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Verbeek MWC, Buracchi C, Laqua A, Nierkens S, Sedek L, Flores-Montero J, Hofmans M, Sobral de Costa E, Nováková M, Mejstrikova E, Barrena S, Kohlscheen S, Szczepanowski M, Kulis J, Oliveira E, Jugooa R, de Jong AX, Szczepanski T, Philippé J, van Dongen JJM, Orfao A, Brüggemann M, Gaipa G, van der Velden VHJ. Flow cytometric minimal residual disease assessment in B-cell precursor acute lymphoblastic leukaemia patients treated with CD19-targeted therapies - a EuroFlow study. Br J Haematol 2021; 197:76-81. [PMID: 34881427 PMCID: PMC9299641 DOI: 10.1111/bjh.17992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023]
Abstract
The standardized EuroFlow protocol, including CD19 as primary B‐cell marker, enables highly sensitive and reliable minimal residual disease (MRD) assessment in B‐cell precursor acute lymphoblastic leukaemia (BCP‐ALL) patients treated with chemotherapy. We developed and validated an alternative gating strategy allowing reliable MRD analysis in BCP‐ALL patients treated with CD19‐targeting therapies. Concordant data were obtained in 92% of targeted therapy patients who remained CD19‐positive, whereas this was 81% in patients that became (partially) CD19‐negative. Nevertheless, in both groups median MRD values showed excellent correlation with the original MRD data, indicating that, despite higher interlaboratory variation, the overall MRD analysis was correct.
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Affiliation(s)
- Martijn W C Verbeek
- Laboratory for Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Chiara Buracchi
- Tettamanti Research Center, Pediatric Clinic University of Milano Bicocca, Monza (MB), Italy
| | - Anna Laqua
- Department of Hematology, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Stefan Nierkens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Lukasz Sedek
- Department of Microbiology and Immunology, Medical University of Silesia in Katowice, Zabrze, Poland.,Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Juan Flores-Montero
- Translational and Clinical Research program, Cancer Research Centre (IBMCC, CSIC-USAL), Cytometry Service, NUCLEUS, Salamanca, Spain.,Department of Medicine, University of Salamanca (USAL), Salamanca, Spain.,Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Mattias Hofmans
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.,Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Elaine Sobral de Costa
- Pediatrics Institute IPPMG, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michaela Nováková
- CLIP-Department of Pediatric Hematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Ester Mejstrikova
- CLIP-Department of Pediatric Hematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Susana Barrena
- Translational and Clinical Research program, Cancer Research Centre (IBMCC, CSIC-USAL), Cytometry Service, NUCLEUS, Salamanca, Spain.,Department of Medicine, University of Salamanca (USAL), Salamanca, Spain.,Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Saskia Kohlscheen
- Department of Hematology, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Monika Szczepanowski
- Department of Hematology, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jan Kulis
- Department of Microbiology and Immunology, Medical University of Silesia in Katowice, Zabrze, Poland.,Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Elen Oliveira
- Pediatrics Institute IPPMG, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Romana Jugooa
- Laboratory for Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anja X de Jong
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Tomasz Szczepanski
- Department of Microbiology and Immunology, Medical University of Silesia in Katowice, Zabrze, Poland.,Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Jan Philippé
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.,Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jacques J M van Dongen
- Department of Immunohematology and Blood Transfusion (IHB), University Medical Center (LUMC), Leiden, the Netherlands
| | - Alberto Orfao
- Translational and Clinical Research program, Cancer Research Centre (IBMCC, CSIC-USAL), Cytometry Service, NUCLEUS, Salamanca, Spain.,Department of Medicine, University of Salamanca (USAL), Salamanca, Spain.,Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Monika Brüggemann
- Department of Hematology, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Giuseppe Gaipa
- Tettamanti Research Center, Pediatric Clinic University of Milano Bicocca, Monza (MB), Italy
