1
|
Bommannan K, Arumugam JR, Radhakrishnan V, Sundersingh S. Relevance of CD20 antigen expression among paediatric patients with B-lineage acute lymphoblastic leukaemia. Br J Haematol 2024; 204:1367-1374. [PMID: 38444113 DOI: 10.1111/bjh.19370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 03/07/2024]
Abstract
Literature regarding prognostic relevance of CD20 antigen expression among paediatric B-lineage acute lymphoblastic leukaemia (B-ALL) patients is sparse and contradictory. We analysed clinical laboratory parameters and survival characteristics pertinent to CD20 expression among 224 treatment-naïve paediatric B-ALL patients. 50% patients had CD20 expression (CD20+ B-ALL). There was no difference in the clinical & laboratory presentation and end of induction measurable residual disease (EOI-MRD) status according to CD20 expression. As compared to CD20- B-ALL patients, CD20+ B-ALL patients had two times more relapse (16% vs. 29%, p = 0.034), inferior relapse-free survival (79% vs. 66%, p = 0.025) but no difference in overall survival (75% vs. 69%, p = 0.126). Similar to high-risk NCI status and EOI-MRD positivity, CD20 expression was an independent predictor for inferior relapse-free survival (HR: 1.860, 95% CI: 1.008-3.432, p = 0.047). Compared to baseline, there was a significant increase in CD20-expressing EOI-residual blasts among CD20- B-ALL patients (5% vs. 13%, p = 0.001). EOI residual blasts of both CD20+ and CD20- patients had three times increased normalized CD20 expression intensity (nCD20), with the intensity among CD20- B-ALL patients reaching the pretreatment nCD20 of CD20+ B-ALL patients (4.9 vs. 3.6, p = 0.666). Rituximab can be considered in managing EOI-MRD-positive CD20- B-ALL patients as the residual blasts of these patients have quantitative and qualitative increases in CD20 expression.
Collapse
Affiliation(s)
- Karthik Bommannan
- Department of Oncopathology, Cancer Institute (W.I.A.), Chennai, India
| | | | | | | |
Collapse
|
2
|
Mungle T, Das N, Pal S, Gogoi MP, Das P, Ghara N, Ghosh D, Arora RS, Bhakta N, Saha V, Krishnan S. Comparative treatment costs of risk-stratified therapy for childhood acute lymphoblastic leukemia in India. Cancer Med 2022; 12:3499-3508. [PMID: 36812120 PMCID: PMC9939102 DOI: 10.1002/cam4.5140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To evaluate the treatment cost and cost effectiveness of a risk-stratified therapy to treat pediatric acute lymphoblastic leukemia (ALL) in India. METHODS The cost of total treatment duration was calculated for a retrospective cohort of ALL children treated at a tertiary care facility. Children were risk stratified into standard (SR), intermediate (IR) and high (HR) for B-cell precursor ALL, and T-ALL. Cost of therapy was obtained from the hospital electronic billing systems and details of outpatient (OP) and inpatient (IP) from electronic medical records. Cost effectiveness was calculated in disability-adjusted life years. RESULTS One hundred and forty five patients, SR (50), IR (36), HR (39), and T-ALL (20) were analyzed. Median cost of the entire treatment for SR, IR, HR, and T-ALL was found to be $3900, $5500, $7400, and $8700, respectively, with chemotherapy contributing to 25%-35% of total cost. Out-patient costs were significantly lower for SR (p < 0.0001). OP costs were higher than in-patient costs for SR and IR, while in-patient costs were higher in T-ALL. Costs for non-therapy admissions were significantly higher in HR and T-ALL (p < 0.0001), representing over 50% of costs of in-patient therapy. HR and T-ALL also had longer durations of non-therapy admissions. Based on WHO-CHOICE guidelines, the risk-stratified approach was very cost effective for all categories of patients. CONCLUSIONS Risk-stratified approach to treat childhood ALL is very cost-effective for all categories in our setting. The cost for SR and IR patients is significantly reduced through decreased IP admissions for both, chemotherapy and non-chemotherapy reasons.
