosis. Renal biopsy showed a glomerulonephritis that turned out to be paraneoplastic as it went into remission after treatment for CLL. Our case shows an unusual presentation of CLL and prompts for increased awareness of lymphoproliferative disorders in the context of seemingly unrelated conditions that may be paraneoplastic in origin.
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Affiliation(s)
- Martina Soldarini
- Dipartimento di Oncologia ed Onco-Ematologia, Universita' degli Studi di Milano, Milano, Italy
| | - Lucia Farina
- Dipartimento di Oncologia medica ed Ematologia, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Augusto Genderini
- Unità operativa complessa di nefrologia e dialisi, Azienda Ospedaliera-Polo Universitario Luigi Sacco, Milano, Italy
| | - Niccolo Bolli
- Dipartimento di Oncologia ed Onco-Ematologia, Universita' degli Studi di Milano, Milano, Italy
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Mason EF, Pozdnyakova O, Li B, Dudley G, Dorfman DM. Flow Cytometric Patterns of CD200 and CD1d Expression Distinguish CD10-Negative, CD5-Negative Mature B-Cell Lymphoproliferative Disorders. Am J Clin Pathol 2017; 148:33-41. [PMID: 28575142 DOI: 10.1093/ajcp/aqx041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The importance of distinguishing mature B-cell lymphoproliferative disorders (B-LPDs) is highlighted by the distinct treatments used for and varying prognoses seen in association with these different diseases. Immunophenotyping allows for accurate and efficient differentiation of many B-LPDs. Recently, we showed that CD200 is highly expressed in hairy cell leukemia (HCL) but not in marginal zone lymphoma (MZL), lymphoplasmacytic lymphoma (LPL), or hairy cell leukemia-variant (HCL-v). Here, we assessed the usefulness of a flow cytometric panel combining CD200 and CD1d with CD25, CD103, and CD11c to distinguish CD10-, CD5- B-LPDs. METHODS We analyzed the expression of CD200 and CD1d by flow cytometric analysis in 79 cases of CD10-, CD5- mature B-LPDs. RESULTS Distinct patterns of CD200 and CD1d expression were seen in the examined B-LPDs. HCL showed bright positivity for CD200 along with positive staining for CD1d, whereas HCL-v showed low levels of expression for both markers. LPL demonstrated positive staining for CD200 in combination with dim to negative staining for CD1d. In contrast, MZL was commonly positive for CD1d and negative for CD200. CONCLUSIONS Flow cytometric analysis of CD200 and CD1d, along with CD25, CD103, and CD11c, can aid in the diagnosis of CD10-, CD5- mature B-LPDs.
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Affiliation(s)
- Emily F Mason
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Olga Pozdnyakova
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Betty Li
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Graham Dudley
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - David M Dorfman
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Arlindo EM, Marcondes NA, Fernandes FB, Faulhaber GAM. Quantitative flow cytometric evaluation of CD200, CD123, CD43 and CD52 as a tool for the differential diagnosis of mature B-cell neoplasms. Rev Bras Hematol Hemoter 2017; 39:252-258. [PMID: 28830605 PMCID: PMC5567423 DOI: 10.1016/j.bjhh.2017.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/17/2017] [Accepted: 05/02/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Distinction between mature B-cell neoplasms can be difficult due to overlapping of immunologic features and clinical manifestations. This study investigated whether quantifying mean fluorescence intensity of four monoclonal antibodies in a flow cytometry panel is useful for the differential diagnosis and characterization of these disorders. METHODS The expressions of CD52, CD200, CD123 and CD43 were analyzed in samples from 124 patients with mature B-cell neoplasms. The quantitative estimation of these antigens was assessed by mean fluorescence intensity. RESULTS The cases included were 78 chronic lymphocytic leukemias, three atypical chronic lymphocytic leukemias, six marginal zone lymphomas, 11 splenic marginal zone lymphomas, nine lymphoplasmacytic lymphomas, six mantle cell lymphomas, two hairy cell leukemias, two hairy cell leukemias variant, five follicular lymphomas, one Burkitt lymphoma and one diffuse large B-cell lymphoma. The mean fluorescence intensity of CD200 was higher in atypical chronic lymphocytic leukemia, chronic lymphocytic leukemia and hairy cell leukemia cases. CD123 showed higher mean fluorescence intensities in hairy cell leukemia cells. Chronic lymphocytic leukemia, atypical chronic lymphocytic leukemia and mantle cell lymphoma had higher expression of CD43 and all follicular lymphoma cases had very low mean fluorescence intensity values. CD52 expression was consistently positive among all cases. CONCLUSION Quantitative evaluation of these markers can be a useful additional tool to better identify some types of mature B-cell neoplasms.