| | - Vincent H J van der Velden
- Laboratory for Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Multicolor flow cytometry immunophenotyping and characterization of aneuploidy in pediatric B-cell precursor acute lymphoblastic leukemia. Cent Eur J Immunol 2021; 46:365-374. [PMID: 34764809 PMCID: PMC8574114 DOI: 10.5114/ceji.2021.109794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 05/31/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to assess the incidence of DNA aneuploidy in Polish children with B-cell precursor acute lymphoblastic leukemia (BCP-ALL) and the relationship between aneuploidy and immunological phenotype, age, leukocyte count, S-phase fraction (SPF) and early response to induction chemotherapy assessed by the percentage of residual blast cells in bone marrow aspirates. The study group consisted of 267 patients. DNA content and immunophenotype were assessed in the bone marrow before treatment using multicolor flow cytometry (FC). DNA aneuploidy was detected in 50/267 (19%) patients. High hyperdiploidy was found to be associated with lower leukocyte count (p = 0.006) and common ALL immunophenotype. Flow cytometry analysis revealed that high hyperdiploid BCP-ALL patients showed significantly higher expression of CD9, CD20, CD22, CD58, CD66c, CD86 and CD123 antigens as compared to other groups of ploidy. In contrast, CD45 showed decreased expression. The percentage of leukemic blasts at diagnosis was lower in high hyperdiploid BCP-ALL cases than in diploid (79% vs. 85.7%, p = 0.001). The difference in minimal residual disease (MRD) levels on day 15 and 33 of induction therapy between analyzed groups was not significant. This study showed that high hyperdiploidy is associated with lower WBC count and specific immunological phenotype. Flow cytometric evaluation of expression of selected antigens can be used for fast identification of markers of aneuploidy in pediatric BCP-ALL, before genetic tests results are available. Understanding the biological significance of aneuploidy in leukemia can potentially be exploited therapeutically using targeted therapies against specific blast cell subclones.
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3
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Chatterjee G, Dudakia V, Ghogale S, Deshpande N, Girase K, Chaturvedi A, Shetty D, Senger M, Jain H, Bagal B, Bonda A, Punatar S, Gokarn A, Khattry N, Patkar NV, Gujral S, Subramanian PG, Tembhare PR. Expression of CD304/neuropilin-1 in adult b-cell lymphoblastic leukemia/lymphoma and its utility for the measurable residual disease assessment. Int J Lab Hematol 2021; 43:990-999. [PMID: 33432783 DOI: 10.1111/ijlh.13456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/27/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Many new markers are being evaluated to increase the sensitivity and applicability of multicolor flow cytometry (MFC)-based measurable residual disease (MRD) monitoring. However, most of the studies are limited to childhood B-cell lymphoblastic leukemia/lymphoma (B-ALL), and reports in adult B-ALL are extremely scarce and limited to small cohorts. We studied the expression of CD304/neuropilin-1 in a large cohort of adult B-ALL patients and evaluated its practical utility in MFC-based MRD analysis. METHODS CD304 was studied in blasts from adult B-ALL patients and normal precursor B cells (NPBC) from non-B-ALL bone marrow samples using MFC. CD304 expression intensity and pattern were studied with normalized-mean fluorescent intensity (nMFI) and coefficient of variation of immunofluorescence (CVIF), respectively. MFC-based MRD was performed at end of induction (EOI; day-35), end of consolidation (EOC; day 78-80), and subsequent follow-up (SFU) time points. RESULTS CD304 was positive in 120/214(56.07%) and was significantly associated with BCR-ABL1 fusion (P = .001). EOI-MRD and EOC-MRD were positive in 129/214(60.3%) and 50/81(61.72%), respectively. CD304 was positive in a significant percentage of EOI (48%, 62/129) and EOC (52%, 26/50) MRD-positive B-ALL samples. Its expression was retained, lost, and gained in 73.7%, 26.3%, and 11.3% of EOI-MRD and 85.7%, 14.3%, and none of EOC-MRD samples, respectively. Low-level MRD (<0.01%) was detectable in 34 of all (EOI + EOC + SFU = 189) MRD-positive samples, and CD304 was found useful in 50% of these samples. CONCLUSION CD304 is commonly expressed in adult B-ALL and clearly distinguish B-ALL blasts from normal precursor B cells. It is a stable MRD marker and distinctly useful in the detection of MFC-based MRD monitoring, especially in high-sensitivity MRD assay.
