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Johansson U, McIver-Brown N, Cullen M, Duetz C, Dunlop A, Oelschlägel U, Psarra K, Subirá D, Westers TM. The flow cytometry myeloid progenitor count: A reproducible parameter for diagnosis and prognosis of myelodysplastic syndromes. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2023; 104:115-127. [PMID: 34931733 DOI: 10.1002/cyto.b.22048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/04/2021] [Accepted: 12/09/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The bone marrow blast count is central to the diagnosis and monitoring of myelodysplastic syndromes (MDS). It is an independent risk factor for worse prognosis whether based on the morphology blast count or the flow cytometry (FC) myeloid progenitor (MyP) count. It is a principal population in FC MDS analysis also because once defined; it provides significant contributions to the overall FC MDS score. METHODS We elected to investigate inter-analyst agreement for the most fundamental parameter of the FC MDS diagnostic score: the MyP count. A common gating strategy was agreed and used by seven cytometrists for blind analysis of 34 routine bone marrows sent for MDS work-up. Additionally, we compared the results with a computational approach. RESULTS Concordance was excellent: Intraclass correlation was 0.993 whether measuring %MyP of total cells or CD45+ cells, and no significant difference was observed between files from different centers or for samples with abnormal MyP phenotypes. Computational and manual results were similar. Applying the common strategy to individual laboratories' control cohorts produced similar MyP reference ranges across centers. CONCLUSION The FC MyP count offers a reliable diagnostic and prognostic measurement in MDS. The use of manual and computational approaches side by side may allow for optimizing both strategies. Considering its known prognostic power, the MyP count could be considered a useful and reliable addition to existing prognostic scoring systems.
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Affiliation(s)
- Ulrika Johansson
- Haematological Malignancy Diagnostic Service, University Hospitals and Weston NHS Foundation Trust, Bristol, UK
| | - Neil McIver-Brown
- Molecular Pathology Department, Royal Bournemouth Hospital, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Matthew Cullen
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Carolien Duetz
- Department of Haematology, Amsterdam University Medical Centres, VU University Medical Center, Amsterdam, The Netherlands
| | - Alan Dunlop
- Haematological Malignancy Diagnostic Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Uta Oelschlägel
- Department of Haematology, Medical Clinic and Policlinic I, University Hospital of TU Dresden, Dresden, Germany
| | - Katherina Psarra
- Department of Immunology and Histocompatibility, Evangelismos Hospital, Athens, Greece
| | - Dolores Subirá
- Department of Haematology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Theresia M Westers
- Department of Hematology, Amsterdam University Medical Centers, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
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2
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Kern W, Westers TM, Bellos F, Bene MC, Bettelheim P, Brodersen LE, Burbury K, Chu SC, Cullen M, Porta MD, Dunlop AS, Johansson U, Matarraz S, Oelschlaegel U, Ogata K, Porwit A, Preijers F, Psarra K, Saft L, Subirá D, Weiß E, van der Velden VHJ, van de Loosdrecht A. Multicenter prospective evaluation of diagnostic potential of flow cytometric aberrancies in myelodysplastic syndromes by the ELN iMDS flow working group. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2023; 104:51-65. [PMID: 36416672 DOI: 10.1002/cyto.b.22105] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) represent a diagnostic challenge. This prospective multicenter study was conducted to evaluate pre-defined flow cytometric markers in the diagnostic work-up of MDS and chronic myelomonocytic leukemia (CMML). METHODS Thousand six hundred and eighty-two patients with suspected MDS/CMML were analyzed by both cytomorphology according to WHO 2016 criteria and flow cytometry according to ELN recommendations. Flow cytometric readout was categorized 'non-MDS' (i.e. no signs of MDS/CMML and limited signs of MDS/CMML) and 'in agreement with MDS' (i.e., in agreement with MDS/CMML). RESULTS Flow cytometric readout categorized 60% of patients in agreement with MDS, 28% showed limited signs of MDS and 12% had no signs of MDS. In 81% of cases flow cytometric readouts and cytomorphologic diagnosis correlated. For high-risk MDS, the level of concordance was 92%. A total of 17 immunophenotypic aberrancies were found independently related to MDS/CMML in ≥1 of the subgroups of low-risk MDS, high-risk MDS, CMML. A cut-off of ≥3 of these aberrancies resulted in 80% agreement with cytomorphology (20% cases concordantly negative, 60% positive). Moreover, >3% myeloid progenitor cells were significantly associated with MDS (286/293 such cases, 98%). CONCLUSION Data from this prospective multicenter study led to recognition of 17 immunophenotypic markers allowing to identify cases 'in agreement with MDS'. Moreover, data emphasizes the clinical utility of immunophenotyping in MDS diagnostics, given the high concordance between cytomorphology and the flow cytometric readout. Results from the current study challenge the application of the cytomorphologically defined cut-off of 5% blasts for flow cytometry and rather suggest a 3% cut-off for the latter.
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Affiliation(s)
| | - Theresia M Westers
- Department of Hematology, Amsterdam University Medical Centers, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | | | - Peter Bettelheim
- Department of Hematology, Elisabethinen Hospital, Linz, Upper Austria, Austria
| | | | - Kate Burbury
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sung-Chao Chu
- Department of Hematology and Oncology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Matthew Cullen
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Matteo Della Porta
- Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | | | - Ulrika Johansson
- Laboratory Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sergio Matarraz
- Cytometry Service (NUCLEUS), Department of Medicine and IBSAL, Cancer Research Center (IBMCC, University of Salamanca-CSIC), Salamanca, Spain and Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Salamanca, Spain
| | - Uta Oelschlaegel
- Department of Internal Medicine, University Hospital of Technical University Dresden, Dresden, Germany
| | - Kiyoyuki Ogata
- Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Anna Porwit
- Division of Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Frank Preijers
- Department of Laboratory Medicine, Laboratory of Hematology, Radboudumc, Nijmegen, The Netherlands
| | - Katherina Psarra
- Immunology Histocompatibility Department, Evangelismos Hospital, Athens, Greece
| | - Leonie Saft
- Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital and Institute, Stockholm, Sweden
| | - Dolores Subirá
- Department of Medical Immunology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - Vincent H J van der Velden
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arjan van de Loosdrecht
- Department of Hematology, Amsterdam University Medical Centers, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
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3
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Aladily TN, Obiedat S, Bustami N, Alhesa A, Altantawi AM, Khader M, Mansour AT. Combined utility of CD177, P53, CD105 and c-kit immunohistochemical stains improves the detection of myelodysplastic syndrome. Ann Diagn Pathol 2021; 55:151810. [PMID: 34482217 DOI: 10.1016/j.anndiagpath.2021.151810] [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: 05/31/2021] [Revised: 08/01/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
The diagnosis of myelodysplastic syndrome (MDS) relies primarily on identifying peripheral blood cytopenia and morphologic dysplasia as well as detecting cytogenetic aberrations in a subset of patients. Accumulating data points to the importance of examining certain immunophenotypic changes characteristic of MDS, most of which are tested by flow cytometry. The role of immunohistochemistry in the diagnostic workup of MDS is less known. In this study, we used immunohistochemistry to survey the expression patterns of CD177, P53, CD105 and c- kit in a cohort of MDS bone marrow specimens (n = 57) and compared the results with a control group of patients who had cytopenia for other benign conditions (n = 49). MDS cases showed significant higher rates of: CD177-loss (13/57, 23% vs 1/49, 2%; P = .0016), P53 overexpression (8/57, 14% vs none; P = .005) and the presence of clusters of CD105-positive cells (6/57, 11% vs none; P = .021). Increased c-kit-positive cells was more common in MDS patients, but not statistically significant (17/57, 30% vs 8/49, 16%; P = .102). On multivariate analysis, only loss of CD177 expression was significantly higher in MDS group (P = .014). These findings suggest that a panel of immunohistochemical stains could serve as an adjunct tool in investigating unexplained cytopenias and warrant further comparative studies with flow cytometry.