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Affiliation(s)
| | - Natália Aydos Marcondes
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Laboratório Zanol, Porto Alegre, RS, Brazil
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Rahman K, Kumar P, Gupta R, Singh MK, Nityanand S. Role of CD200 in differential diagnosis of mature B-cell neoplasm. Int J Lab Hematol 2017; 39:384-391. [DOI: 10.1111/ijlh.12637] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/12/2017] [Indexed: 11/29/2022]
Affiliation(s)
- K. Rahman
- Department of Hematology; SGPGI; Lucknow India
| | - P. Kumar
- Department of Hematology; SGPGI; Lucknow India
| | - R. Gupta
- Department of Hematology; SGPGI; Lucknow India
| | - M. K. Singh
- Department of Hematology; SGPGI; Lucknow India
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Grever MR, Abdel-Wahab O, Andritsos LA, Banerji V, Barrientos J, Blachly JS, Call TG, Catovsky D, Dearden C, Demeter J, Else M, Forconi F, Gozzetti A, Ho AD, Johnston JB, Jones J, Juliusson G, Kraut E, Kreitman RJ, Larratt L, Lauria F, Lozanski G, Montserrat E, Parikh SA, Park JH, Polliack A, Quest GR, Rai KR, Ravandi F, Robak T, Saven A, Seymour JF, Tadmor T, Tallman MS, Tam C, Tiacci E, Troussard X, Zent CS, Zenz T, Zinzani PL, Falini B. Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia. Blood 2017; 129:553-560. [PMID: 27903528 PMCID: PMC5290982 DOI: 10.1182/blood-2016-01-689422] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 11/06/2016] [Indexed: 12/20/2022] Open
Abstract
Hairy cell leukemia is an uncommon hematologic malignancy characterized by pancytopenia and marked susceptibility to infection. Tremendous progress in the management of patients with this disease has resulted in high response rates and improved survival, yet relapse and an appropriate approach to re-treatment present continuing areas for research. The disease and its effective treatment are associated with immunosuppression. Because more patients are being treated with alternative programs, comparison of results will require general agreement on definitions of response, relapse, and methods of determining minimal residual disease. The development of internationally accepted, reproducible criteria is of paramount importance in evaluating and comparing clinical trials to provide optimal care. Despite the success achieved in managing these patients, continued participation in available clinical trials in the first-line and particularly in the relapse setting is highly recommended. The Hairy Cell Leukemia Foundation convened an international conference to provide common definitions and structure to guide current management. There is substantial opportunity for continued research in this disease. In addition to the importance of optimizing the prevention and management of the serious risk of infection, organized evaluations of minimal residual disease and treatment at relapse offer ample opportunities for clinical research. Finally, a scholarly evaluation of quality of life in the increasing number of survivors of this now manageable chronic illness merits further study. The development of consensus guidelines for this disease offers a framework for continued enhancement of the outcome for patients.