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Affiliation(s)
- Gaurav Chatterjee
- Department of Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, India
| | - Vishesh Dudakia
- Department of Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, India
| | - Sitaram Ghogale
- Department of Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, India
| | - Nilesh Deshpande
- Department of Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, India
| | - Karishma Girase
- Department of Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, India
| | - Anumeha Chaturvedi
- Department of Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, India
| | - Dhanlaxmi Shetty
- Department of Department of Cancer Cytogenetics, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, India
| | - Manju Senger
- Department of Medical Oncology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Hasmukh Jain
- Department of Medical Oncology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Avinash Bonda
- Department of Medical Oncology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Sachin Punatar
- Department of Medical Oncology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Anant Gokarn
- Department of Medical Oncology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Navin Khattry
- Department of Medical Oncology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Nikhil V Patkar
- Department of Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, India
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Papagudi G Subramanian
- Department of Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, India
| | - Prashant R Tembhare
- Department of Hematopathology Laboratory, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, India
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4
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The prognostic significance of hematogones and CD34+ myeloblasts in bone marrow for adult B-cell lymphoblastic leukemia without minimal residual disease. Sci Rep 2019; 9:19722. [PMID: 31871314 PMCID: PMC6928064 DOI: 10.1038/s41598-019-56126-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/05/2019] [Indexed: 02/05/2023] Open
Abstract
This study was aimed to dissect the prognostic significances of hematogones and CD34+ myeloblasts in bone marrow for adult B-cell acute lymphoblastic leukemia(ALL) without minimal residual disease(MRD) after the induction chemotherapy cycle. A total of 113 ALL patients who have received standardized chemotherapy cycle were analyzed. Cases that were not remission after induction chemotherapy or have received stem cell transplantation were excluded. Flow cytometry was used to quantify the levels of hematogones and CD34+ myeloblasts in bone marrow aspirations, and the patients were grouped according to the levels of these two precursor cell types. The long-term relapse-free survival(RFS) and recovery of peripheral blood cells of each group after induction chemotherapy were compared. The results indicated that, after induction chemotherapy, patients with hematogones ≥0.1% have a significantly longer remission period than patients with hematogones <0.1% (p = 0.001). Meanwhile, the level of hematogones was positively associated with the recovery of both hemoglobin and platelet in peripheral blood, while CD34+ myeloblasts level is irrelevant to the recovery of Hb and PLT in peripheral blood, level of hematogones and long-term prognosis. This study confirmed hematogones level after induction chemotherapy can be used as a prognostic factor for ALL without MRD. It is more applicable for evaluation prognosis than CD34+ myeloblasts.
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Janke LJ, Mullighan CG, Dang J, Rehg JE. Immunophenotyping of Murine Precursor B-Cell Leukemia/Lymphoma: A Comparison of Immunohistochemistry and Flow Cytometry. Vet Pathol 2019; 56:950-958. [PMID: 31170889 PMCID: PMC7140381 DOI: 10.1177/0300985819852138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In humans and in mouse models, precursor B-cell lymphoblastic leukemia (B-ALL)/lymphoblastic lymphoma (B-LBL) can be classified as either the pro-B or pre-B subtype. This is based on the expression of antigens associated with the pro-B and pre-B stages of B-cell development. Antigenic markers can be detected by flow cytometry or immunohistochemistry (IHC), but no comparison of results from these techniques has been reported for murine B-ALL/LBL. In our analysis of 30 cases induced by chemical or viral mutagenesis on a WT or Pax5+/- background, 18 (60%) were diagnosed as pro-B by both flow cytometry and IHC. Discordant results were found for 12 (40%); 6 were designated pro-B by IHC and pre-B by flow cytometry and the reverse for the remaining 6 cases. Discordance occurred because different markers were used to define the pro-B-to-pre-B transition by IHC vs flow cytometry. IHC expression of cytoplasmic IgM (μIgM) defined the pre-B stage, whereas the common practice of using CD25 as a surrogate marker in flow cytometry was employed here. These results show that CD25 and μIgM are not always concurrently expressed in B-ALL/LBL, in contrast to normal B-cell development. Therefore, when subtyping B-ALL/LBL in mice, an IHC panel of B220, PAX5, TdT, c-Kit/CD117, CD43, IgM, and ΚLC should be considered. For flow cytometry, cytoplasmic IgM may be an appropriate marker in conjunction with the surface markers B220, CD19, CD43, c-Kit/CD117, BP-1, and CD25.