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Affiliation(s)
- Tariq N Aladily
- Department of Hematopathology, The University of Jordan, Amman 11910, Jordan.
| | - Sara Obiedat
- Department of Hematopathology, The University of Jordan, Amman 11910, Jordan
| | - Nadwa Bustami
- Department of Hematopathology, The University of Jordan, Amman 11910, Jordan
| | - Ahmad Alhesa
- Department of Hematopathology, The University of Jordan, Amman 11910, Jordan
| | - Ahmad M Altantawi
- Department of Hematopathology, The University of Jordan, Amman 11910, Jordan
| | - Majd Khader
- Department of Hematopathology, The University of Jordan, Amman 11910, Jordan
| | - Ahmad T Mansour
- Department of Hematopathology, The University of Jordan, Amman 11910, Jordan; Department of Pathology and Laboratory Medicine, University of Cincinnati, OH 45220, USA.
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Alayed K, Meyerson JB, Osei ES, Blidaru G, Schlegelmilch J, Johnson M, Meyerson HJ. CD177 Enhances the Detection of Myelodysplastic Syndrome by Flow Cytometry. Am J Clin Pathol 2020; 153:554-565. [PMID: 32011681 DOI: 10.1093/ajcp/aqz196] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Previously we demonstrated that a decreased percentage of CD177-positive granulocytes detected by flow cytometry (FCM) was associated with myelodysplastic syndrome (MDS). Here we expand on those findings to more rigorously evaluate the utility of CD177 for the detection of MDS. METHODS Two hundred patient samples (100 MDS and 100 controls) were evaluated for granulocyte expression of CD177 and 11 other flow cytometric parameters known to be associated with MDS. RESULTS We show that CD177, as a single analyte, is highly correlated with MDS with a receiver operating characteristic area under curve value of 0.8. CD177 expression below 30% demonstrated a sensitivity of 51% and a specificity of 94% for detecting MDS with a positive predictive value of 89.5%. In multivariate analysis of 12 MDS-associated FCM metrics, CD177 and the Ogata parameters were significant indicators of MDS, and CD177 increased sensitivity of the Ogata score by 16% (63%-79%) for predicting MDS. Finally, diagnostic criteria incorporating these parameters with a 1% blast cutoff level and CD177 resulted in a sensitivity of 90% and specificity of 91% for detecting MDS. CONCLUSIONS The findings indicate CD177 is a useful FCM marker for MDS.
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Affiliation(s)
- Khaled Alayed
- Department of Pathology, King Saud University, Riyadh, Saudi Arabia
| | | | - Ebenezer S Osei
- Department of Pathology, Case Western Reserve University, Cleveland, OH
| | - Georgeta Blidaru
- Department of Pathology, Case Western Reserve University, Cleveland, OH
| | | | - Michael Johnson
- Department of Pathology, Case Western Reserve University, Cleveland, OH
| | - Howard J Meyerson
- Department of Pathology, Case Western Reserve University, Cleveland, OH
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5
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Mannelli F, Gesullo F, Rotunno G, Pacilli A, Bencini S, Annunziato F, Zanotti R, Scaffidi L, Giona F, Santopietro M, Grifoni F, Pieri L, Guglielmelli P, Vannucchi AM. Myelodysplasia as assessed by multiparameter flow cytometry refines prognostic stratification provided by genotypic risk in systemic mastocytosis. Am J Hematol 2019; 94:845-852. [PMID: 31056768 DOI: 10.1002/ajh.25506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/22/2022]
Abstract
Systemic mastocytosis (SM) is characterized by extreme heterogeneity of manifestations and prognosis. Several disease-related biomarkers, including clinical, hematological and molecular variables, have been correlated with prognosis. Although relevant, the mutation profile closely reflects the WHO classification that has per se prognostic value. High-risk mutations (HRM) are largely confined to advanced forms, and thus fail in providing information regarding progression and outcome in the not-advanced variants. In this work, we studied hematopoietic cells by multi-parameter flow cytometry (MFC) in order to highlight dysplastic traits that might provide insights into outcome. A score previously validated for myelodysplastic syndromes, with high reproducibility in standard diagnostics, was used. The application of an MFC score to a cohort of 71 SM cases, concurrently genotyped for configuring a HRM category, resulted in the identification of two separate patients' categories (MFC+ and MFC-) characterized by significantly different clinical and laboratory features at presentation. The extent of dysplasia by MFC tended to parallel WHO-category and genotype-related stratification. MFC+ patients had shorter survival compared to MFC- ones, for whom the incidence of progression and/or death was virtually null. Of note, MFC score remained prognostically informative in unadvanced subsets. Furthermore, the integration of MFC and HRM was an independent predictor for outcome, also overcoming WHO-categories in multivariate analysis for EFS. Our results support the use of MFC analysis in the evaluation of patients with SM, alone and in combination with HRM, for refinement of prognosis assessment.