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Affiliation(s)
- Michael R Grever
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Omar Abdel-Wahab
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leslie A Andritsos
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Versha Banerji
- Section of Hematology/Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Jacqueline Barrientos
- Department of Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Hofstra University, Hempstead, NY
| | - James S Blachly
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | | | - Daniel Catovsky
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Claire Dearden
- Department of Haemato-Oncology, Royal Marsden Biomedical Research Centre, London, United Kingdom
| | - Judit Demeter
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Monica Else
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Francesco Forconi
- Haematology Department, University Hospital Trust and Cancer Sciences Unit, Cancer Research UK and National Institute for Health Research Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | | | - Anthony D Ho
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - James B Johnston
- Section of Hematology/Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Jeffrey Jones
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Gunnar Juliusson
- Department of Hematology, Skåne University Hospital and Stem Cell Center, Lund University, Lund, Sweden
| | - Eric Kraut
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Robert J Kreitman
- Laboratory of Molecular Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Loree Larratt
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Francesco Lauria
- Hematology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Emili Montserrat
- Department of Hematology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Jae H Park
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Aaron Polliack
- Department of Hematology, Hadassah University Hospital and Hebrew University Medical School, Jerusalem, Israel
| | - Graeme R Quest
- Department of Laboratory Medicine and Pathology, University Health Network, Toronto, ON, Canada
| | - Kanti R Rai
- Department of Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Hofstra University, Hempstead, NY
| | - Farhad Ravandi
- Section of Developmental Therapeutics, Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Alan Saven
- Division of Hematology and Oncology, Scripps Clinic, La Jolla, CA
| | - John F Seymour
- Haematology Department, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, and the Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Martin S Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Constantine Tam
- Haematology Department, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Enrico Tiacci
- Institute of Hematology, Department of Medicine, University and Hospital of Perugia, Perugia, Italy
| | - Xavier Troussard
- Department of Hematology, Centre Hospitalier Universitaire Côte de Nacre, Caen, France
| | - Clive S Zent
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Thorsten Zenz
- Department of Molecular Therapy in Hematology and Oncology, National Center for Tumor Diseases and German Cancer Research Center (DKFZ), Heidelberg, Germany; and
| | - Pier Luigi Zinzani
- Institute of Hematology "Seràgnoli," University of Bologna, Bologna, Italy
| | - Brunangelo Falini
- Institute of Hematology, Department of Medicine, University and Hospital of Perugia, Perugia, Italy
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Present and future of personalized medicine in CLL. Best Pract Res Clin Haematol 2016; 29:100-110. [PMID: 27742064 DOI: 10.1016/j.beha.2016.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 07/19/2016] [Accepted: 08/04/2016] [Indexed: 12/27/2022]
Abstract
Medicine has been 'personalized' (i.e. centred in persons) since its foundation. Recently, however, the term 'personalized medicine' (or, better, 'precision medicine') has been introduced to define 'a form of medicine that uses information about a person's genes, proteins, and environment to prevent, diagnose, and treat disease'. This concept has gained momentum thanks to next-generation-sequencing (NGS) techniques that allow identification of molecular characteristics unique to the patient and to the tumour. It is hoped that NGS will not only contribute to a better understanding of chronic lymphocytic leukaemia (CLL), but will identify disease subsets that could benefit from specific treatment interventions. Recent advances in diagnosis (e.g. high-resolution immunophenotyping, markers of genetic abnormalities), prognosis (e.g. biomarkers), response predictors [e.g. del(17p)/TP53 mutations even at subclonal level], treatment (e.g. BCR signalling inhibitors, BCL2 antagonists, CAR-T cells) and methods to evaluate minimal residual disease constitute good examples of tools facilitating 'personalized' management of patients with CLL.
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Jain D, Dorwal P, Gajendra S, Pande A, Mehra S, Sachdev R. CD5 positive hairy cell leukemia: A rare case report with brief review of literature. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 90:467-72. [PMID: 27129891 DOI: 10.1002/cyto.b.21365] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/04/2016] [Accepted: 02/18/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aberrant expression of CD5 in both HCL and HCL-v is a very rare event. Although a number of CD5 positive HCL and HCL-v cases have been reported, but these are far and few in between. We aimed to review the reported cases of CD5 positive HCL and its variant. METHOD We hereby report a case of CD5 positive HCL, with variations in PIK3CA and PDGFRA gene, along with a brief review of literature of the cases of CD5 positive HCL and its variant. RESULTS AND CONCLUSION The current case was positive for CD103, CD11c, CD25, and CD123 which has led the diagnosis to be of typical HCL. With the extensive literature review we found that only 26 cases of hairy cell leukemia [HCL and HCL-v] bearing CD5 expression have been reported so far. The positivity of CD5 is more common in HCL-v as compared to HCL. Additional prospective studies of CD5+ HCL and its variants are required to show whether they are a clinically significant subgroup of lymphoid malignancies. © 2016 International Clinical Cytometry Society.
