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Riley RS, Massey D, Jackson-Cook C, Idowu M, Romagnoli G. Immunophenotypic analysis of acute lymphocytic leukemia. Hematol Oncol Clin North Am 2002; 16:245-99, v. [PMID: 12094473 DOI: 10.1016/s0889-8588(02)00004-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is one of the most common hematologic malignancies. Flow cytometry is an integral part of ALL diagnosis and also provides significant patient prognostic information. This article is a practical review of the basic principles of the flow cytometric evaluation of acute leukemias, the interpretation of flow cytometric data, and the management of practical problems such as aberrant antigen, hematogones, bone marrow regeneration, and minimal residual disease.
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Affiliation(s)
- Roger S Riley
- Department of Pathology, Medical College of Virginia, Hospitals of Virginia Commonwealth University, 403 North 13th Street, Richmond, VA 23298-0250, USA.
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San-Miguel JF, Vidriales MB, Orfão A. Immunological evaluation of minimal residual disease (MRD) in acute myeloid leukaemia (AML). Best Pract Res Clin Haematol 2002; 15:105-18. [PMID: 11987919 DOI: 10.1053/beha.2001.0193] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Immunophenotypic analysis of leukaemic cells using multiparametric flow cytometry has proved to be an attractive approach for MRD investigation in acute lymphoblastic leukaemia (ALL); by contrast, information on acute myeloid leukaemia (AML) is still scanty. Here, we first review the methodological strategies for these studies. Triple or quadruple antigenic combinations, analysed by multiparametric flow cytometry, have shown that in 80% of AML patients it is possible to identify aberrant or uncommon phenotypic profiles on blast cells, thereby allowing their distinction from normal cells and their use as leukaemia-associated phenotypes (LAP). We also focus on technical aspects that are important in the definition of LAP. We then review pitfalls that could potentially affect results using this approach. Finally, we review available information concerning the clinical value of these studies. Although reported data in the literature are still scanty, several authors have shown that this technique could be used for the prognostic evaluation of AML patients, when immunophenotypic evaluation is applied after induction therapy.
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Affiliation(s)
- Jesús F San-Miguel
- Department of Haematology, University Hospital of Salamanca, Paseo de San Vicente 58-182, 37007 Salamanca, Spain
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García Vela JA, Monteserin MC, Delgado I, Benito L, Oña F. Aberrant immunophenotypes detected by flow cytometry in acute lymphoblastic leukemia. Leuk Lymphoma 2000; 36:275-84. [PMID: 10674899 DOI: 10.3109/10428190009148848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The present study was designed to analyse the proportion of ALL patients in which the phenotypic detection of minimal residual disease (MRD) is feasible, based on the presence of aberrant phenotypes: lineage infidelity, asynchronous expression, overexpression and ectopic phenotype. For this purpose we have prospectively investigated the phenotype of blast cells from 25 patients at diagnosis using a large panel of monoclonal antibodies by multiparametric flow cytometry. The mean age was 23.3 +/- 17.3 with 10 children and 15 adults. 14 patients were classified as L1, 9 L2 and 2 L3 according to the FAB classification. 17 cases were B-lineage ALL and 8 T-ALL. 23 out of 25 cases (92%) included in this study displayed phenotypic aberrations at diagnosis (15 out of 17 cases of B-lineage ALL and all T-ALL patients). 76% of patients displayed two or more than two aberrancies. The phenotypic aberrations were lineage infidelity, found in 12 patients, asynchronous antigen expression detected in 17 patients, antigen overexpression in 4 patients and ectopic phenotype in 7 patients. In summary our results show that when a large panel of MoAbs is used for the immunophenotypical characterization of ALL, most patients display aberrant phenotypes, the coexistence of more than two aberrant antigen expressions being frequently detected. These results suggest that the use of immunological methods for the detection of MRD in ALL based on the existence of aberrant phenotypes could be of great help for the follow-up of patients in complete remission.
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Affiliation(s)
- J A García Vela
- Department of Hematology, Hospital Universitario de Getafe, Madrid, Spain.
