1
|
Multiparametric Flow Cytometry for MRD Monitoring in Hematologic Malignancies: Clinical Applications and New Challenges. Cancers (Basel) 2021; 13:cancers13184582. [PMID: 34572809 PMCID: PMC8470441 DOI: 10.3390/cancers13184582] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary In hematologic cancers, Minimal Residual Disease (MRD) monitoring, using either molecular (PCR) or immunophenotypic (MFC) diagnostics, allows the identification of rare cancer cells, readily detectable either in the bone marrow or in the peripheral blood at very low levels, far below the limit of classic microscopy. In this paper, we outlined the state-of-the-art of MFC-based MRD detection in different hematologic settings, highlighting main recommendations and new challenges for using such method in patients with acute leukemias or chronic hematologic neoplasms. The combination of new molecular technologies with advanced flow cytometry is progressively allowing clinicians to design a personalized therapeutic path, proportionate to the biological aggressiveness of the disease, in particular by using novel immunotherapies, in view of a modern decision-making process, based on precision medicine. Abstract Along with the evolution of immunophenotypic and molecular diagnostics, the assessment of Minimal Residual Disease (MRD) has progressively become a keystone in the clinical management of hematologic malignancies, enabling valuable post-therapy risk stratifications and guiding risk-adapted therapeutic approaches. However, specific prognostic values of MRD in different hematological settings, as well as its appropriate clinical uses (basically, when to measure it and how to deal with different MRD levels), still need further investigations, aiming to improve standardization and harmonization of MRD monitoring protocols and MRD-driven therapeutic strategies. Currently, MRD measurement in hematological neoplasms with bone marrow involvement is based on advanced highly sensitive methods, able to detect either specific genetic abnormalities (by PCR-based techniques and next-generation sequencing) or tumor-associated immunophenotypic profiles (by multiparametric flow cytometry, MFC). In this review, we focus on the growing clinical role for MFC-MRD diagnostics in hematological malignancies—from acute myeloid and lymphoblastic leukemias (AML, B-ALL and T-ALL) to chronic lymphocytic leukemia (CLL) and multiple myeloma (MM)—providing a comparative overview on technical aspects, clinical implications, advantages and pitfalls of MFC-MRD monitoring in different clinical settings.
Collapse
|
2
|
Illingworth A, Johansson U, Huang S, Horna P, Wang SA, Almeida J, Wolniak KL, Psarra K, Torres R, Craig FE. International guidelines for the flow cytometric evaluation of peripheral blood for suspected Sézary syndrome or mycosis fungoides: Assay development/optimization, validation, and ongoing quality monitors. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 100:156-182. [PMID: 33112044 DOI: 10.1002/cyto.b.21963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 12/23/2022]
Abstract
Introducing a sensitive and specific peripheral blood flow cytometric assay for Sézary syndrome and mycosis fungoides (SS/MF) requires careful selection of assay design characteristics, and translation into a laboratory developed assay through development/optimization, validation, and continual quality monitoring. As outlined in a previous article in this series, the recommended design characteristics of this assay include at a minimum, evaluation of CD7, CD3, CD4, CD8, CD26, and CD45, analyzed simultaneously, requiring at least a 6 color flow cytometry system, with both quantitative and qualitative components. This article provides guidance from an international group of cytometry specialists in implementing an assay to those design specifications, outlining specific considerations, and best practices. Key points presented in detail are: (a) Pre-analytic components (reagents, specimen processing, and acquisition) must be optimized to: (i) identify and characterize an abnormal population of T-cells (qualitative component) and (ii) quantitate the abnormal population (semi/quasi-quantitative component). (b)Analytic components (instrument set-up/acquisition/analysis strategy and interpretation) must be optimized for the identification of SS/MF populations, which can vary widely in phenotype. Comparison with expert laboratories is strongly encouraged in order to establish competency. (c) Assay performance must be validated and documented through a validation plan and report, which covers both qualitative and semi/quasi-quantitative assay components (example template provided). (d) Ongoing assay-specific quality monitoring should be performed to ensure consistency.