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Affiliation(s)
- Dharmendra Jain
- Molecular Genetics and Immunology Laboratory, Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Gurgaon, India.
| | - Pranav Dorwal
- Molecular Genetics and Immunology Laboratory, Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Gurgaon, India
| | - Smeeta Gajendra
- Molecular Genetics and Immunology Laboratory, Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Gurgaon, India
| | - Amit Pande
- Molecular Genetics and Immunology Laboratory, Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Gurgaon, India
| | - Simmi Mehra
- Molecular Genetics and Immunology Laboratory, Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Gurgaon, India
| | - Ritesh Sachdev
- Molecular Genetics and Immunology Laboratory, Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Gurgaon, India
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Bohling SD, Davis E, Thompson K, Kussick SJ, Love J. Flow cytometric analysis of CD200 expression by pulmonary small cell carcinoma. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 90:493-498. [PMID: 26584149 DOI: 10.1002/cyto.b.21340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 09/04/2015] [Accepted: 11/11/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND CD200 is a membrane bound glycoprotein that is expressed by a variety of normal tissues and hematopoietic malignancies. Flow cytometric analysis of CD200 expression has utility in the evaluation of mature B-cell neoplasms, myeloma, and acute leukemia; however, CD200 expression in nonhematopoietic malignancies has not been extensively studied. METHODS We studied 14 cases of biopsy proven pulmonary small cell carcinoma in which a discrete CD45 negative, CD56 positive abnormal cell population was identified by flow cytometry. We retrospectively evaluated these cases for flow cytometric and immunohistochemical evidence of CD200 expression. RESULTS Twelve of the 14 cases of pulmonary small cell carcinoma showed convincing expression of CD200 by both immunohistochemistry and flow cytometry. CONCLUSIONS Pulmonary small cell carcinoma frequently expresses CD200 at a level that can be detected by flow cytometry and immunohistochemistry. CD200 expression therefore may be used to help identify pulmonary small cell carcinoma in flow cytometry specimens and tissue sections. CD200 may also play a role in the biology of pulmonary small cell carcinoma and is a potential target of future therapies. © 2015 International Clinical Cytometry Society.
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Affiliation(s)
| | - Evan Davis
- Multicare Health System, Tacoma, Washington
| | | | | | - Jason Love
- Western Washington Pathology, Tacoma, Washington
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35
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Muccio VE, Saraci E, Gilestro M, Gattei V, Zucchetto A, Astolfi M, Ruggeri M, Marzanati E, Passera R, Palumbo A, Boccadoro M, Omedè P. Multiple myeloma: New surface antigens for the characterization of plasma cells in the era of novel agents. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 90:81-90. [DOI: 10.1002/cyto.b.21279] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 07/17/2015] [Accepted: 07/29/2015] [Indexed: 12/18/2022]
Affiliation(s)
- Vittorio Emanuele Muccio
- Divisione Universitaria Di Ematologia; AOU Città Della Salute E Della Scienza Di Torino, Torino, Italy
| | - Elona Saraci
- Divisione Universitaria Di Ematologia; AOU Città Della Salute E Della Scienza Di Torino, Torino, Italy
| | - Milena Gilestro
- Divisione Universitaria Di Ematologia; AOU Città Della Salute E Della Scienza Di Torino, Torino, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit; Centro Di Riferimento Oncologico I.R.C.C.S, Torino, Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco-Hematology Unit; Centro Di Riferimento Oncologico I.R.C.C.S, Torino, Italy
| | - Monica Astolfi
- Divisione Universitaria Di Ematologia; AOU Città Della Salute E Della Scienza Di Torino, Torino, Italy
| | - Marina Ruggeri
- Divisione Universitaria Di Ematologia; AOU Città Della Salute E Della Scienza Di Torino, Torino, Italy
| | - Eleonora Marzanati
- Divisione Universitaria Di Ematologia; AOU Città Della Salute E Della Scienza Di Torino, Torino, Italy