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Affiliation(s)
- Laura J Janke
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Charles G Mullighan
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jinjun Dang
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jerold E Rehg
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
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6
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Jiang XY, Luider J, Shameli A. Artifactual Kappa Light Chain Restriction of Marrow Hematogones: A Potential Diagnostic Pitfall in Minimal Residual Disease Assessment of Plasma Cell Myeloma Patients on Daratumumab. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019; 98:68-74. [DOI: 10.1002/cyto.b.21837] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/10/2019] [Accepted: 06/27/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Xiu yan Jiang
- Division of Hematology, Alberta Public Laboratories & Department of Pathology & Laboratory MedicineUniversity of Calgary Calgary Alberta Canada
| | - Joanne Luider
- Division of Hematology, Alberta Public Laboratories & Department of Pathology & Laboratory MedicineUniversity of Calgary Calgary Alberta Canada
| | - Afshin Shameli
- Division of Hematology, Alberta Public Laboratories & Department of Pathology & Laboratory MedicineUniversity of Calgary Calgary Alberta Canada
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7
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Pastorczak A, Sedek L, Braun M, Madzio J, Sonsala A, Twardoch M, Fendler W, Nebral K, Taha J, Bielska M, Gorniak P, Romiszewska M, Matysiak M, Derwich K, Lejman M, Kowalczyk J, Badowska W, Niedzwiecki M, Kazanowska B, Muszynska-Roslan K, Sobol-Milejska G, Karolczyk G, Koltan A, Ociepa T, Szczepanski T, Młynarski W. Surface expression of Cytokine Receptor-Like Factor 2 increases risk of relapse in pediatric acute lymphoblastic leukemia patients harboring IKZF1 deletions. Oncotarget 2018; 9:25971-25982. [PMID: 29899835 PMCID: PMC5995260 DOI: 10.18632/oncotarget.25411] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 04/27/2018] [Indexed: 01/13/2023] Open
Abstract
We prospectively examined whether surface expression of Cytokine Receptor-Like Factor 2 (CRLF2) on leukemic blasts is associated with survival and induction treatment response in pediatric B-cell precursor acute lymphoblastic leukemia (BCP-ALL) patients. Flow cytometric analysis of bone marrow-derived leukemia cells revealed that 7.51% (29/286) of 386 pediatric BCP-ALL patients were CRLF2-positive (CRLF2pos) at diagnosis. The median minimal residual disease (MRD) was lower in CRLF2pos than CRLF2-negative (CRLF2neg) patients on day 15 (MRD15) after induction therapy [0.01% (0.001-0.42%) vs. 0.45% (0.05-3.50%); p=0.001]. By contrast, the MRD15 was higher in Ikaros family Zinc Finger Protein 1 (IKZF1)-deleted BCP-ALL patients than in BCP-ALL patients without IKZF1 deletions [1.18% (0.06-12.0%) vs 0.33% (0.03-2.6%); p=0.003]. Subgroup analysis showed that MRD15 levels were lower in IKZF1Δ/CRLF2pos patients than in IKZF1Δ/CRLF2neg patients [0.1% (0.02-5.06%) vs. 2.9% (0.25-12%); p=0.005]. Furthermore, MRD15 levels were higher in IKZF1WT/CRLF2neg patients than in IKZF1WT/CRLF2pos patients [0.40% (0.04-2.7%) vs. 0.001% (0.001-0.01%)]. Despite the low MRD15 levels, IKZF1Δ/CRLF2pos patients showed poorer relapse-free survival (RFS) than other patient groups (p=0.003). These findings demonstrate that surface CRLF2 expression is associated with increased risk of relapse in pediatric BCP-ALL patients harboring IKZF1 deletions.