Collapse
Affiliation(s)
- Tushar Mungle
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
| | - Nandana Das
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
| | - Saikat Pal
- Tata Consultancy ServicesTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
| | - Manash Pratim Gogoi
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
| | - Parag Das
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
| | - Niharendu Ghara
- Department of Paediatric Haematology and OncologyTata Medical CenterKolkataIndia
| | - Debjani Ghosh
- Department of Paediatric Haematology and OncologyTata Medical CenterKolkataIndia
| | | | - Nickhill Bhakta
- Department of Global Pediatric MedicineSt Jude Children's Research HospitalMemphisTennesseeUSA
| | - Vaskar Saha
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia,Department of Paediatric Haematology and OncologyTata Medical CenterKolkataIndia,Division of Cancer Sciences, Faculty of Biology, Medicine and HealthSchool of Medical Sciences, University of ManchesterManchesterUK
| | - Shekhar Krishnan
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia,Department of Paediatric Haematology and OncologyTata Medical CenterKolkataIndia,Division of Cancer Sciences, Faculty of Biology, Medicine and HealthSchool of Medical Sciences, University of ManchesterManchesterUK
| |
Collapse
|
3
|
Devi Sundaresan D, Kalikkaleth Sasidharan Pillai L, Sharma P, Mallik N, Sreedharanunni S, Sharma P, Sachdeva MUS, Jain A, Lad D, Malhotra P. Dual peaks on flow cytometric DNA ploidy analysis in chronic lymphocytic leukemia with Richter transformation. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2022; 102:323-325. [PMID: 35560867 DOI: 10.1002/cyto.b.22071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/12/2022] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Durga Devi Sundaresan
- Department of Hematology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Praveen Sharma
- Department of Hematology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Nabhajit Mallik
- Department of Hematology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sreejesh Sreedharanunni
- Department of Hematology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Prashant Sharma
- Department of Hematology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Arihant Jain
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh Lad
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
4
|
Chaturvedi A, Shetty D, Ghogale SG, Deshpande N, Badrinath Y, Chatterjee G, Girase K, Sriram H, Khanka T, Mishra C, Dasgupta N, Gujarathi SA, Rajpal S, Patkar N, Amare-Kadam P, Gujral S, Subramanian PG, Tembhare PR. Detecting hypodiploidy with endoreduplication and masked hypodiploidy in B-cell acute lymphoblastic leukemia using multicolor flow cytometry. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2022; 102:199-208. [PMID: 35212133 DOI: 10.1002/cyto.b.22063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 02/06/2022] [Accepted: 02/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Multicolor flow cytometry-based DNA-ploidy (MFC-ploidy) analysis is a simple, sensitive, and popular method for ploidy analysis in B-cell acute lymphoblastic leukemia (B-ALL). However, the utility of MFC-ploidy in the detection of B-ALL with endoreduplication or masked hypodiploidy has not been reported. Herein, we studied the patterns of MFC-ploidy assessment and its utility to detect B-ALL with hypodiploidy and endoreduplication. METHODS MFC-ploidy analysis was performed using FxCycle Violet-dye-based method, and cytogenetic ploidy was evaluated using chromosomal-counting and FISH analysis. A total of 20 B-ALL cases with endoreduplication were studied for the patterns of MFC-ploidy analysis and compared with 250 patients with hyperdiploidy and 11 cases with pure hypodiploidy. RESULTS All B-ALL with endoreduplication revealed two distinct peaks (populations) on MFC-ploidy analysis: the first (hypodiploid) peak (median-DNA-index [DI], 0.82; range, 0.6-0.95) and the second (hyperdiploid) peak with almost twice DI (median-DI, 1.53; range, 1.14-1.75). Cytogenetic findings were available in 19 cases and confirmed hypodiploidy with endoreduplication in 13/19 (68.4%) and only hypodiploidy in 3/19 cases. The remaining three cases showed hyperdiploid blasts in cytogenetic studies. Of these three, two cases had <10% blasts population with hypodiploidy. Thus, masked-hypodiploidy could be diagnosed correctly in 3/19 cases on MFC-ploidy analysis. CONCLUSION MFC-ploidy analysis shows a characteristic pattern of DNA-ploidy in samples with endoreduplication. It allows the distinction between samples with masked hypodiploidy from true hyperdiploidy. An integrated approach involving cytogenetic and MFC-ploidy detection is very helpful in the risk stratification of B-ALL in routine clinical practice.