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Affiliation(s)
- Francesco Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Francesca Gesullo
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Giada Rotunno
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Annalisa Pacilli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Sara Bencini
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e ClinicaDenothe Excellence Center Firenze Italy
| | - Francesco Annunziato
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e ClinicaDenothe Excellence Center Firenze Italy
| | - Roberta Zanotti
- Multidisplinary Outpatients Clinic for Mastocytosis (GISM)Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
- Department of Medicine, Haematology UnitAzienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Luigi Scaffidi
- Multidisplinary Outpatients Clinic for Mastocytosis (GISM)Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
- Department of Medicine, Haematology UnitAzienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Fiorina Giona
- EmatologiaDipartimento di Medicina Traslazionale e di Precisione, Università Sapienza Roma Italy
| | - Michelina Santopietro
- EmatologiaDipartimento di Medicina Traslazionale e di Precisione, Università Sapienza Roma Italy
| | - Federica Grifoni
- UOC EmatologiaFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Milano Italy
| | - Lisa Pieri
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Paola Guglielmelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Alessandro M. Vannucchi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
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6
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Matzen SMH, Raaschou‐Jensen KK, Kallenbach K. Implementation of the Ogata flow cytometric scoring system in routine diagnostics of myelodysplastic syndrome. Health Sci Rep 2018; 1:e90. [PMID: 30623045 PMCID: PMC6242364 DOI: 10.1002/hsr2.90] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/12/2018] [Accepted: 08/09/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIMS Compiling evidence has emerged for the relevance of flow cytometric assessment as a valuable part of the diagnostic work-up of myelodysplastic syndrome (MDS). This study aimed at evaluating the implementation of a simple flow cytometric scoring system (FCSS), the Ogata score, in a routine diagnostic laboratory. METHODS A total of 35 patient samples with a clinical suspicion of MDS were retrospectively assessed using the FCSS. The accuracy of the FCSS was evaluated on the basis of the final diagnoses of the patients. RESULTS The final diagnoses included 17 MDS, 4 other myeloid cancers, and 14 reactive changes. Thirty-two of 35 (91%) were correctly scored by the FCSS. All 3 incorrect scores were from samples classified as "other myeloid cancers." Of the initial pathological evaluation of the bone marrows, 20% were inconclusive or incorrect. All inconclusive samples were correctly scored using the FCSS. CONCLUSION The FCSS evaluated here has high accuracy and low complexity. Cases with inconclusive pathological evaluation will especially potentially benefit from adding the Ogata score to the diagnostic work-up. The system will be feasible to implement in most flow cytometry laboratories without the need for supplemental antibody panels. It should be emphasized that the FCSS, in our hands, provided poor discrimination between MDS and other myeloid clonal diseases.
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Affiliation(s)
| | - Klas Kræsten Raaschou‐Jensen
- Department of HaematologyZealand University HospitalRoskildeDenmark
- Department of HaematologyOdense University HospitalOdenseDenmark
| | - Klaus Kallenbach
- Department of Clinical PathologyZealand University HospitalRoskildeDenmark
- Department of Pathology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
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7
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Revising flow cytometric mini-panel for diagnosing low-grade myelodysplastic syndromes: Introducing a parameter quantifying CD33 expression on CD34+ cells. Leuk Res 2018; 71:75-81. [DOI: 10.1016/j.leukres.2018.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 11/18/2022]
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8
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Chen-Liang TH, Casado-Prieto AM, Campos-Rodríguez V, Hurtado AM, Amigo ML, García-Malo MD, Vicente V, Ortuño FJ, Jerez A. An increased percentage of myeloid CD34+ bone marrow cells stratifies intermediate IPSS-R myelodysplastic syndrome patients into prognostically significant groups. Int J Lab Hematol 2018; 40:549-555. [PMID: 29774987 DOI: 10.1111/ijlh.12860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/11/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The Revised International Prognostic Scoring System (IPSS-R) for myelodysplastic syndromes (MDS) has established an intermediate category where a disease-modifying intervention is a matter of debate. Flow cytometry allows us to determine a fraction of immature myeloid cells in a semiautomated procedure. The aim of this study, mirroring IPSS-R study inclusion criteria, was to test whether bone marrow (BM) CD34+My percentage has independent prognostic value in the MDS setting. METHODS BM CD34+My cells were quantified, at diagnosis, selecting CD34+/CD45+/CD11b±/CD13+. Patients were excluded when receiving treatment for altering the natural course of the disease and when IPSS-R could not be calculated due to the lack of metaphases. Finally, Cox analyses were performed, on a series of 260 patients, for overall survival (OS) and time to acute myeloid leukemia (AML) transformation. RESULTS By analyzing ROC curves, the most accurate prognostic variable, regarding blasts by cytology and CD34+ by cytometry, was the percentage of blasts by microscopy. The percentage of CD34+My in BM showed an AUC of 0.767 and 0.576 for time to AML transformation and OS, respectively. When performing a multivariate regression including the IPSS-R and the percentage of BM CD34+My cells >1%, both factors predicted for a shorter time to AML transformation. In addition, CD34+My percentage successfully stratified the intermediate IPSS-R category into two prognostic groups with a relative risk of 5.73 (95% CI [1.2-27.8]; P = .03). CONCLUSION We found that BM CD34+My percentage has an independent value concerning the IPSS-R, especially relevant for the prediction of transformation to AML and within the intermediate group.