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Affiliation(s)
- Agata Pastorczak
- Department of Pediatrics, Hematology, Oncology and Diabetology, Medical University of Łódź, Łódź, Poland
| | - Lukasz Sedek
- Department of Pediatric Hematology and Oncology, Medical University of Silesia, Zabrze, Poland
| | - Marcin Braun
- Department of Pediatrics, Hematology, Oncology and Diabetology, Medical University of Łódź, Łódź, Poland.,Postgraduate School of Molecular Medicine, Medical University of Warsaw, Warsaw, Poland.,Department of Pathology, Chair of Oncology, Medical University of Łódź, Łódź, Poland
| | - Joanna Madzio
- Department of Pediatrics, Hematology, Oncology and Diabetology, Medical University of Łódź, Łódź, Poland.,Postgraduate School of Molecular Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Alicja Sonsala
- Department of Pediatric Hematology and Oncology, Medical University of Silesia, Zabrze, Poland
| | - Magdalena Twardoch
- Department of Pediatric Hematology and Oncology, Medical University of Silesia, Zabrze, Poland
| | - Wojciech Fendler
- Department of Pediatrics, Hematology, Oncology and Diabetology, Medical University of Łódź, Łódź, Poland.,Department of Biostatistics and Translational Medicine, Medical University of Łódź, Łódź, Poland
| | - Karin Nebral
- Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Joanna Taha
- Department of Pediatrics, Hematology, Oncology and Diabetology, Medical University of Łódź, Łódź, Poland
| | - Marta Bielska
- Department of Pediatrics, Hematology, Oncology and Diabetology, Medical University of Łódź, Łódź, Poland
| | - Patryk Gorniak
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Magdalena Romiszewska
- Department of Pediatrics, Oncology and Hematology, Medical University of Warsaw, Warsaw, Poland
| | - Michal Matysiak
- Department of Pediatrics, Oncology and Hematology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Derwich
- Department of Pediatric Hematology, Oncology, Transplantology, Medical University of Poznań, Poznań, Poland
| | - Monika Lejman
- Department of Pediatric Hematology and Oncology, Medical University of Lublin, Lublin, Poland
| | - Jerzy Kowalczyk
- Department of Pediatric Hematology and Oncology, Medical University of Lublin, Lublin, Poland
| | - Wanda Badowska
- Department of Pediatric Hematology and Oncology, Children's Hospital in Olsztyn, Olsztyn, Poland
| | - Maciej Niedzwiecki
- Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdańsk, Gdańsk, Poland
| | - Bernarda Kazanowska
- Department of Transplantology, Pediatric Oncology and Hematology, Medical University of Wrocław, Wrocław, Poland
| | | | | | | | - Andrzej Koltan
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Mikolaj Kopernik University, Bydgoszcz, Poland
| | - Tomasz Ociepa
- Department of Pediatrics, Hematology and Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Szczepanski
- Department of Pediatric Hematology and Oncology, Medical University of Silesia, Zabrze, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Hematology, Oncology and Diabetology, Medical University of Łódź, Łódź, Poland
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8
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Gajendra S, Misra R, Dorwal P, Sharma R, Sachdev R. Significant Haematogone Proliferation Mimicking Relapse in Acute Lymphoblastic Leukaemia on Therapy. J Clin Diagn Res 2017; 11:ED01-ED03. [PMID: 28384870 DOI: 10.7860/jcdr/2017/23650.9190] [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] [Received: 08/19/2016] [Accepted: 10/29/2016] [Indexed: 11/24/2022]
Abstract
Haematogones are benign B lymphoid precursors which may mimic neoplastic lymphoblasts and pose diagnostic difficulty especially when the percentage of haematogones exceeds 10% in the bone marrow. Flow cytometric analysis with combination of CD19/CD10/CD20/CD34/CD38/CD58 can be used to differentiate the two depending upon the difference in the fluorescence intensity between blasts and haematogones. We hereby present a case of Common Acute Lymphoblastic Leukaemia Associated Antigen (CALLA) positive Acute Lymphoblastic Leukaemia (ALL), in which patient presented with haematogone proliferation in bone marrow after 6 months of chemotherapy mimicking relapse. The distinction was made on flow cytometric immunophenotyping by using optimal antibody combination. Distinction of benign haematogones from neoplastic lymphoblasts is essential for disease management in cases of post chemotherapy or post marrow transplant, especially in patients of ALL. Flow cytometric immunophenotyping is reliable to distinguish haematogones from residual lymphoblasts in almost all cases when optimal antibody combinations are used.
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Affiliation(s)
- Smeeta Gajendra
- Associate Consultant, Department of Pathology and Laboratory Medicine, Medanta - The Medicity , Gurgaon, Haryana, India
| | - Ruchira Misra
- Consultant, Department of Paediatric Hemat-Oncology, Medanta - The Medicity , Gurgaon, Haryana, India
| | - Pranav Dorwal
- Associate Consultant, Department of Pathology and Laboratory Medicine, Medanta - The Medicity , Gurgaon, Haryana, India
| | - Rashi Sharma
- Senior Resident, Department of Pathology and Laboratory Medicine, Medanta - The Medicity , Gurgaon, Haryana, India
| | - Ritesh Sachdev
- Senior Consultant, Department of Pathology and Laboratory Medicine, Medanta - The Medicity , Gurgaon, Haryana, India
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9
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Wallace PK. Issue highlights--November 2015 (88:B6). CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 88:355-7. [PMID: 26372922 DOI: 10.1002/cyto.b.21324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Paietta E. Minimal Residual Disease in AML: Why Has It Lagged Behind Pediatric ALL? CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 15 Suppl:S2-6. [PMID: 26297274 DOI: 10.1016/j.clml.2015.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 02/03/2015] [Indexed: 12/16/2022]
Abstract
Although the concept of minimal residual disease (MRD) as an indicator for the quality of treatment response is the same in acute myeloid leukemia (AML) and acute lymphoid leukemia (ALL), the practice of measuring MRD levels for monitoring response and guiding therapy after induction has been implemented much more rapidly in ALL, particularly pediatric ALL, than in AML. In this perspective we examine the facts and discuss why ALL appears to be more amenable to MRD-shaped risk allocation and a revised definition of complete remission.
