1
|
Nguyen-Them L, Alentorn A, Ahle G, Soussain C, Mathon B, Le Garff Tavernier M, Houillier C, Hoang-Xuan K. CSF biomarkers in primary CNS lymphoma. Rev Neurol (Paris) 2023; 179:141-149. [PMID: 36336490 DOI: 10.1016/j.neurol.2022.06.014] [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: 03/16/2022] [Revised: 06/04/2022] [Accepted: 06/10/2022] [Indexed: 11/06/2022]
Abstract
PCNSL is a non-Hodgkin lymphoma (NHL) affecting brain, spinal cord, eyes and leptomeninges. In the past two decades, its prognosis significantly improved due to therapeutic advances but it remains a highly aggressive tumor and early diagnosis is necessary for optimal management. Diagnosis relies on the identification of lymphoma cells in brain tissue obtained by stereotactic biopsy. Alternatively, lymphoma cells may be found in CSF through lumbar puncture (LP) or by a vitrectomy. For several reasons, the diagnosis of PCNSL may be challenging. Misleading radiological presentations are frequent. Dramatic response to steroids may bias histological analysis and deep brain location or frail health status can contraindicate brain biopsy. In the follow-up of patients who have been previously treated, differential diagnosis between tumor relapse and post-treatment may be also difficult. Therefore, the development of complementary reliable diagnostic tools is needed. This review will summarize several diagnostic or prognostic CSF biomarkers which have been proposed in PCNSL, their interests and limits.
Collapse
Affiliation(s)
- L Nguyen-Them
- Centre Hospitalier Saint Jean, 20 Avenue du Languedoc, 66000 Perpignan, France; Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
| | - A Alentorn
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - G Ahle
- Hôpitaux Civils de Colmar, 39 Avenue Liberté, 68024 Colmar, France
| | - C Soussain
- Institut Curie - site de Saint Cloud, 35 Rue Dailly, 92210 Saint-Cloud, France
| | - B Mathon
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - M Le Garff Tavernier
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - C Houillier
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - K Hoang-Xuan
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| |
Collapse
|
2
|
Mokhtari M, Alizadeh A, Monabati A, Safaei A. Comparison of flowcytometry and conventional cytology for diagnosis of CNS involvement in hematologic malignancies. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2022. [DOI: 10.1016/j.phoj.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
3
|
Bennett R, Ruskova A, Petrasich M, Theakston E. Value of cerebrospinal fluid white cell count and protein level in predicting leptomeningeal involvement by systemic aggressive B-cell lymphoma. Int J Lab Hematol 2022; 44:490-496. [PMID: 35166454 DOI: 10.1111/ijlh.13815] [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: 12/10/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Diagnostic cerebrospinal fluid (CSF) analysis for patients with newly diagnosed aggressive B-cell lymphoma at risk of secondary central nervous system involvement typically includes multiparametric flow cytometry (MFC), cytology (CC), white cell count (WCC) and total protein. The strength of relationships between MFC results and the remaining variables has been disputed in small studies. We explored these relationships in a large homogeneous cohort of patient samples, aiming to establish the relationship between WCC and protein level and MFC results. METHODS Adult patients with aggressive B-cell lymphoma at risk of CNS involvement who underwent staging CSF analysis by MFC were identified retrospectively from institutional electronic records between October 2011 and December 2020. RESULTS Three hundred and seventy eight samples, including 45 (11.9%) MFC+ samples, were analysed. The relative sensitivity of CC for MFC positivity was 0.38, with PPV of 0.68. Significantly higher median WCC (p < .001) and protein levels (p = .011) were seen in MFC+ vs. MFC- samples. MFC + CC+ (vs. MFC + CC- samples) demonstrated higher median neoplastic events and neoplastic cell concentration. WCC ≥36 × 106 /L and protein ≥1.12 g/L cut-off values demonstrated the highest PPVs for MFC positivity (0.67 and 0.88, respectively). CONCLUSIONS Statistically significant associations exist between elevated WCC and protein and MFC positivity, and selected WCC and protein cut-off values have PPVs comparable to that of cytological assessment. Whilst routine WCC and protein analysis may be unnecessary, WCC/protein values above these levels could be regarded as reasonable evidence of CSF involvement in the appropriate setting.