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Affiliation(s)
- T-H Chen-Liang
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - A M Casado-Prieto
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - V Campos-Rodríguez
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - A M Hurtado
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - M L Amigo
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - M D García-Malo
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - V Vicente
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - F J Ortuño
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - A Jerez
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
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9
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Lorand-Metze I, Longhini AL, Oliveira-Duarte G, Correia RP, Santos-Silva MC, Yamamoto M, Sandes AF, Oliveira AF, Souto EX, Ikoma MRV, Pereira-Cunha FG, Beltrame M, Metze K. Normal variation of bone marrow B-cell precursors according to age - reference ranges for studies in myelodysplastic syndromes in Brazil. CYTOMETRY PART B-CLINICAL CYTOMETRY 2017; 94:644-650. [DOI: 10.1002/cyto.b.21604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 12/21/2022]
Affiliation(s)
- I. Lorand-Metze
- Hematology - Hemotherapy Center, University of Campinas, Campinas; São Paulo Brazil
| | - A. L. Longhini
- Hematology - Hemotherapy Center, University of Campinas, Campinas; São Paulo Brazil
| | - G. Oliveira-Duarte
- Hematology - Hemotherapy Center, University of Campinas, Campinas; São Paulo Brazil
| | - R. P. Correia
- Laboratory of Hematology, Hospital Albert Einstein; São Paulo Brazil
| | - M. C. Santos-Silva
- Laboratory of Experimental Oncology; Federal University of Santa Catarina; Florianópolis Brazil
| | - M. Yamamoto
- Department of Hematology; Federal University of São Paulo; São Paulo Brazil
| | - A. F. Sandes
- Laboratory of Hematology; Laboratórios Fleury; São Paulo Brazil
| | - A. F. Oliveira
- Laboratory of Hematology; Childrens' Cancer Hospital, Barretos Cancer Center; Barretos Brazil
| | - E. X. Souto
- Laboratory of Hematology; DASA; São Paulo Brazil
| | - M. R. V. Ikoma
- Laboratory of Cytometry; Hospital Amaral Carvalho; Jaú, São Paulo Brazil
| | | | - M. Beltrame
- Department of Hematology; Federal University of Paraná; Curitiba Brazil
| | - K. Metze
- Department of Pathology; University of Campinas; Campinas Brazil
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10
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Shi M, Nguyen P, Jevremovic D. Flow Cytometric Assessment of Chronic Myeloid Neoplasms. Clin Lab Med 2017; 37:803-819. [DOI: 10.1016/j.cll.2017.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Diagnostic Utility of Flow Cytometry in Myelodysplastic Syndromes. Mediterr J Hematol Infect Dis 2017; 9:e2017017. [PMID: 28293405 PMCID: PMC5333741 DOI: 10.4084/mjhid.2017.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/20/2017] [Indexed: 12/19/2022] Open
Abstract
The pathological hallmark of myelodysplastic syndromes (MDS) is marrow dysplasia, which represents the basis of the WHO classification of these disorders. This classification provides clinicians with a useful tool for defining the different subtypes of MDS and individual prognosis. The WHO proposal has raised some concern regarding minimal diagnostic criteria particularly in patients with normal karyotype without robust morphological markers of dysplasia (such as ring sideroblasts or excess of blasts). Therefore, there is clearly need to refine the accuracy to detect marrow dysplasia. Flow cytometry (FCM) immunophenotyping has been proposed as a tool to improve the evaluation of marrow dysplasia. The rationale for the application of FCM in the diagnostic work up of MDS is that immunophenotyping is an accurate method for quantitative and qualitative evaluation of hematopoietic cells and that MDS have been found to have abnormal expression of several cellular antigens. To become applicable in clinical practice, FCM analysis should be based on parameters with sufficient specificity and sensitivity, data should be reproducible between different operators, and the results should be easily understood by clinicians. In this review, we discuss the most relevant progresses in detection of marrow dysplasia by FCM in MDS
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WANG XIANWEN, CHEN FENG, CHENG ZHI, DU YAOHUA, WU TAIHU. AUTOMATED GATING OF PORTABLE CYTOMETER DATA BASED ON SKEW t MIXTURE MODELS. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415500335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A major component of flow cytometry (FCM) data analysis involves gating, which is the process of identifying homogeneous groups of cells. With the rapid development of the portable flow cytometer, manual gating techniques have been unable to meet the demand for accurate and rapid analysis of samples. To provide a practical application for portable devices, we propose a flexible, statistical model-based clustering approach for identifying cell populations in FCM data. This approach, which mimics the manual gating process, employs a finite mixture model with a density function of skew t distribution and estimates parameters via an expectation maximization algorithm. Data analysis from an experiment on a patient’s peripheral blood samples have proven that the proposed methodology yields better results in terms of robustness against outliers than current state-of-the-art automated gating methods, has more flexibility in clustering symmetric data and leads to lower misclassification rates (misclassification rates of skew t method is 0.06442) when handling highly asymmetric data. The method we proposed will improve data analysis of portable flow cytometers, especially when the users have no professional training.
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Affiliation(s)
- XIANWEN WANG
- Institute of Medical Equipment, Academy of Military Medical Sciences, Wandong Road 106, Hedong District, Tianjin 300161, P. R. China
| | - FENG CHEN
- Institute of Medical Equipment, Academy of Military Medical Sciences, Wandong Road 106, Hedong District, Tianjin 300161, P. R. China
| | - ZHI CHENG
- Institute of Medical Equipment, Academy of Military Medical Sciences, Wandong Road 106, Hedong District, Tianjin 300161, P. R. China
| | - YAOHUA DU
- Institute of Medical Equipment, Academy of Military Medical Sciences, Wandong Road 106, Hedong District, Tianjin 300161, P. R. China
| | - TAIHU WU
- Institute of Medical Equipment, Academy of Military Medical Sciences, Wandong Road 106, Hedong District, Tianjin 300161, P. R. China
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Reis-Alves SC, Traina F, Metze K, Lorand-Metze I. Improving the differential diagnosis between myelodysplastic syndromes and reactive peripheral cytopenias by multiparametric flow cytometry: the role of B-cell precursors. Diagn Pathol 2015; 10:44. [PMID: 25924846 PMCID: PMC4428240 DOI: 10.1186/s13000-015-0259-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/31/2015] [Indexed: 11/17/2022] Open
Abstract
Background Immunophenotyping is a valuable ancillary technique for the differential diagnosis between myelodysplastic syndromes (MDS) with low bone marrow (BM) blast counts and a normal karyotype, and reactive peripheral (PB) cytopenias. Our aim was to search for the most important variables for this purpose. We also analyzed the age variation of BM B-cell precursors (BCP) and its differences in reactive and clonal cytopenias. Methods Immunophenotypic analyzes were performed in BM of 54 patients with MDS (76% with BM blasts <5%) and 35 cases of reactive cytopenias. Healthy allogeneic BM transplantation donors (n = 41) were used as controls. We used a four-color panel of antibodies analyzing 9 granulocytic, 8 monocytic and 6 CD34+ cell features. Results Asynchronous shift to the left in maturing granulocytes and increase in CD16+ monocytes were also found in reactive PB cytopenias, but the most important aberrancies in MDS were seen in myeloid CD34+ cells. Decrease in BCP, that is a hallmark of MDS, could also be found in reactive cytopenias, especially in patients >55 years. % BM BCP could be calculated by the formula: (−7.97 × log age) + (4.24 × log % CD34+cells) – (0.22 x nr. alterations CD34+cells) + 0.577. Corrected R2 = 0.467. Conclusion Analysis of myelomonocytic precursors and CD34+ cells was satisfactory for the differential diagnosis between reactive PB cytopenias and MDS. The most specific alterations were found in CD34+ cells. Comparison of the values obtained with those of normal age-matched controls is recommended.