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Ciudad J, San Miguel JF, López-Berges MC, García Marcos MA, González M, Vázquez L, del Cañizo MC, López A, Van Dongen JJ, Orfao A. Detection of abnormalities in B-cell differentiation pattern is a useful tool to predict relapse in precursor-B-ALL. Br J Haematol 1999; 104:695-705. [PMID: 10192428 DOI: 10.1046/j.1365-2141.1999.01236.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Immunophenotypic investigation of minimal residual disease (MRD) has traditionally been based on the investigation of phenotypic aberrants at diagnosis to be used later as a target for MRD detection. This approach has several shortcomings (it is only applicable to patients with aberrant phenotypes, requires a diagnostic sample, and is patient-specific) and therefore a search for simpler alternatives is warranted. The present study is based on the hypothesis that in precursor-B-ALL patients the persistence of residual leukaemic cells may induce abnormalities in the precursor-B-cell compartment in bone marrow (BM) and these could be used as a criteria to predict relapse. These abnormalities may include: (1) the presence of an increase in the frequencies of immature B cells (CD34+/CD19+ or CD20-/CD19+) or (2) the existence of an altered B-cell differentiation pathway due to a blockade or to the presence of B cells outside the normal pathway. A total of 180 BM samples from 45 consecutive precursor-B-ALL patients who achieved morphological complete remission (CR) were analysed by multiparametric flow cytometry. Our results show that a significant increase in immature B-cell subsets or an altered B-cell differentiation predicts a high relapse rate (P<0.01) and a shorter disease-free survival (P<0.01). Moreover, abnormalities in either of these two criteria detected at specific time points during follow-up (end of induction, maintenance, or after treatment) were associated with a significantly shorter disease-free survival (P<0.01). In summary, the investigation of abnormalities in B-cell differentiation is a relatively simple and cheap approach for predicting relapse in precursor-B-ALL patients.
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Affiliation(s)
- J Ciudad
- Servicio General de Citometría, Universidad de Salamanca, Spain
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Li Y, Wood N, Yellowlees D, Donnelly PK. Expression of alpha2-macroglobulin receptor-associated protein in normal human epidermal melanocytes and human melanoma cell lines. J Cell Biochem 1998; 71:149-57. [PMID: 9779814 DOI: 10.1002/(sici)1097-4644(19981101)71:2<149::aid-jcb1>3.0.co;2-v] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Alpha2-Macroglobulin receptor/low-density lipoprotein receptor-related protein is a multifunctional cell surface receptor known to bind and internalize a large number of ligands. alpha2-Macroglobulin receptor-associated protein acts as an intracellular "chaperone" for this receptor, and it has been shown to inhibit binding of all its known ligands. In this paper, we characterize the expression of the receptor-associated protein in both normal human epidermal melanocytes and in six different human melanoma cell lines, by the use of flow cytometry and Western blotting analysis. We show that all the melanoma cell lines and the normal melanocytes express the receptor-associated protein at similar levels, with most located intracellularly. No receptor-associated protein was detected at the cell surface in the melanocytes or in three of the cell lines. However, in two of the melanoma cell lines, large amounts of receptor-associated protein were found on the cell surface, these having the largest amounts of it reported to date; in a further melanoma cell line, there was a small amount at the cell surface. We have also shown that the melanocytes and all the melanoma cell lines express the receptor itself at a wide range of levels, the highest levels of both the cell surface receptor and the cell surface receptor-associated protein being found in one particular melanoma cell line. By growing the cell lines under controlled conditions, we have demonstrated that, although the total cellular content of the receptor is markedly increased at high cell culture density, this treatment has no effect on the level of expression of the receptor-associated protein.
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Affiliation(s)
- Y Li
- Department of Surgery, North Queensland Clinical School, University of Queensland, Townsville, Australia
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Paietta E, Meenan B, Heavey C, Thomas D. Detection of terminal transferase in acute myeloid leukemia by flow cytometry. CYTOMETRY 1994; 16:256-61. [PMID: 7924695 DOI: 10.1002/cyto.990160310] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The purpose of this study was twofold: (1) to develop an optimized, reliable method for the flow cytometric analysis of the intranuclear DNA polymerase, terminal deoxynucleotidyl transferase (TdT) in acute myeloid leukemia, and (2) to establish the usefulness of a novel, fluorescein-isothiocyanate conjugated monoclonal anti-TdT antibody (HT-6) in double-fluorescence staining for surface antigens in the characterization of leukemic cells. Inclusion of an aldehyde blocking buffer in the staining protocol reduced background fluorescence sufficiently to allow for the detection of the low-level fluorescent TdT+ myeloblasts. When admixed to normal peripheral blood mononuclear cells, 0.4-0.5% of HLA-DR+ or myeloid surface antigen+, TdT+ double-stained myeloblasts could be reliably detected above background levels. Flow cytometric TdT measurements using the HT-6 antibody in 55 patients with TdT+ acute lymphocytic or myelocytic leukemia or blast crisis of chronic myelogenous leukemia were equal or superior to the results obtained with a mixture of monoclonal anti-TdT antibodies (anti-HTDT-Mix) and comparable to those obtained by the conventional slide method employing polyclonal rabbit anti-human TdT antiserum. This flow cytometric TdT determination in combination with surface antigen staining using a novel anti-TdT monoclonal antibody (HT-6) allows for the recognition of minimal leukemic blast cells during clinical remission in acute myeloid leukemia.