Collapse
Affiliation(s)
- Andrea Illingworth
- Flow Cytometry Division, Dahl-Chase Diagnostic Services, Bangor, Maine, USA
| | - Ulrika Johansson
- SI-HMDS, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sa A Wang
- Department of Hematopathology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Julia Almeida
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, IBSAL and CIBERONC, University of Salamanca, Salamanca, Spain
| | - Kristy L Wolniak
- Division of Hematopathology, Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katherina Psarra
- Department of Immunology - Histocompatibility, "Evangelismos" Hospital, Athens, Greece
| | - Richard Torres
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Fiona E Craig
- Division of Hematopathology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| |
Collapse
|
3
|
Lacombe F, Bernal E, Bloxham D, Couzens S, Porta MGD, Johansson U, Kern W, Macey M, Matthes T, Morilla R, Paiva A, Palacio C, Preijers F, Ratei R, Siitonen S, Allou K, Porwit A, Béné MC. Harmonemia: a universal strategy for flow cytometry immunophenotyping-A European LeukemiaNet WP10 study. Leukemia 2016; 30:1769-72. [PMID: 26922887 DOI: 10.1038/leu.2016.44] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- F Lacombe
- Hematology Laboratory, Bordeaux University Hospital, Bordeaux, France
| | - E Bernal
- Douglass Hanly Moir Pathology, Sonic Healthcare, Sydney, New South Wales, Australia
| | - D Bloxham
- Department of Haematology, Addenbrookes Hospital, Cambridge, UK
| | - S Couzens
- Immunophenotyping Laboratory, Cardiff University, Cardiff, UK
| | - M G D Porta
- Department of Hematology Oncology, University of Pavia and IRCCS Policlinico San Matteo, Pavia, Italy
| | - U Johansson
- Flow Cytometry Laboratory, Bristol Royal Infirmary, Bristol, UK
| | - W Kern
- München Leukemia Labor, Munich, Germany
| | - M Macey
- St Bartholomew's and Royal London School of Medicine and Dentistry, London, UK
| | - T Matthes
- Hematology Laboratory, Geneva University Hospital, Geneva, Switzerland
| | - R Morilla
- The Institute of Cancer Research, Royal Cancer Hospital, London, UK
| | - A Paiva
- Flow Cytometry Unit, Clinical Pathology Service, Coimbra University Hospital Centre, Coimbra, Portugal
| | - C Palacio
- Department of Hematology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - F Preijers
- Department of Laboratory Medicine-Laboratory for Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R Ratei
- Department of Hematology and Oncology, Helios Klinikum Berlin Buch, Berlin, Germany
| | - S Siitonen
- Laboratory Services (HUSLAB), University Central Hospital, University of Helsinki, Helsinki, Finland
| | - K Allou
- Hematology Laboratory, Bordeaux University Hospital, Bordeaux, France
| | - A Porwit
- Department of Pathobiology and Laboratory Medicine, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - M C Béné
- Hematology Laboratory, Nantes University Hospital, Nantes, France
| |
Collapse
|
4
|
Flores-Montero J, de Tute R, Paiva B, Perez JJ, Böttcher S, Wind H, Sanoja L, Puig N, Lecrevisse Q, Vidriales MB, van Dongen JJM, Orfao A. Immunophenotype of normal vs. myeloma plasma cells: Toward antibody panel specifications for MRD detection in multiple myeloma. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 90:61-72. [PMID: 26100534 DOI: 10.1002/cyto.b.21265] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/25/2015] [Accepted: 06/17/2015] [Indexed: 01/04/2023]
Abstract
In recent years, several studies on large series of multiple myeloma (MM) patients have demonstrated the clinical utility of flow cytometry monitoring of minimal residual disease (flow-MRD) in bone marrow (BM), for improved assessment of response to therapy and prognostication. However, disturbing levels of variability exist regarding the specific protocols and antibody panels used in individual laboratories. Overall, consensus exists about the utility of combined assessment of CD38 and CD138 for the identification of BM plasma cells (PC); in contrast, more heterogeneous lists of markers are used to further distinguish between normal/reactive PCs and myeloma PCs in the MRD settings. Among the later markers, CD19, CD45, CD27, and CD81, together with CD56, CD117, CD200, and CD307, have emerged as particularly informative; however, no single marker provides enough specificity for clear discrimination between clonal PCs and normal PCs. Accordingly, multivariate analyses of single PCs from large series of normal/reactive vs. myeloma BM samples have shown that combined assessment of CD138 and CD38, together with CD45, CD19, CD56, CD27, CD81, and CD117 would be ideally suited for MRD monitoring in virtually every MM patient. However, the specific antibody clones, fluorochrome conjugates and sources of the individual markers determines its optimal (vs. suboptimal or poor) performance in an eight-color staining. Assessment of clonality, via additional cytoplasmic immunoglobulin (CyIg) κ vs. CyIgλ evaluation, may contribute to further establish the normal/reactive vs. clonal nature of small suspicious PC populations at high sensitivity levels, provided that enough cells are evaluated.