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Affiliation(s)
- Suiellen C Reis-Alves
- Hematology and Hemotherapy Center, University of Campinas, Carlos Chagas Street, 480, 13083-878 Campinas, São Paulo, Brazil.
| | - Fabiola Traina
- Faculty of Medicine of Ribeirão Preto, University of São Paulo, Vila Monte Alegre, 14048-900, Ribeirão Preto, Sao Paulo, Brazil.
| | - Konradin Metze
- Faculty of Medicine, University of Campinas, Tessália Vieira de Camargo Street 126, 13083-887, Campinas, São Paulo, Brazil.
| | - Irene Lorand-Metze
- Hematology and Hemotherapy Center, University of Campinas, Carlos Chagas Street, 480, 13083-878 Campinas, São Paulo, Brazil. .,Faculty of Medicine, University of Campinas, Tessália Vieira de Camargo Street 126, 13083-887, Campinas, São Paulo, Brazil.
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14
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Prognostic significance of flow cytometric residual disease, dysregulated neutrophils/monocytes, and hematogones in adult acute myeloid leukemia in first remission. Int J Hematol 2014; 99:296-304. [PMID: 24481944 DOI: 10.1007/s12185-014-1525-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 01/15/2014] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
Abstract
Fifty-one consecutive non-M3 acute myeloid leukemia (AML) patients who had achieved morphologic complete remission (mCR) after induction chemotherapy were enrolled in the present study. Three characteristics of bone marrow (BM) composition analyzed by flow cytometry were combined to determine the prognostic impact. A standardized panel of reagents was used to detect residual disease of aberrant myeloid progenitor cells (RD), identify neutrophils/monocytes with dysregulated immunophenotype (dysregulated neutro/mono) and quantify the appearance of CD34(+) B-progenitor-related cluster (hematogones) simultaneously in post-induction BM of adult AML patients. Patients who had detectable RD ≥0.2 % exhibited significantly lower median leukemia-free survival (LFS) than those who did not (13.5 vs. 48.0 months; P = 0.042). Dysregulated neutro/mono abnormalities assessed by this flow cytometric scoring system (FCSS ≥2) predicted shorter LFS (8.0 vs. 39.0 months; P = 0.008). While B-progenitor-related cluster size ≥5 % predicted improved outcome, with longer LFS (not reached vs. 13.5 months; P = 0.023) and better overall survival (not reached vs. 24.0 months; P = 0.027). The proposed RD/dysregulated neutro/mono/hematogones score showed a new risk groups with different LFS in the overall patients (P = 0.0006) as well as in the subgroup of intermediate cytogenetic risk (P = 0.001). The RD/dysregulated neutro/mono/hematogones score assessed by flow cytometry for adult AML in mCR may offer a rapid and practical risk assessment providing better refinement in risk-adapted management after induction chemotherapy.
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15
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Immunophenotyping in myelodysplastic syndromes can add prognostic information to well-established and new clinical scores. PLoS One 2013; 8:e81048. [PMID: 24324660 PMCID: PMC3855682 DOI: 10.1371/journal.pone.0081048] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 10/17/2013] [Indexed: 12/30/2022] Open
Abstract
Background myelodysplastic syndromes (MDS) are a heterogeneous group of hematopoietic clonal disorders. So, prognostic variables are important to separate patients with a similar biology and clinical outcome. We compared the importance of risk stratification in primary MDS of IPSS and WPSS with the just described revision of IPSS (IPSS-R), and examined if variables obtained by bone marrow immunophenotyping could add prognostic information to any of the scores. Methods In this prospective study of 101 cases of primary MDS we compared the relation of patients’ overall survival with WHO types, IPSS, IPSS-R, WPSS and phenotypic abnormalities of hematopoietic precursors. We examined aberrancies in myelomonocytic precursors and CD34+ cells. Patients were censored when receiving chemotherapy or BM transplantation. Survival analysis was made by Cox regressions and stability of the models was examined by bootstrap resampling. Results median age: 64 years (15–93). WHO types: 2 cases of 5q- syndrome, 7 of RA, 64 of RCDM and 28 of RAEB. In the univariate Cox analysis, increasing risk category of all scores, degree of anemia, higher percentage of BM blasts, higher number of CD34+ cells and their myeloid fractions besides increasing number of phenotypic abnormalities detected were significantly associated with a shorter survival. In the multivariate analysis comparing the three scores, IPSS-R was the only independent risk factor. Comparing WPSS with phenotypic variables (CD34+/CD13+ cells, CD34+/CD13− cells and “total alterations”) the score and “CD34+/CD13+ cells” remained in the model. When IPSS was tested together with these phenotypic variables, only “CD34+/CD13+ cells”, and “total alterations” remained in the model. Testing IPSS-R with the phenotypic variables studied, only the score and “CD34+/CD13+ cells” entered the model. Conclusions Immunophenotypic analysis of myelomonocytic progenitors provides additional prognostic information to all clinical scores studied. IPSS-R improved risk stratification in MDS compared to the former scores.
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16
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Differences in blast immunophenotypes among disease types in myelodysplastic syndromes: a multicenter validation study. Leuk Res 2012; 36:1229-36. [PMID: 22682984 DOI: 10.1016/j.leukres.2012.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 04/24/2012] [Accepted: 05/11/2012] [Indexed: 01/24/2023]
Abstract
We conducted a multicenter, flow cytometry study to validate differences in immunophenotypes among disease types in melodysplastic syndromes (MDS). The data obtained from 115 patients were combined into three groups according to disease grade, i.e., low-grade MDS, refractory anemia with excess blasts, and acute leukemia transformed from MDS (AL-MDS). The data comparison showed that with the progression of disease grade, the immunophenotypes of CD34(+) myeloblasts were more immature, with an increase and a decrease in CD7 and CD15 expression, respectively, and the percentages of CD34(+) B-progenitors among total CD34(+) cells and the granularity of granulocytes decreased. Logistic regression analyses showed that, in addition to myeloblast percentages, the expression of CD7 and B7-H1 on myeloblasts was independently associated with AL-MDS patients.