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Affiliation(s)
- E Paietta
- Department of Oncology, Montefiore Center, The Bronx, New York 10467
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Cole-Sinclair MF, Foroni L, Hoffbrand AV. Genetic changes: relevance for diagnosis and detection of minimal residual disease in acute lymphoblastic leukaemia. BAILLIERE'S CLINICAL HAEMATOLOGY 1994; 7:183-233. [PMID: 7803899 DOI: 10.1016/s0950-3536(05)80200-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Cure can now be achieved in a proportion of patients with ALL. However, relapse and eventual treatment failure occur in many cases receiving identical treatment, presumably as a result of failure to eradicate MRD. While for many years marrow morphology has been the standard by which leukaemic remission has been assessed, more sensitive techniques have been developed for detection of MRD including immunophenotypic analysis, and as discussed in this chapter, methods which detect leukemia-associated clonal genetic changes at the karyotypic and genomic levels. Table 10 lists the applicability and sensitivity of various markers used in MRD analysis in ALL. It is apparent that of the karyotypic and molecular approaches described, only PCR-based strategies for detection of either leukaemia-specific translocations or clonal Ag receptor rearrangements are reliably applicable to a high proportion of both B- and T-ALL at sufficiently high sensitivity. Initial clinical studies of patients undergoing therapy for ALL using a variety of PCR-based methods suggest that in some cases a persistent or increasing level of residual disease may be predictive for clinical relapse, although a number of technical factors and the phenomena of oligo-clonality and clonal evolution may limit the usefulness of this analysis in a few instances. From current available data it appears that in order to define the potential predictive value of PCR detection of MRD a large number of patients will need to be prospectively assessed over several years at multiple time points during and after therapy, preferably using more than one semi-quantitative PCR approach. In addition to reliable prediction of clinical relapse allowing appropriate individual treatment modification, progress in the molecular detection of MRD in ALL is also likely to be of benefit in the assessment of the efficacy of autograft purging and the evaluation of new therapeutic strategies such as the use of biological response modifiers to eliminate a low tumour burden.
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Affiliation(s)
- M F Cole-Sinclair
- Department of Haematology, Royal Free Hospital Medical School, Hampstead, London, UK
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Hechinger MK, Hernandez AM, Barr NJ, Parker JW. A clinical laboratory approach to the evaluation of terminal deoxynucleotidyl transferase (TdT) by flow cytometry (FCM). J Clin Lab Anal 1994; 8:211-8. [PMID: 7931815 DOI: 10.1002/jcla.1860080406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- M K Hechinger
- USC Flow Cytometry Laboratory-CSC 109, Department of Pathology, USC School of Medicine, Los Angeles 90033
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Knapp W, Majdic O, Strobl H. Flow cytometric analysis of intracellular myeloperoxidase and lactoferrin in leukemia diagnosis. Recent Results Cancer Res 1993; 131:31-40. [PMID: 8210650 DOI: 10.1007/978-3-642-84895-7_4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- W Knapp
- Institut für Immunologie, Universität Wien, Austria
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Abstract
The anatomic description of the extent of tumor spread (tumor staging) assists clinical management, facilitates communication among physicians, is an essential part of randomized controlled trials, and may help in the counseling patients and their families. However, in recent years, additional "prognostic factors" have been defined, many of which assess or reflect the biologic behavior of malignant neoplasms. Other measures of tumor biochemistry address the natural history of neoplastic development and often are included in a discussion of new prognostic factors. This review article summarizes current knowledge and thinking related to tumor prognostic factors in four areas by providing: (1) a definition and principles of anatomic spread of tumor (staging) and some suggestions for improvement, (2) a description of some examples of additional factors of prognostic significance, (3) some statistical methods to evaluate prognostic factors, and (4) an examination of the possible future of summary statements of outcome (i.e., prognostic indexes).
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Affiliation(s)
- L P Fielding
- Department of Surgery, St. Mary's Hospital, Waterbury, New Haven, Connecticut 06706
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Abstract
In this article, the use of cellular and molecular markers to diagnose and stage tumors is discussed. Their role in the evaluation of tumor prognosis and tumor susceptibility also is covered. The immunologic, cytogenetic, and molecular phenotype is discussed. Traditional markers are compared with newer methodologic approaches including evaluation of oncogenes, tumor suppressor genes, and genes that predict tumor susceptibility. These discussions are presented in relation to specific tumors. Finally, statements one might use to decide which tests to perform are presented.
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