Collapse
Affiliation(s)
- Juan Flores-Montero
- Centro de Investigación del Cáncer (Instituto de Biología Molecular y Celular del Cáncer, CSIC-USAL), Instituto Biosanitario de Salamanca (IBSAL), Servicio de Citometría y Departamento de Medicina-NUCLEUS, Universidad de Salamanca (Salamanca), Spain
| | - Ruth de Tute
- Haematological Malignancy Diagnostic Service, St James Institute of Oncology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Bruno Paiva
- Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas (CIMA), Pamplona, Spain
| | - José Juan Perez
- Department of Hematology, Hospital Universitario de Salamanca, Instituto Biosanitario de Salamanca (IBSAL), Centro de Investigación del Cáncer (Instituto de Biología Molecular y Celular del Cáncer, CSIC-USAL), Salamanca, Spain
| | - Sebastian Böttcher
- Second Department of Medicine, University Hospital of Schleswig Holstein, Campus Kiel (UNIKIEL), Kiel, Germany
| | - Henk Wind
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam (Erasmus MC), Rotterdam, The Netherlands
| | - Luzalba Sanoja
- Centro de Investigación del Cáncer (Instituto de Biología Molecular y Celular del Cáncer, CSIC-USAL), Instituto Biosanitario de Salamanca (IBSAL), Servicio de Citometría y Departamento de Medicina-NUCLEUS, Universidad de Salamanca (Salamanca), Spain
| | - Noemí Puig
- Department of Hematology, Hospital Universitario de Salamanca, Instituto Biosanitario de Salamanca (IBSAL), Centro de Investigación del Cáncer (Instituto de Biología Molecular y Celular del Cáncer, CSIC-USAL), Salamanca, Spain
| | - Quentin Lecrevisse
- Centro de Investigación del Cáncer (Instituto de Biología Molecular y Celular del Cáncer, CSIC-USAL), Instituto Biosanitario de Salamanca (IBSAL), Servicio de Citometría y Departamento de Medicina-NUCLEUS, Universidad de Salamanca (Salamanca), Spain
| | - María Belén Vidriales
- Department of Hematology, Hospital Universitario de Salamanca, Instituto Biosanitario de Salamanca (IBSAL), Centro de Investigación del Cáncer (Instituto de Biología Molecular y Celular del Cáncer, CSIC-USAL), Salamanca, Spain
| | - Jacques J M van Dongen
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam (Erasmus MC), Rotterdam, The Netherlands
| | - Alberto Orfao
- Centro de Investigación del Cáncer (Instituto de Biología Molecular y Celular del Cáncer, CSIC-USAL), Instituto Biosanitario de Salamanca (IBSAL), Servicio de Citometría y Departamento de Medicina-NUCLEUS, Universidad de Salamanca (Salamanca), Spain
| |
Collapse
|
5
|
Cogbill CH, Spears MD, Vantuinen P, Harrington AM, Olteanu H, Kroft SH. Morphologic and cytogenetic variables affect the flow cytometric recovery of plasma cell myeloma cells in bone marrow aspirates. Int J Lab Hematol 2015. [DOI: 10.1111/ijlh.12411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C. H. Cogbill
- Department of Pathology; Medical College of Wisconsin; Milwaukee WI USA
| | - M. D. Spears
- Department of Pathology; Medical College of Wisconsin; Milwaukee WI USA
| | - P. Vantuinen
- Department of Pathology; Medical College of Wisconsin; Milwaukee WI USA
| | - A. M. Harrington
- Department of Pathology; Medical College of Wisconsin; Milwaukee WI USA
| | - H. Olteanu
- Department of Pathology; Medical College of Wisconsin; Milwaukee WI USA
| | - S. H. Kroft
- Department of Pathology; Medical College of Wisconsin; Milwaukee WI USA
| |
Collapse
|
6
|
Gormley NJ, Turley DM, Dickey JS, Farrell AT, Reaman GH, Stafford E, Carrington L, Marti GE. Regulatory perspective on minimal residual disease flow cytometry testing in multiple myeloma. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 90:73-80. [PMID: 26108351 DOI: 10.1002/cyto.b.21268] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 06/19/2015] [Indexed: 11/06/2022]
Abstract