Collapse
Affiliation(s)
- Anumeha Chaturvedi
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Dhanalaxmi Shetty
- Cancer Cytogenetics Department, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, Maharashtra, India
| | - Sitaram Gundu Ghogale
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Nilesh Deshpande
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Yajamanam Badrinath
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Gaurav Chatterjee
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Karishma Girase
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Harshini Sriram
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Twinkle Khanka
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Chetna Mishra
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Niharika Dasgupta
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Sejal Anil Gujarathi
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Sweta Rajpal
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Nikhil Patkar
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Prathibha Amare-Kadam
- Cancer Cytogenetics Department, ACTREC, Tata Memorial Center, HBNI University, Navi Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Papagudi Ganesan Subramanian
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| | - Prashant Ramesh Tembhare
- Hematopathology Laboratory, ACTREC, Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Navi Mumbai, Maharashtra, India
| |
Collapse
|
5
|
Handoo A, Gupta N, Dadu T, Mittal A. Donor origin precursor B-cell lymphoblastic leukemia post beta-thalassemia haploidentical transplant – A rare case report. JOURNAL OF CANCER RESEARCH AND PRACTICE 2022. [DOI: 10.4103/jcrp.jcrp_1_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
6
|
A Systematic Cytogenetic Strategy to Identify Masked Hypodiploidy in Precursor B Acute Lymphoblastic Leukemia in Low Resource Settings. Indian J Hematol Blood Transfus 2021; 37:576-585. [PMID: 34690454 DOI: 10.1007/s12288-021-01409-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022] Open
Abstract
Hypodiploidy with < 40 chromosomes is associated with poor prognosis in B cell precursor acute lymphoblastic leukemia. In some patients, the hypodiploid clone undergoes endoreduplication, resulting in doubling of the number of chromosomes and masquerades as a high hyperdiploid BCP-ALL. Karyotyping reveals metaphases with 50-79 chromosomes masking the hypodiploid clone. Identifying hypodiploidy in such cases requires awareness of non random alterations of chromosomal copy numbers found in hypodiploid BCP-ALL. We used a systematic strategy to identify masked hypodiploidy integrating targeted fluorescence in situ hybridization (FISH) analysis directed towards identifying monosomies of chromosomes 7, 15 and 17 and flow cytometry-based ploidy analysis (FCPA). Of 445 patients diagnosed as BCP ALL, 2.9% (13/445) were classified as hypodiploid including patients with masked hypodiploidy. Karyotype analysis showed hypodiploidy in 3 patients, near triploidy in 4 patients and normal karyotype in 6 patients. Four patients with near triploid clone on karyotype showed either bimodal peak (2 patients) or single low hypodiploid peak (1 patient) or only near triploid peak (1 patient) on FCPA. All 6 patients with normal karyotype revealed either bimodal peak (4 patients) or hypodiploid peak (2 patients) on FCPA. Targeted FISH analysis unmasked hypodiploid clone showing monosomies of chromosomes 7, 15 and 17 in all ten patients. Our algorithm successfully identified masked hypodiploidy in patients, including those with endoreduplication (4 patients) and normal karyotype (6 patients). Integrating FCPA with targeted FISH analysis provides a practical, sensitive and specific approach to identify masked hypodiploidy in low resource settings.