Collapse
Affiliation(s)
- Rory Bennett
- Department of Pathology and Laboratory Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Anna Ruskova
- Department of Pathology and Laboratory Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Michelle Petrasich
- Department of Pathology and Laboratory Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Edward Theakston
- Department of Pathology and Laboratory Medicine, Auckland District Health Board, Auckland, New Zealand
| |
Collapse
|
4
|
Central Nervous System Involvement in Adults with Acute Leukemia: Diagnosis, Prevention, and Management. Curr Oncol Rep 2022; 24:427-436. [PMID: 35141858 DOI: 10.1007/s11912-022-01220-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Recent treatment advances in both acute myeloid leukemia and acute lymphoblastic leukemia have drastically improved outcomes for these diseases, but central nervous system (CNS) relapses still occur. Treatment of CNS disease can be challenging due to the impermeability of the blood-brain barrier to many systemic therapies. RECENT FINDINGS The diagnosis of CNS leukemia relies on assessment of clinical symptoms, cerebrospinal fluid sampling for conventional cytology and/or flow cytometry, and neuroimaging. While treatment of CNS leukemia with systemic or intrathecal chemotherapy and/or radiation can be curative in some patients, these modalities can also lead to serious toxicities. In the modern era, prophylaxis with intrathecal chemotherapy is the most important strategy to prevent CNS relapses in high risk patients. Accurate risk stratification tools and the use of risk-adapted prophylactic therapy are imperative to improving the outcomes of patients with acute leukemias and preventing the development of CNS leukemia.
Collapse
|
5
|
Domingues RB, de Moura Leite FBV, Senne C. Cerebrospinal fluid findings in patients with hematologic neoplasms and meningeal infiltration. Acta Neurol Belg 2021; 121:1543-1546. [PMID: 32519319 DOI: 10.1007/s13760-020-01397-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/02/2020] [Indexed: 11/24/2022]
Abstract
Neoplastic cell infiltration into the central nervous system (CNS) is a serious complication of hematological neoplasms. Cytomorphology (CM) and flow cytometry (FC) have been used to detect meningeal infiltration. The association between CSF findings with the results of CM and FC is still poorly understood. We retrospectively evaluated CSF findings in 72 patients with hematological neoplasm and meningeal infiltration detected either by CM or FC. We compared CSF cell count, total protein concentration, and lactate concentration according to the type of hematological neoplasm. We also compared these CSF findings according to the FC and CM results (FC + CM + , FC + CM-, and FC-CM +). The proportion of patients with positive FC was higher than with CM (FC - 91.7%; CM - 63.9%). Thirty-five (48.6%) patients with meningeal infiltration had normal CSF cell count, normal total protein concentration, and normal lactate concentration. The proportion of cases in which these CSF parameters were normal did not differ according to the type of hematological neoplasm. The positivity of CM was significantly higher in patients with > 3 cell/mm3 (P = 0.015) but the positivity of FC was not significantly different between patients with > 3 cell/mm3 or ≤ 3 cells/mm3. Patients with positive CM had more CSF cells (P = 0.0005) and higher lactate concentration (P = 0.0165) than patients with negative CM. The absence of CSF changes in cell count and total protein and lactate concentrations does not exclude the presence of meningeal infiltration. Although CM is considered the gold standard, the probability of positive CM is low in patients without CSF abnormalities in these parameters. Patients with hematological neoplasm with suspected meningeal infiltration should be investigated with both methods.
Collapse
|
6
|
Cordone I, Masi S, Giannarelli D, Pasquale A, Conti L, Telera S, Pace A, Papa E, Marino M, de Fabritiis P, Mengarelli A. Major Differences in Lymphocyte Subpopulations Between Cerebrospinal Fluid and Peripheral Blood in Non-Hodgkin Lymphoma Without Leptomeningeal Involvement: Flow Cytometry Evidence of a Cerebral Lymphatic System. Front Oncol 2021; 11:685786. [PMID: 34150651 PMCID: PMC8210665 DOI: 10.3389/fonc.2021.685786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/22/2021] [Indexed: 11/13/2022] Open
Abstract
Cerebrospinal fluid (CSF) flow cytometry has a crucial role in the diagnosis of leptomeningeal disease in onco-hematology. This report describes the flow cytometry characterization of 138 CSF samples from patients affected by non-Hodgkin lymphoma, negative for disease infiltration. The aim was to focus on the CSF non-neoplastic population, to compare the cellular composition of the CSF with paired peripheral blood samples and to document the feasibility of flow cytometry in hypocellular samples. Despite the extremely low cell count (1 cell/µl, range 1.0-35) the study was successfully conducted in 95% of the samples. T lymphocytes were the most abundant subset in CSF (77%; range 20-100%) with a predominance of CD4-positive over CD8-positive T cells (CD4/CD8 ratio = 2) together with a minority of monocytes (15%; range 0-70%). No B cells were identified in 90% of samples. Of relevance, a normal, non-clonal B-cell population was documented in 5/7 (71%) patients with primary central nervous system lymphoma at diagnosis (p<0.0001), suggesting a possible involvement of blood-brain barrier cell permeability in the pathogenesis of cerebral B-cell lymphomas. The highly significant differences between CSF and paired peripheral blood lymphoid phenotype (p<0.0001) confirms the existence of an active mechanism of lymphoid migration through the meninges.