The FDA has co-sponsored three workshops to address minimal residual disease (MRD) detection in acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), and acute myeloid leukemia (AML) as well as an FDA-NCI roundtable symposium on MRD detection and its use as a response biomarker in Multiple Myeloma (MM). As clinical outcomes in MM continue to improve with the introduction of new therapeutics, consideration of biomarkers and their development as validated surrogate endpoints that can be used in the place of traditional clinical trial endpoints of progression-free survival (PFS) will be fundamental to expeditious drug development. This article will describe the FDA drug approval process, the regulatory framework through which a biomarker can be used as a surrogate endpoint for drug approval, and how MRD detection in MM fits within this context. In parallel, this article will also describe the FDA current device clearance process with emphasis on the analytical development as it might apply to an in vitro diagnostic assay for the detection of MRD in MM. It is anticipated that this Special Issue may possibly represent how MRD might serve as a drug development tool in hematological malignancies.
Collapse
Affiliation(s)
- Nicole J Gormley
- Center for Drug Evaluation and Research (CDER) and Center for Devices and Radiologic Health (CDRH), Food and Drug Administration (FDA)
| | - Danielle M Turley
- Center for Drug Evaluation and Research (CDER) and Center for Devices and Radiologic Health (CDRH), Food and Drug Administration (FDA)
| | - Jennifer S Dickey
- Center for Drug Evaluation and Research (CDER) and Center for Devices and Radiologic Health (CDRH), Food and Drug Administration (FDA)
| | - Ann T Farrell
- Center for Drug Evaluation and Research (CDER) and Center for Devices and Radiologic Health (CDRH), Food and Drug Administration (FDA)
| | - Gregory H Reaman
- Center for Drug Evaluation and Research (CDER) and Center for Devices and Radiologic Health (CDRH), Food and Drug Administration (FDA)
| | - Elizabeth Stafford
- Center for Drug Evaluation and Research (CDER) and Center for Devices and Radiologic Health (CDRH), Food and Drug Administration (FDA)
| | - Lea Carrington
- Center for Drug Evaluation and Research (CDER) and Center for Devices and Radiologic Health (CDRH), Food and Drug Administration (FDA)
| | - Gerald E Marti
- Center for Drug Evaluation and Research (CDER) and Center for Devices and Radiologic Health (CDRH), Food and Drug Administration (FDA)
| |
Collapse
|
7
|
Wood BL. Principles of minimal residual disease detection for hematopoietic neoplasms by flow cytometry. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 90:47-53. [PMID: 25906832 DOI: 10.1002/cyto.b.21239] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/09/2015] [Accepted: 03/18/2015] [Indexed: 01/22/2023]
Abstract
Flow cytometry has become an indispensible tool for the diagnosis and classification of hematopoietic neoplasms. The ability to rapidly distinguish cellular subpopulations via multiparametric assessment of quantitative differences in antigen expression on single cells and enumerate the relative sizes of the resulting subpopulations is a key feature of the technology. More recently, these capabilities have been expanded to include the identification and enumeration of rare subpopulations within complex cellular mixtures, for example, blood or bone marrow, leading to the application for post-therapeutic monitoring or minimal residual disease detection. This review will briefly present the principles to be considered in the construction and use of flow cytometric assays for minimal residual disease detection including the use of informative antibody combinations, the impact of immunophenotypic instability, enumeration, assay sensitivity, and reproducibility.
Collapse
Affiliation(s)
- Brent L Wood
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington.,Seattle Cancer Care Alliance, Seattle, Washington
| |
Collapse
|