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17
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Della Porta MG, Picone C, Pascutto C, Malcovati L, Tamura H, Handa H, Czader M, Freeman S, Vyas P, Porwit A, Saft L, Westers TM, Alhan C, Cali C, van de Loosdrecht AA, Ogata K. Multicenter validation of a reproducible flow cytometric score for the diagnosis of low-grade myelodysplastic syndromes: results of a European LeukemiaNET study. Haematologica 2012; 97:1209-17. [PMID: 22315489 DOI: 10.3324/haematol.2011.048421] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The current World Health Organization classification of myelodysplastic syndromes is based morphological evaluation of bone marrow dysplasia. In clinical practice, the reproducibility of the recognition of dysplasia is usually poor especially in cases that lack specific markers such as ring sideroblasts and clonal cytogenetic abnormalities. DESIGN AND METHODS We aimed to develop and validate a flow cytometric score for the diagnosis of myelodysplastic syndrome. Four reproducible parameters were analyzed: CD34(+) myeloblast-related and B-progenitor-related cluster size (defined by CD45 expression and side scatter characteristics CD34(+) marrow cells), myeloblast CD45 expression and granulocyte side scatter value. The study comprised a "learning cohort" (n=538) to define the score and a "validation cohort" (n=259) to confirm its diagnostic value. RESULTS With respect to non-clonal cytopenias, patients with myelodysplastic syndrome had increased myeloblast-related cluster size, decreased B-progenitor-related cluster size, aberrant CD45 expression and reduced granulocyte side scatter (P<0.001). To define the flow cytometric score, these four parameters were combined in a regression model and the weight for each variable was estimated based on coefficients from that model. In the learning cohort a correct diagnosis of myelodysplastic syndrome was formulated in 198/281 cases (sensitivity 70%), while 18 false-positive results were noted among 257 controls (specificity 93%). Sixty-five percent of patients without specific markers of dysplasia (ring sideroblasts and clonal cytogenetic abnormalities) were correctly classified. A high value of the flow cytometric score was associated with multilineage dysplasia (P=0.001), transfusion dependency (P=0.02), and poor-risk cytogenetics (P=0.04). The sensitivity and specificity in the validation cohort (69% and 92%, respectively) were comparable to those in the learning cohort. The likelihood ratio of the flow cytometric score was 10. CONCLUSIONS A flow cytometric score may help to establish the diagnosis of myelodysplastic syndrome, especially when morphology and cytogenetics are indeterminate.
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Affiliation(s)
- Matteo G Della Porta
- Department of Hematology Oncology, University of Pavia Medical School Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy.
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18
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Westers TM, Ireland R, Kern W, Alhan C, Balleisen JS, Bettelheim P, Burbury K, Cullen M, Cutler JA, Della Porta MG, Dräger AM, Feuillard J, Font P, Germing U, Haase D, Johansson U, Kordasti S, Loken MR, Malcovati L, te Marvelde JG, Matarraz S, Milne T, Moshaver B, Mufti GJ, Ogata K, Orfao A, Porwit A, Psarra K, Richards SJ, Subirá D, Tindell V, Vallespi T, Valent P, van der Velden VHJ, de Witte TM, Wells DA, Zettl F, Béné MC, van de Loosdrecht AA. Standardization of flow cytometry in myelodysplastic syndromes: a report from an international consortium and the European LeukemiaNet Working Group. Leukemia 2012; 26:1730-41. [PMID: 22307178 DOI: 10.1038/leu.2012.30] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Flow cytometry (FC) is increasingly recognized as an important tool in the diagnosis and prognosis of myelodysplastic syndromes (MDS). However, validation of current assays and agreement upon the techniques are prerequisites for its widespread acceptance and application in clinical practice. Therefore, a working group was initiated (Amsterdam, 2008) to discuss and propose standards for FC in MDS. In 2009 and 2010, representatives from 23, mainly European, institutes participated in the second and third European LeukemiaNet (ELN) MDS workshops. In the present report, minimal requirements to analyze dysplasia are refined. The proposed core markers should enable a categorization of FC results in cytopenic patients as 'normal', 'suggestive of', or 'diagnostic of' MDS. An FC report should include a description of validated FC abnormalities such as aberrant marker expression on myeloid progenitors and, furthermore, dysgranulopoiesis and/or dysmonocytopoiesis, if at least two abnormalities are evidenced. The working group is dedicated to initiate further studies to establish robust diagnostic and prognostic FC panels in MDS. An ultimate goal is to refine and improve diagnosis and prognostic scoring systems. Finally, the working group stresses that FC should be part of an integrated diagnosis rather than a separate technique.
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Affiliation(s)
- T M Westers
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
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19
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Westers TM, van der Velden VHJ, Alhan C, Bekkema R, Bijkerk A, Brooimans RA, Cali C, Dräger AM, de Haas V, Homburg C, de Jong A, Kuiper-Kramer PEA, Leenders M, Lommerse I, te Marvelde JG, van der Molen-Sinke JK, Moshaver B, Mulder AB, Preijers FWMB, Schindhelm RK, van der Sluijs A, van Wering ER, Westra AH, van de Loosdrecht AA. Implementation of flow cytometry in the diagnostic work-up of myelodysplastic syndromes in a multicenter approach: report from the Dutch Working Party on Flow Cytometry in MDS. Leuk Res 2011; 36:422-30. [PMID: 21982641 DOI: 10.1016/j.leukres.2011.09.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/16/2011] [Accepted: 09/18/2011] [Indexed: 11/27/2022]
Abstract
Flow cytometry (FC) is recognized as an important tool in the diagnosis of myelodysplastic syndromes (MDS) especially when standard criteria fail. A working group within the Dutch Society of Cytometry aimed to implement FC in the diagnostic work-up of MDS. Hereto, guidelines for data acquisition, analysis and interpretation were formulated. Based on discussions on analyses of list mode data files and fresh MDS bone marrow samples and recent literature, the guidelines were modified. Over the years (2005-2011), the concordance between the participating centers increased indicating that the proposed guidelines contributed to a more objective, standardized FC analysis, thereby ratifying the implementation of FC in MDS.
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Affiliation(s)
- Theresia M Westers
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands.
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20
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Della Porta MG, Lanza F, Del Vecchio L. Flow cytometry immunophenotyping for the evaluation of bone marrow dysplasia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2011; 80:201-11. [PMID: 21674774 DOI: 10.1002/cyto.b.20607] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 05/06/2011] [Accepted: 05/17/2011] [Indexed: 01/28/2023]
Abstract
The pathological hallmark of myelodysplastic syndromes (MDS) is marrow dysplasia, which represents the basis of the WHO classification of these disorders. This classification provides clinicians with a useful tool for defining the different subtypes of MDS and determining individual prognosis. The WHO proposal has raised some concern regarding minimal diagnostic criteria particularly in patients with normal karyotype without robust morphological markers of dysplasia (such as ring sideroblasts or excess of blasts). Therefore, there is clearly a need to refine the accuracy to detect marrow dysplasia. Flow cytometry (FCM) immunophenotyping has been proposed as a tool to improve the evaluation of marrow dysplasia. Rationale for the application of FCM in the diagnostic work up of MDS is that immunophenotyping is an accurate method for quantitative and qualitative evaluation of hematopoietic cells and that MDS have been found to have abnormal expression of several cellular antigens. To become clinically applicable, FCM analysis should be based on parameters with sufficient specificity and sensitivity, data should be reproducible between different operators and the results should be easily understood by clinicians. In this report, we reviewed the most relevant progresses in detection of marrow dysplasia by FCM in MDS as defined by WHO criteria.