| | - Roberto Passera
- AOU Città Della Salute E Della Scienza Di Torino, Divisione Di Medicina Nucleare; Università Di Torino, Torino, Italy
| | - Antonio Palumbo
- Divisione Universitaria Di Ematologia; AOU Città Della Salute E Della Scienza Di Torino, Torino, Italy
| | - Mario Boccadoro
- Divisione Universitaria Di Ematologia; AOU Città Della Salute E Della Scienza Di Torino, Torino, Italy
| | - Paola Omedè
- Divisione Universitaria Di Ematologia; AOU Città Della Salute E Della Scienza Di Torino, Torino, Italy
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36
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Dorwal P, Mehra S, Pande A, Jain D, Smeeta G, Sachdev R, Raina V. Aberrant NK cell associated marker (CD56 and CD57) expression in chronic lymphocytic leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 88:348-51. [PMID: 26013700 DOI: 10.1002/cyto.b.21254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/25/2015] [Accepted: 05/20/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Pranav Dorwal
- Department of Pathology and Laboratory Medicine; Medanta the Medicity; Gurgaon Haryana 122 001 India
| | - Simmi Mehra
- Department of Pathology and Laboratory Medicine; Medanta the Medicity; Gurgaon Haryana 122 001 India
| | - Amit Pande
- Department of Pathology and Laboratory Medicine; Medanta the Medicity; Gurgaon Haryana 122 001 India
| | - Dharmendra Jain
- Department of Pathology and Laboratory Medicine; Medanta the Medicity; Gurgaon Haryana 122 001 India
| | - G. Smeeta
- Department of Pathology and Laboratory Medicine; Medanta the Medicity; Gurgaon Haryana 122 001 India
| | - Ritesh Sachdev
- Department of Pathology and Laboratory Medicine; Medanta the Medicity; Gurgaon Haryana 122 001 India
| | - Vimarsh Raina
- Department of Pathology and Laboratory Medicine; Medanta the Medicity; Gurgaon Haryana 122 001 India
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Fan L, Miao Y, Wu YJ, Wang Y, Guo R, Wang L, Shen AL, Chen YY, Xu W, Li JY. Expression patterns of CD200 and CD148 in leukemic B-cell chronic lymphoproliferative disorders and their potential value in differential diagnosis. Leuk Lymphoma 2015; 56:3329-35. [DOI: 10.3109/10428194.2015.1030642] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Craig F. Issue highlights--Cytometry Part B March 2014. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 86:75-6. [PMID: 24591167 DOI: 10.1002/cyto.b.21161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Fiona Craig
- Division of Hematopathology, Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Chovancová J, Bernard T, Stehlíková O, Šálek D, Janíková A, Mayer J, Doubek M. Detection of minimal residual disease in mantle cell lymphoma-establishment of novel eight-color flow cytometry approach. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 88:92-100. [PMID: 25586981 DOI: 10.1002/cyto.b.21210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 11/05/2014] [Accepted: 11/25/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Minimal residual disease (MRD) detection is an essential tool for therapy response assessment in a considerable number of hematooncologic disorders, including mantle cell lymphoma (MCL). Flow cytometry (FCM) ranks among the most effective approaches, which allows rapid sample processing and compete successfully with highly sensitive molecular methods like polymerase chain reaction. Because FCM is ordinarily applied to detect MRD in B-lineage diseases like chronic lymphocytic leukemia, a similar method could be used in MCL. We decided to test our novel eight-color FCM approach in MCL MRD detection. METHODS Using an eight-color FCM protocol designed by us, the expression of 24 selected surface antigens in a cohort of 30 patients with newly diagnosed leukemic MCL and 20 normal controls were compared to establish markers that can reliably distinguish normal B-lymphocytes from the MCL population. The sensitivity of the designed protocol was tested using serial dilution studies. RESULTS Although MCL presents high immunophenotypic variability, the combination of CD20/23/5/19/200/62L/3/45 seems to be very favorable in flow cytometric MRD measurement. CONCLUSIONS Our eight-color FCM protocol could easily detect MRD in MCL patients, and reaches a sensitivity of up to 2 × 10(-4) .