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Affiliation(s)
- Elisabeth Paietta
- Montefiore Medical Center-North Division, Albert Einstein College of Medicine, Bronx, NY.
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Ghodke K, Bibi A, Rabade N, Patkar N, Subramanian PG, Kadam PA, Badrinath Y, Ghogale S, Gujral S, Tembhare P. CD19 negative precursor B acute lymphoblastic leukemia (B-ALL)-Immunophenotypic challenges in diagnosis and monitoring: A study of three cases. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 92:315-318. [PMID: 27018867 DOI: 10.1002/cyto.b.21373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 03/11/2016] [Accepted: 03/22/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND CD19 is a B-cell specific marker, expressed on all stages of B-lymphocytes including plasma cells. It is widely used in the flow cytometric immunophenotyping (FCI) of B-cell and plasma cell malignancies. The analysis approach of FCI for the diagnosis and monitoring of B-cell acute lymphoblastic leukemia (B-ALL) is totally based on the CD19-based primary gating strategy and it would be challenging to study B-ALL without CD19 expression. Since CD19 negative B-ALL are extremely rare, we report three cases of B-ALL with negative expression of CD19 and discussed its implication in the diagnosis, residual disease monitoring and future targeted therapy. METHODS Peripheral blood (PB) and bone marrow (BM) samples from three cases suspicious of acute leukemia were studied for morphology, cytochemistry, immunophenotyping and cytogenetics. FCI was performed using a comprehensive six to eight-color multiparametric assay. The cytogenetic studies for standard recurrent genetic translocations were performed by FISH & Karyotyping. RESULTS The three cases studied were diagnosed as B-ALL based on the expression of CD10, CD20, CD22, CD34, and CD79a by leukemic blasts. CD19 was studied using two different clones (i.e. J3-119 & HIB-19) and found to be severely down regulated in all three cases. There were no significant differentiating features in morphology. Cytogenetic studies were negative for recurrent translocations. CONCLUSION We report three cases of extremely rare CD19 negative B-ALL. Lack of awareness of negative CD19 expression in B-ALL can leads to incorrect immunophenotypic diagnosis and monitoring of B-ALL, especially in laboratories using limited markers. © 2016 International Clinical Cytometry Society.
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Affiliation(s)
- Kiran Ghodke
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Asma Bibi
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Nikhil Rabade
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Nikhil Patkar
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - P G Subramanian
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
| | | | - Y Badrinath
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Sitaram Ghogale
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Sumeet Gujral
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Prashant Tembhare
- Hematopathology Laboratory, Department of Pathology, Tata Memorial Centre, Mumbai, India
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Shahal-Zimra Y, Rotem Z, Chezar J, Oniashvili N, Leader A, Raanani P, Rabizadeh E. Adult pre B-cell acute lymphoblastic leukemia with unusually large proportion of bone marrow CD45 bright/high SSc blasts. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 92:161-164. [PMID: 26415521 DOI: 10.1002/cyto.b.21329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/31/2015] [Accepted: 09/17/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND We present a pre B-ALL patient with the rare clinical manifestation of extramedullary disease, and a normal hemogram. This patient's blasts expressed bright CD45 and high side scatter (SSc) placing the cells in the monocyte gate. METHODS Samples from peripheral blood and bone marrow (BM) aspirate from a 50-year-old female patient were immunophenotyped by multiparametric flow cytometry. RESULTS Flow cytometry studies of the BM aspirate showed a large monocyte gate with 90-95% of the cells expressing an abnormal B cell phenotype. Peripheral white blood cells count was normal and cytogenetic analysis of the BM revealed a normal karyotype. CONCLUSION It was not possible, based on CD45/SSc to identify a lymphoblast population in this pre B-ALL patient. Although bright expression of CD45 B-ALL blasts has been associated with poor prognosis to the best of our knowledge, the combination of bright CD45 blasts with high SSc has not been reported. As CD45 expression vs. SSc is routinely measured in the diagnostics of acute leukemias, a possible association between CD45 bright positivity and extramedullary disease or prognosis warrants further exploration. © 2015 International Clinical Cytometry Society.