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Affiliation(s)
- Matteo Giovanni Della Porta
- Department of Hematology Oncology, University of Pavia Medical School and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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21
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Ossenkoppele GJ, van de Loosdrecht AA, Schuurhuis GJ. Review of the relevance of aberrant antigen expression by flow cytometry in myeloid neoplasms. Br J Haematol 2011; 153:421-36. [PMID: 21385170 DOI: 10.1111/j.1365-2141.2011.08595.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article reviews the use of aberrant antigen expression detected by flow cytometry in the diagnosis and clinical handling of acute myeloid leukaemia (AML) and the myelodysplastic syndromes (MDS). Such aberrancies offer a valuable tool for the proper classification of these myeloid malignancies according the World Health Organization 2008 classification. Aberrant antigen expression by flow cytometry is also important for prognostification. This review supports the view, that minimal residual disease detection methods that make use of such aberrancies should be part of the routine management of AML patients to guide therapy, but also suggests the introduction of flow cytometry in MDS for diagnosis and treatment decisions in the near future.
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Affiliation(s)
- Gert J Ossenkoppele
- Department of Haematology, VU University Medical Center, De Boelelaan 1117, Amsterdam, the Netherlands.
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22
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Abstract
We have developed flowMeans, a time-efficient and accurate method for automated identification of cell populations in flow cytometry (FCM) data based on K-means clustering. Unlike traditional K-means, flowMeans can identify concave cell populations by modelling a single population with multiple clusters. flowMeans uses a change point detection algorithm to determine the number of sub-populations, enabling the method to be used in high throughput FCM data analysis pipelines. Our approach compares favorably to manual analysis by human experts and current state-of-the-art automated gating algorithms. flowMeans is freely available as an open source R package through Bioconductor.
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Affiliation(s)
- Nima Aghaeepour
- Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada
- Department of Bioinformatics, University of British Columbia, British Columbia, Canada
| | - Radina Nikolic
- Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada
- Department of Statistics, University of Oxford, Oxford, United Kingdom
| | - Holger H. Hoos
- Department of Computer Science, University of British Columbia, British Columbia, Canada
| | - Ryan R. Brinkman
- Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, British Columbia, Canada
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23
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Goardon N, Nikolousis E, Sternberg A, Chu WK, Craddock C, Richardson P, Benson R, Drayson M, Standen G, Vyas P, Freeman S. Reduced CD38 expression on CD34+ cells as a diagnostic test in myelodysplastic syndromes. Haematologica 2009; 94:1160-3. [PMID: 19644143 DOI: 10.3324/haematol.2008.004085] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Diagnosis of myelodysplastic syndrome can be difficult especially in cases with a low blast count and a normal karyotype. Flow cytometry has been used to distinguish myelodysplastic syndrome from non-clonal cytopenias. No one single simple flow cytometric parameter has been proposed to be diagnostic of myelodysplastic syndrome. We have studied samples from 100 myelodysplastic syndrome patients and as control samples; 70 non-clonal cytopenias, 5 subjects with normal hematology, 31 patients with acute myeloid leukemia and 11 with chronic myelomonocytic leukemia or myeloproliferative disorder. We show that reduced relative mean fluorescence of CD38 below a threshold value on CD34(+) cells diagnosed low-grade myelodysplastic syndrome with 95% sensitivity (95% confidence interval, 87-99%) and 92% specificity (95% confidence interval, 82-97%). This simple flow cytometric test may be of value in the routine clinical diagnosis of myelodysplastic syndrome, especially in cases with a low blast count and normal karyotype.
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Affiliation(s)
- Nicolas Goardon
- Department of Haematology, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, Oxford, UK
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24
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Merging mixture components for cell population identification in flow cytometry. Adv Bioinformatics 2009:247646. [PMID: 20049161 PMCID: PMC2798116 DOI: 10.1155/2009/247646] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 07/06/2009] [Accepted: 08/22/2009] [Indexed: 11/21/2022] Open
Abstract
We present a framework for the identification of cell subpopulations in
flow cytometry data based on merging mixture components using the
flowClust methodology. We show that the cluster merging algorithm
under our framework improves model fit and provides a better
estimate of the number of distinct cell subpopulations than
either Gaussian mixture models or flowClust, especially for
complicated flow cytometry data distributions. Our framework
allows the automated selection of the number of distinct cell
subpopulations and we are able to identify cases where the
algorithm fails, thus making it suitable for application in a high
throughput FCM analysis pipeline. Furthermore, we demonstrate a
method for summarizing complex merged cell subpopulations in a
simple manner that integrates with the existing flowClust
framework and enables downstream data analysis. We demonstrate the
performance of our framework on simulated and real FCM data. The
software is available in the flowMerge package through the
Bioconductor project.
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Ogata K, Della Porta MG, Malcovati L, Picone C, Yokose N, Matsuda A, Yamashita T, Tamura H, Tsukada J, Dan K. Diagnostic utility of flow cytometry in low-grade myelodysplastic syndromes: a prospective validation study. Haematologica 2009; 94:1066-74. [PMID: 19546439 DOI: 10.3324/haematol.2009.008532] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The diagnosis of myelodysplastic syndromes is not always straightforward when patients lack specific diagnostic markers, such as blast excess, karyotype abnormality, and ringed sideroblasts. DESIGN AND METHODS We designed a flow cytometry protocol applicable in many laboratories and verified its diagnostic utility in patients without those diagnostic markers. The cardinal parameters, analyzable from one cell aliquot, were myeloblasts (%), B-cell progenitors (%), myeloblast CD45 expression, and channel number of side scatter where the maximum number of granulocytes occurs. The adjunctive parameters were CD11b, CD15, and CD56 expression (%) on myeloblasts. Marrow samples from 106 control patients with cytopenia and 134 low-grade myelodysplastic syndromes patients, including 81 lacking both ringed sideroblasts and cytogenetic aberrations, were prospectively analyzed in Japan and Italy. RESULTS Data outside the predetermined reference range in 2 or more parameters (multiple abnormalities) were common in myelodysplastic syndromes patients. In those lacking ringed sideroblasts and cytogenetic aberrations, multiple abnormalities were observed in 8/26 Japanese (30.8%) and 37/55 Italians (67.3%) when the cardinal parameters alone were considered, and in 17/26 Japanese (65.4%) and 42/47 Italians (89.4%) when all parameters were taken into account. Multiple abnormalities were rare in controls. When data from all parameters were used, the diagnostic sensitivities were 65% and 89%, specificities were 98% and 90%, and likelihood ratios were 28.1 and 8.5 for the Japanese and Italian cohorts, respectively. CONCLUSIONS This protocol can be used in the diagnostic work-up of low-grade myelodysplastic syndromes patients who lack specific diagnostic markers, although further improvement in diagnostic power is desirable.