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Affiliation(s)
- Jana Chovancová
- Department of Internal Medicine-Hematology and Oncology, University Hospital, Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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Lesesve JF, Tardy S, Frotscher B, Latger-Cannard V, Feugier P, De Carvalho Bittencourt M. Combination of CD160 and CD200 as a useful tool for differential diagnosis between chronic lymphocytic leukemia and other mature B-cell neoplasms. Int J Lab Hematol 2014; 37:486-94. [DOI: 10.1111/ijlh.12315] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 10/13/2014] [Indexed: 11/29/2022]
Affiliation(s)
- J.-F. Lesesve
- Laboratory of Hematology; University Hospital; Nancy France
| | - S. Tardy
- Laboratory of Hematology; University Hospital; Nancy France
- Department of Hematology; University Hospital; Nancy France
| | - B. Frotscher
- Laboratory of Hematology; University Hospital; Nancy France
| | | | - P. Feugier
- Department of Hematology; University Hospital; Nancy France
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Wasik AM, Priebe V, Lord M, Jeppsson-Ahlberg Å, Christensson B, Sander B. Flow cytometric analysis of SOX11: a new diagnostic method for distinguishing B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma from mantle cell lymphoma. Leuk Lymphoma 2014; 56:1425-31. [PMID: 25120048 DOI: 10.3109/10428194.2014.953147] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The differential diagnosis between mantle cell lymphoma (MCL) and B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (B-CLL/SLL) is essential, since MCL usually has a more aggressive clinical course. By flow cytometry both MCL and B-CLL are CD19, CD20 and usually CD5 positive. However, ambiguities in other immune phenotypic markers of these lymphoma entities sometimes complicate the flow cytometric differential diagnosis. We here demonstrate that the transcription factor SOX11, which is highly up-regulated in most MCL, can be analyzed by flow cytometry. SOX11 protein could be consistently detected in ex vivo isolated MCL but not in B-CLL/SLL. Flow cytometry also enabled protein quantification, and SOX11 protein levels correlated with mRNA expression. We suggest that implementing detection of SOX11 in diagnostic flow cytometry would be beneficial for accurate and reliable diagnosis of MCL, especially for distinguishing cases of MCL and B-CLL/SLL with aberrant immune phenotypes, and for cases of rare cyclin D1 negative MCL.
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Affiliation(s)
- Agata M Wasik
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet , Stockholm , Sweden
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Atypical case of B-cell Chronic Lymphocytic Leukemia presenting with extreme hyperleukocytosis / Hiperleucocitoză extremă într-un caz atipic de leucemie limfatică cronică cu celulă B. REV ROMANA MED LAB 2014. [DOI: 10.2478/rrlm-2014-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AbstractVery few cases of chronic lymphocytic leukemia (CLL) presenting with extreme hyperleukocytosis are reported in the literature. We describe the case of a 66 years old woman, with newly diagnosed CLL presenting with extreme hyperleukocytosis of 774.2 x 109/liter, Rai stage III and Binet stage C. The patient has no comorbidities and the CIRS score (cumulative illness rating scale) is well below 6, with normal creatinine clearance. Some other interesting aspects related with this case are the atypical immunophenotype, the expression of Cyclin D1, and the B hepatitis viral infection, which made her diagnosis and treatment challenging. The patient was tested for NOTCH1 mutation and it was positive. There is important evidence that NOTCH1 mutations are associated with rapidly progressive disease and resistance to treatment. The distinction of CLL from mantle cell lymphoma (MCL) is not always easy because some MCLs may mimic CLL clinically, histologically, and/or phenotypically. The hepatitis B prophylaxis for viral reactivation was not available an in the end the patient was treated only with fludarabine and cyclophosphamide, without rituximab. CD200 should be introduced in the routine panel for flow cytometry to distinguish CLL from mantle cell lymphoma and NOTCH1 mutation is associated with poor prognosis and should be evaluated at diagnosis. CLL with extreme hyperleukocytosis presentation is very rare and sometimes an atypical CLL may represent a diagnostic pitfall.
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