Collapse
|
7
|
Lanza F, Maffini E. ISSUE HIGHLIGHTS - July 2020. CYTOMETRY PART B-CLINICAL CYTOMETRY 2021; 98:295-298. [PMID: 32687692 DOI: 10.1002/cyto.b.21937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Francesco Lanza
- Hematology Unit and Romagna Transplant Network, Ravenna & Ferrara University, Italy
| | - Enrico Maffini
- Hematology Unit and Romagna Transplant Network, Ravenna & Ferrara University, Italy
| |
Collapse
|
8
|
Virk H, Rana S, Sharma P, Bose PL, Yadav DD, Sachdeva MUS, Varma N, Trehan A, Lad D, Khadwal AR, Malhotra P, Sreedharanunni S. Hematological characteristics, cytogenetic features, and post-induction measurable residual disease in thymic stromal lymphopoietin receptor (TSLPR) overexpressed B-cell acute lymphoblastic leukemia in an Indian cohort. Ann Hematol 2021; 100:2031-2041. [PMID: 34159401 DOI: 10.1007/s00277-021-04574-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022]
Abstract
The overexpression of cytokine receptor-like factor-2 (CRLF2) identified by anti-thymic stromal lymphopoietin receptor/TSLPR flow cytometry (FCM) has been reported as a screening tool for the identification of BCR-ABL1-like B-cell acute lymphoblastic leukemia/B-ALL with CRLF2 re-arrangement. TSLPR expression was studied prospectively in consecutive 478 B-ALLs (≤ 12 years (n = 244); 13-25 years (n = 129); > 25 years (n = 105)) and correlated with various hematological parameters and end-of-induction measurable residual disease (day 29; MRD ≥ 0.01% by 10-color FCM). TSLPR positivity in ≥ 10% leukemic cells was detected in 14.6% (n = 70) of B-ALLs. CRLF2 re-arrangement was detected in eight cases (11.4%) including P2RY8-CRLF2 (n = 6), and IgH-CRLF2 (n = 2) with a median TSLPR positivity of 48.8% and 99% leukemic cells, respectively. Recurrent gene fusions/RGF (BCR-ABL1 (17.1%); ETV6-RUNX1 (4.2%), TCF3-PBX1 (1.4%)), other BCR-ABL1-like chimeric gene fusions/CGFs (PDGFRB-rearrangement (2.9%), IgH-EPOR (1.4%)), CRLF2 extra-copies/hyperdiploidy (17.1%), and IgH translocation without a known partner (10%) were also detected in TSLPR-positive patients. CD20 positivity (52.9% vs 38.5%; p = 0.02) as well as iAMP21 (4.3% vs 0.5%; p = 0.004) was significantly more frequent in TSLPR-positive cases. TSLPR-positive patients did not show a significantly higher MRD, compared to TSLPR-negative cases (37% vs 33%). Increasing the threshold cut-off (from ≥ 10 to > 50% or > 74%) increased the specificity to 88% and 100% respectively in identifying CRLF2 translocation. TSLPR expression is not exclusive for CRLF2 translocations and can be seen with various other RGFs, necessitating their testing before its application in diagnostic algorithms. In patients with high TSLPR positivity (> 50%), the testing may be restricted to CRLF2 aberrancies, while patients with 10-50% TSLPR positivity need to be tested for both CRLF2- and non-CRLF2 BCR-ABL1-like CGFs.
Collapse
Affiliation(s)
- Harpreet Virk
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Sonia Rana
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Praveen Sharma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Parveen Lata Bose
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Diksha Dev Yadav
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Man Updesh Singh Sachdeva
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Amita Trehan
- Pediatric Hematology/Oncology Unit, Department of Pediatric Medicine, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh Lad
- Adult Clinical Hematology Unit, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Rani Khadwal
- Adult Clinical Hematology Unit, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Adult Clinical Hematology Unit, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreejesh Sreedharanunni
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 160012.
| |
Collapse
|
9
|
Sharma P, Rana S, Sreedharanunni S, Gautam A, Sachdeva MUS, Naseem S, Varma N, Jain R, Bansal D, Trehan A. An Evaluation of a Fluorescence In Situ Hybridization Strategy Using Air-dried Blood and Bone-marrow Smears in the Risk Stratification of Pediatric B-Lineage Acute Lymphoblastic Leukemia in Resource-limited Settings. J Pediatr Hematol Oncol 2021; 43:e481-e485. [PMID: 32769569 DOI: 10.1097/mph.0000000000001892] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/09/2020] [Indexed: 12/20/2022]
Abstract