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Affiliation(s)
- Yael Shahal-Zimra
- Hematology Laboratory, Flow Cytometry Division, Hematology Institute; Tel Aviv University. Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.,Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University. Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Zohar Rotem
- Hematology Laboratory, Flow Cytometry Division, Hematology Institute; Tel Aviv University. Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Judith Chezar
- Hematology Laboratory, Flow Cytometry Division, Hematology Institute; Tel Aviv University. Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Nino Oniashvili
- Cytogenetic Institute; Tel Aviv University, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Avi Leader
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center Petah Tikva and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center Petah Tikva and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Esther Rabizadeh
- Hematology Laboratory, Flow Cytometry Division, Hematology Institute; Tel Aviv University. Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.,Cytogenetic Institute; Tel Aviv University, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
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13
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Ikoma MRV, Beltrame MP, Ferreira SIACP, Souto EX, Malvezzi M, Yamamoto M. Proposal for the standardization of flow cytometry protocols to detect minimal residual disease in acute lymphoblastic leukemia. Rev Bras Hematol Hemoter 2015; 37:406-13. [PMID: 26670404 PMCID: PMC4678914 DOI: 10.1016/j.bjhh.2015.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 07/23/2015] [Accepted: 07/27/2015] [Indexed: 01/26/2023] Open
Abstract
Minimal residual disease is the most powerful predictor of outcome in acute leukemia and is useful in therapeutic stratification for acute lymphoblastic leukemia protocols. Nowadays, the most reliable methods for studying minimal residual disease in acute lymphoblastic leukemia are multiparametric flow cytometry and polymerase chain reaction. Both provide similar results at a minimal residual disease level of 0.01% of normal cells, that is, detection of one leukemic cell in up to 10,000 normal nucleated cells. Currently, therapeutic protocols establish the minimal residual disease threshold value at the most informative time points according to the appropriate methodology employed. The expertise of the laboratory in a cancer center or a cooperative group could be the most important factor in determining which method should be used. In Brazil, multiparametric flow cytometry laboratories are available in most leukemia treatment centers, but multiparametric flow cytometry processes must be standardized for minimal residual disease investigations in order to offer reliable and reproducible results that ensure quality in the clinical application of the method. The Minimal Residual Disease Working Group of the Brazilian Society of Bone Marrow Transplantation (SBTMO) was created with that aim. This paper presents recommendations for the detection of minimal residual disease in acute lymphoblastic leukemia based on the literature and expertise of the laboratories who participated in this consensus, including pre-analytical and analytical methods. This paper also recommends that both multiparametric flow cytometry and polymerase chain reaction are complementary methods, and so more laboratories with expertise in immunoglobulin/T cell receptor (Ig/TCR) gene assays are necessary in Brazil.