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Affiliation(s)
- Kiyoyuki Ogata
- Division of Hematology, Department of Medicine, Nippon Medical School, Tokyo, Japan.
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26
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Truong F, Smith BR, Stachurski D, Cerny J, Medeiros LJ, Woda BA, Wang SA. The utility of flow cytometric immunophenotyping in cytopenic patients with a non-diagnostic bone marrow: a prospective study. Leuk Res 2009; 33:1039-46. [PMID: 19232722 DOI: 10.1016/j.leukres.2009.01.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 01/11/2009] [Accepted: 01/13/2009] [Indexed: 11/17/2022]
Abstract
Cytopenia is a common problem in hematology outpatient clinics and among hospitalized patients. A bone marrow (BM) aspirate and biopsy are often performed to rule out an infiltrative versus intrinsic BM process, such as myelodysplastic syndrome (MDS). We have previously described a flow cytometric (FCM) assay useful in diagnosing MDS and demonstrated its good correlation with "gold standard" morphologic and cytogenetic criteria. In this study, we prospectively tested the utility of the FCM assay in 102 cytopenic patients with BMs showing neither diagnostic morphological dysplasia nor abnormal cytogenetics. FCM, following our published criteria, was positive in 22 cases (21.6%), intermediate in 11 cases (10.8%) and negative in 69 cases (67.6%). With a median follow-up period of 11 months (range, 4-24 months), 12 (11.8%) patients were proven to have or/develop MDS or related BM diseases (group-1); 61 (59.8%) patients had their cytopenia(s) attributed to various medical causes (group-2). In the remaining 29 patients, the causes of cytopenia(s) were not found, and some had the features consistent with the recently defined clinical entity -- idiopathic cytopenia of uncertain significance. A positive FCM result was significantly more prevalent (9/12, 75%) in group-1 patients; while a negative FCM result was significantly more frequent in group-2 patients (4/61, 7%) (p<0.0001) with a positive predictive value of 69% and a negative predictive value of 95%. We conclude that FCM analysis of myelomonocytic maturation has diagnostic utility in cytopenic patients who have an inconclusive BM examination by morphologic and cytogenetic evaluation, and may therefore be a useful adjunct in clinical management of these patients.
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Affiliation(s)
- Francoise Truong
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts School of Medicine, Worcester, MA, USA
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27
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Abstract
It has long been considered that flow cytometry (FCM) has little role in clinical practice in the diagnosis of myelodysplastic syndromes (MDS). However, recent advances in the analytical method and knowledge of MDS FCM are changing this stereotype. This paper reviews the concept and current status of FCM in the diagnosis of low-grade MDS. The diagnosis of low-grade MDS in the absence of ringed sideroblasts and chromosomal aberration is not always straightforward, and a report from a recent international working conference has proposed FCM as an adjunctive diagnostic test for such cases. Currently, only a limited number of laboratories are applying FCM to the diagnosis of MDS. Furthermore, standard analytical methods in FCM for MDS have not been established, and no single FCM parameter is sufficiently sensitive and specific to make the diagnosis of MDS. To establish MDS FCM as a widely accepted, dependable diagnostic tool, prospective studies should increase flow parameters that can be analysed reproducibly and determine their sensitivity and specificity, either alone or in combination. CD34+ cell-related parameters that are applicable for diagnosing low-grade MDS in many laboratories are introduced here.
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Affiliation(s)
- Kiyoyuki Ogata
- Division of Hematology, Department of Medicine, Nippon Medical School, Tokyo, Japan.
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28
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Capiod JC, Tournois C, Vitry F, Sevestre MA, Daliphard S, Reix T, Nguyen P, Lefrère JJ, Pignon B. Characterization and comparison of bone marrow and peripheral blood mononuclear cells used for cellular therapy in critical leg ischaemia: towards a new cellular product. Vox Sang 2008; 96:256-65. [PMID: 19207166 DOI: 10.1111/j.1423-0410.2008.01138.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Autologous transplantation of either bone marrow (BM) or peripheral blood (PB) mononuclear cells (MNC) induces therapeutic angiogenesis in patients with peripheral arterial occlusive disease. Yet, the precise nature of the cellular product obtained from BM or PB and used in these therapeutic strategies remains unclear. MATERIALS AND METHODS We have analysed the characteristics of BM-MNC and PB-MNC collected without mobilization and implanted in patients with critical limb ischaemia in a clinical trial of cellular therapy including 16 individuals treated by BM-MNC and eight by PB-MNC. These MNCs were characterized by cell counts, viability assessment and enumeration of leucocyte subsets, CD34 stem and endothelial progenitor cells (EPCs) (CD34+/CD133+/VEGF-R2+) by flow cytometry. Mean fluorescence intensity ratios were determined for CD34, CD133 and VEGF-R2 markers. All analyses were simultaneously performed in two laboratories. RESULTS Accuracy and reliability between both laboratories were achieved. BM-MNCs and PB-MNCs were quantitatively and qualitatively heterogeneous and quite different from each other. Stem cells and EPCs were significantly more present in BM- compared to PB-cell products, but with similar mean fluorescence intensity ratios. A weakly positive correlation was observed between CD34+ cell counts and EPCs levels, confirming the specificity of cell identification. CONCLUSION A great variability was observed in cell product characteristics according to their origin and also between individuals. These data stress the necessity of optimal characterization of cell products especially in multicentric clinical trials.
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Affiliation(s)
- J-C Capiod
- Laboratory of Haematology, University Hospital of Amiens, Amiens, France
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