Cytogenetic abnormalities (CAs), one of the strongest influencers of therapeutic outcome in pediatric B-cell precursor acute lymphoblastic leukemia (BCP-ALL), can be identified by different techniques. Despite several technological advances, many centers with resource-limited settings continue to use either reverse-transcriptase polymerase chain reaction (RT-PCR) and/or fluorescence in situ hybridization (FISH) to identify prognostically relevant CAs. We evaluated a simple and cost-effective triple-probe FISH strategy on air-dried blood and bone-marrow smears and compared its performance with a multiplex RT-PCR-based approach in the prognostication of pediatric BCP-ALL patients. Three hundred twenty BCP-ALL patients were tested prospectively and in parallel by FISH on air-dried blood or bone-marrow smears and RT-PCR. The FISH strategy correctly diagnosed all genetic abnormalities identified by RT-PCR. Prognostically relevant genetic abnormalities were missed by RT-PCR in 24 (8.1%) patients. In another 20 children (6%), with samples inadequate for RT-PCR testing (dry taps or due to poor sample quality), a successful FISH testing could be performed on bone-marrow aspirate or trephine-imprint smears. In addition, FISH detected ploidy changes, which could be confirmed by FxCycle Violet-based flow-cytometry. FISH testing on air-dried smears identified more prognostically relevant CAs, provided information on the ploidy status, and could be successfully performed in children with difficulty in bone-marrow sampling.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Richa Jain
- Unit of Paediatric Haemato-oncology, Department of Paediatrics, Advanced Paediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Unit of Paediatric Haemato-oncology, Department of Paediatrics, Advanced Paediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Unit of Paediatric Haemato-oncology, Department of Paediatrics, Advanced Paediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
10
|
Bommannan K, Arumugam JR, Koshy T, Radhakrishnan V, Sagar TG, Sundersingh S. Blast size-specific flowcytometric ploidy assessment using FxCycle TM Violet dye and its correlation with conventional cytogenetic ploidy in pediatric precursor B-lineage acute lymphoblastic leukemia patients. Int J Lab Hematol 2020; 43:760-770. [PMID: 33345449 DOI: 10.1111/ijlh.13436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/20/2020] [Accepted: 11/28/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Numerical chromosomal abnormalities (aneuploidies), present in approximately 30%-50% of pediatric precursor B-lineage acute lymphoblastic leukemia (B-ALL) patients, are commonly identified through a laborious conventional cytogenetic (CG) technique. Flow cytometry (FCM) can identify both physical and fluorescent properties of cells together, and by using fluorescent nucleic-acid-binding dyes, FCM can identify variations in total nucleic-acid content of cells. FxCycleTM Violet dye (FxCV) is a selective DNA-binding dye which permits simultaneous multiparametric immunophenotyping and cell-cycle/ploidy assessment in a single assay. To date, only two studies have demonstrated the feasibility of FxCV-aided FCM-ploidy analysis in B-ALL patients and only one of these studies have compared their results with CG-ploidy. METHODOLOGY Blast size-specific FCM-ploidy was prospectively analyzed using FxCV-dye in 109 pediatric B-ALL patients, and the results were compared with concurrent CG-ploidy status. RESULTS FCM-ploidy categorization was feasible in 98% of samples tested and the results were 82% concordant with CG-ploidy status. We observed significant correlation between DNA content and blast size (r = .823, P < .001) and could demonstrate size differences between diploid vs low-hyperdiploid (P = .025), diploid vs high-hyperdiploid (P < .001) and low- vs high-hyperdiploid blasts (P = .007). CONCLUSION FCM-ploidy assessment using FxCV dye is a reliable assay and the results closely concur with CG-based ploidy stratification and risk assessment. Using blast size-assisted DNA content analysis, the results of FCM-ploidy analysis can be further fine-tuned.
Collapse
Affiliation(s)
- Karthik Bommannan
- Department of Oncopathology, Cancer Institute (W.I.A.), Chennai, India
| | | | - Teena Koshy
- Department of Oncopathology, Cancer Institute (W.I.A.), Chennai, India
| | | | - Tenali Gnana Sagar
- Department of Medical Oncology, Cancer Institute (W.I.A.), Chennai, India
| | | |
Collapse
|
11
|
Kern W. Issue Highlights - September 2019. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 96:335-337. [PMID: 31566911 DOI: 10.1002/cyto.b.21848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/21/2019] [Accepted: 09/05/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Wolfgang Kern
- MLL Munich Leukemia Laboratory, Max-Lebsche-Platz 31, Munich, Germany
| |
Collapse
|
12
|