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Affiliation(s)
| | | | | | | | | | - Mihoko Yamamoto
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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14
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Bagwell CB, Hill BL, Wood BL, Wallace PK, Alrazzak M, Kelliher AS, Preffer FI. Human B-cell and progenitor stages as determined by probability state modeling of multidimensional cytometry data. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2015; 88:214-26. [PMID: 25850810 PMCID: PMC5828699 DOI: 10.1002/cyto.b.21243] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 04/01/2015] [Accepted: 04/03/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Human progenitor and B-cell development is a highly regulated process characterized by the ordered differential expression of numerous cell-surface and intracytoplasmic antigens. This study investigates the underlying coordination of these modulations by examining a series of normal bone marrow samples with the method of probability state modeling or PSM. RESULTS The study is divided into two sections. The first section examines B-cell stages subsequent to CD19 up-regulation. The second section assesses an earlier differentiation stage before and including CD19 up-regulation. POST-CD19 ANTIGENIC UP-REGULATION: Statistical analyses of cytometry data derived from sixteen normal bone marrow specimens revealed that B cells have at least three distinct coordinated changes, forming four stages labeled as B1, B2, B3, and B4. At the end of B1; CD34 antigen expression down-regulates with TdT while CD45, CD81, and CD20 slightly up-regulate. At the end of B2, CD45 and CD20 up-regulate. At the end of B3 and beginning of B4; CD10, CD38, and CD81 down-regulate while CD22 and CD44 up-regulate. PRE-CD19 ANTIGENIC UP-REGULATION: Statistical analysis of ten normal bone marrows revealed that there are at least two measurable coordinated changes with progenitors, forming three stages labeled as P1, P2, and P3. At the end of P1, CD38 up-regulates. At the end of P2; CD19, CD10, CD81, CD22, and CD9 up-regulate while CD44 down-regulates slightly. CONCLUSIONS These objective results yield a clearer immunophenotypic picture of the underlying cellular mechanisms that are operating in these important developmental processes. Also, unambiguously determined stages define what is meant by "normal" B-cell development and may serve as a preliminary step for the development of highly sensitive minimum residual disease detection systems. A companion article is simultaneously being published in Cytometry Part A that will explain in further detail the theory behind PSM. Three short relevant videos are available in the online supporting information for both of these papers.
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Affiliation(s)
| | | | - Brent L Wood
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, 98195
- Department of Pathology, University of Washington, Seattle, Washington, 98195
| | - Paul K Wallace
- Department of Flow and Image Cytometry, Roswell Park Cancer Institute, Buffalo, New York, 14263
| | - Muaz Alrazzak
- Department of Flow and Image Cytometry, Roswell Park Cancer Institute, Buffalo, New York, 14263
| | - Abigail S Kelliher
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, 02114
| | - Frederic I Preffer
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, 02114
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15
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Montezuma-Rusca JM, Moir S, Kardava L, Buckner CM, Louie A, Kim LJY, Santich BH, Wang W, Fankuchen OR, Diaz G, Daub JR, Rosenzweig SD, Chun TW, Li Y, Braylan RC, Calvo KR, Fauci AS. Bone marrow plasma cells are a primary source of serum HIV-1-specific antibodies in chronically infected individuals. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2015; 194:2561-8. [PMID: 25681347 PMCID: PMC4355319 DOI: 10.4049/jimmunol.1402424] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Several potent and broadly neutralizing Abs to HIV-1 have been isolated recently from peripheral blood B cells of infected individuals, based on prescreening of Ab activity in the serum. However, little is known regarding the cells that make the Abs that circulate in the blood. Accordingly, we investigated the most likely source, the bone marrow, of chronically HIV-1-infected individuals who were not receiving antiretroviral therapy. Increased frequencies of plasma cells, as well as B cell precursors, namely preB-I and preB-II, and decreased frequencies of mature B cells were observed in bone marrow aspirates of these individuals compared with HIV-negative counterparts. Increased frequencies of bone marrow plasma cells are consistent with known hallmarks of HIV-1 infection, namely hypergammaglobulinemia and increased frequencies of peripheral blood plasmablasts. Levels of HIV-1 envelope (Env)-binding and HIV-1-neutralizing Abs were measured in serum, and corresponding frequencies of Ab-secreting or Env-binding cells were measured in the blood (plasmablasts and memory B cells) and in the bone marrow (plasma cells). A strong correlation was observed between serum HIV-1-specific Abs and Env-specific bone marrow-derived plasma cells, but not circulating plasmablasts or memory B cells. These findings demonstrate that, despite HIV-1-induced phenotypic and functional B cell dysregulation in the peripheral blood and secondary lymphoid tissues, bone marrow plasma cells remain a primary source for circulating HIV-1-specific Abs in HIV-1-infected individuals.
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Affiliation(s)
- Jairo M Montezuma-Rusca
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Susan Moir
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892;
| | - Lela Kardava
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Clarisa M Buckner
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Aaron Louie
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Leo J Y Kim
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Brian H Santich
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Wei Wang
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Olivia R Fankuchen
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Gabriella Diaz
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland 21702
| | - Janine R Daub
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Sergio D Rosenzweig
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | - Tae-Wook Chun
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Yuxing Li
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892; International AIDS Vaccine Initiative Neutralizing Antibody Center, The Scripps Research Institute, La Jolla, CA 92037; and Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla, CA 92037
| | - Raul C Braylan
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | - Katherine R Calvo
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | - Anthony S Fauci
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
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