Zhou Z, Gao Y, Li X, Ren J, Liu Y, Li J. The clinical characteristics of patients with acute leukemia or stem cell transplantation exhibiting immune based platelet refractoriness. Transfus Apher Sci 2020; 59:102725. [PMID: 31974031 DOI: 10.1016/j.transci.2020.102725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/01/2019] [Accepted: 12/23/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND To investigate the related factors influencing immune platelet transfusion refractoriness (PTR) in acute leukemia (AL) from induction to consolidation and compare management for immune PTR, so as to improve the Platelet increment in AL. METHODS The primary analysis included 890 patients with AL, 225 of whom were the immune PTR (25 %).They are patients in our center from induction to consolidation or transplantation in the past 10 years. Flow cytometry, karyotype characteristics and other basic information were compared between the immune PTR vs control (no-PTR) groups. We analyzed the treatment outcomes of immune PTR including matched platelets, intravenous immunoglobulin (IVIG), increasing apheresis platelet does. RESULTS Immune PTR is more likely to occur in patients with poor prognosis in acute lymphoblastic leukemia (ALL) (P = 0.01).There is a relation between NPM1 mutation and occurrence of immune PTR (P = 0.029).The incidence of PTR at 35-59Y was higher than that at <35Y(OR = 0.68, 95 % CI = 0.48-0.96) and ≥60Y(OR = 0.49,95 % CI = 0.28-0.83), and the difference was statistically significant(P = 0.03, P = 0.01).The Platelet increment with 1 unit (u) was 47.12 %, 2 u increased to 71.14 %, and the matched 2 u (75.11 %) had the best effect. IVIG improved the Platelet increment, but there was no difference between 0.4 g/kg IVIG and 1 g/kg IVIG. Immune PTR is more likely to occur in the ages of 35-60 years. CONCLUSION There are specific AL patient characteristics which predispose to the phenomenon of immune based PTR. Meanwhile, increasing the IVIG dose could not improve Platelet increment obviously.
Collapse
Affiliation(s)
- Zhenhai Zhou
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, 58 zhongshan er ave, Guangzhou, China.
| | - Yixin Gao
- Department of Blood Transfusion, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyin Li
- Department of Radiology Intervention, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Ren
- Department of Blood Transfusion, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuxuan Liu
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, 58 zhongshan er ave, Guangzhou, China
| | - Juan Li
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, 58 zhongshan er ave, Guangzhou, China
| |
Collapse
|
13
|
Roy P, Islam R, Saha D, Gogoi M, Mishra DK, Arora N, Parihar M, Krishnan S, Saha V. Efficacy and safety of a bortezomib and reduced-intensity cytarabine-based protocol, TMC ALLR1, for relapsed childhood ALL in India. Br J Haematol 2019; 186:861-865. [PMID: 31168836 PMCID: PMC6785345 DOI: 10.1111/bjh.16005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 04/23/2019] [Indexed: 12/17/2022]
Abstract
The feasibility of bortezomib (BZB) in induction and reduced cytarabine doses in intensification was evaluated in children with relapsed acute lymphoblastic leukaemia (rALL) at a single centre in India. Of 55 children with rALL, 23 received supportive care and 7 refused treatment, with a median survival of 2 (interquartile range 1-6) months. Twenty-two (88%) of 25 children who were treated achieved second remission and 9 (69%) of 13 had end-of-induction minimal residual disease of <10-4 . The lower cytarabine dose was associated with decreased hospitalisation. One-year event-free and overall survival for the treated group was 74·7% (95% confidence interval 52-88) and 79·6% (58-91) respectively.
Collapse
Affiliation(s)
- Prakriti Roy
- Tata Translational Cancer Research Centre and Department of Paediatric Haematology Oncology, Tata Medical Center, Kolkata, India
| | - Rubina Islam
- Tata Translational Cancer Research Centre and Department of Paediatric Haematology Oncology, Tata Medical Center, Kolkata, India
| | - Debparna Saha
- Tata Translational Cancer Research Centre and Department of Paediatric Haematology Oncology, Tata Medical Center, Kolkata, India
| | - Manash Gogoi
- Tata Translational Cancer Research Centre and Department of Paediatric Haematology Oncology, Tata Medical Center, Kolkata, India
| | - Deepak Kumar Mishra
- Department of Cytogenetics and Lab Haematology, Tata Medical Center, Kolkata, India
| | - Neeraj Arora
- Department of Cytogenetics and Lab Haematology, Tata Medical Center, Kolkata, India
| | - Mayur Parihar
- Department of Cytogenetics and Lab Haematology, Tata Medical Center, Kolkata, India
| | - Shekhar Krishnan
- Tata Translational Cancer Research Centre and Department of Paediatric Haematology Oncology, Tata Medical Center, Kolkata, India
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Vaskar Saha
- Tata Translational Cancer Research Centre and Department of Paediatric Haematology Oncology, Tata Medical Center, Kolkata, India
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| |
Collapse
|