Collapse
Affiliation(s)
- Iole Cordone
- Department of Research, Advanced Diagnostics and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Serena Masi
- Department of Research, Advanced Diagnostics and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Diana Giannarelli
- Department of Research, Advanced Diagnostics and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessia Pasquale
- Department of Research, Advanced Diagnostics and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Conti
- Department of Research, Advanced Diagnostics and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Stefano Telera
- Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Pace
- Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Elena Papa
- Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Mirella Marino
- Department of Research, Advanced Diagnostics and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo de Fabritiis
- Hematology, S Eugenio Hospital, ASL Roma2, Tor Vergata University, Rome, Italy
| | - Andrea Mengarelli
- Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| |
Collapse
|
7
|
Del Principe MI, Buzzatti E, Piciocchi A, Forghieri F, Bonifacio M, Lessi F, Imbergamo S, Orciuolo E, Rossi G, Fracchiolla N, Trappolini S, Neri B, Sarlo C, Zappasodi P, Dargenio M, Cefalo M, Irno-Consalvo MA, Conti C, Paterno G, De Angelis G, Sciumè M, Della Starza I, Venditti A, Foà R, Guarini AR. Clinical significance of occult central nervous system disease in adult acute lymphoblastic leukemia. A multicenter report from the Campus ALL Network. Haematologica 2021; 106:39-45. [PMID: 31879328 PMCID: PMC7776237 DOI: 10.3324/haematol.2019.231704] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/20/2019] [Indexed: 12/21/2022] Open
Abstract
In acute lymphoblastic leukemia (ALL), flow cytometry (FCM) detects leukemic cells in patients’ cerebrospinal fluid (CSF) more accurately than conventional cytology (CC). However, the clinical significance of FCM positivity with a negative cytology (i.e., occult central nervous system [CNS] disease) is not clear. In the framework of the national Campus ALL program, we retrospectively evaluated the incidence of occult CNS disease and its impact on outcome in 240 adult patients with newly diagnosed ALL. All CSF samples were investigated by CC and FCM. The presence of ≥10 phenotypically abnormal events, forming a cluster, was considered to be FCM positivity. No CNS involvement was documented in 179 patients, while 18 were positive by modified conventional morphology with CC and 43 were occult CNS disease positive. The relapse rate was significantly lower in CNS disease negative patients and the disease-free and overall survival (OS) were significantly longer in CNS disease negative patients than in those with manifest or occult CNS disease positivity. In multivariate analysis, the status of manifest and occult CNS disease positivity was independently associated with a worse OS. In conclusion, we demonstrate that in adult ALL patients at diagnosis FCM can detect occult CNS disease at high sensitivity and that the status of occult CNS disease positivity is associated with an adverse outcome. (Registered at clinicaltrials.gov identifier: NCT03803670).
Collapse
Affiliation(s)
| | - Elisa Buzzatti
- Hematology Unit, Department of Biomedicine and Prevention, University tor Vergata of Rome,Rome,Italy
| | | | - Fabio Forghieri
- University of Modena and Reggio Emilia, Azienda Ospedaliera di Modena, Modena, Italy
| | | | - Federica Lessi
- Ematologia ed Immunologia Clinica, Azienda Ospedaliera di Padova, Padova, Italy
| | - Silvia Imbergamo
- Ematologia ed Immunologia Clinica, Azienda Ospedaliera di Padova, Padova, Italy
| | - Enrico Orciuolo
- UO Ematologia Univ, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Nicola Fracchiolla
- UOC di Ematologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Silvia Trappolini
- Clinica di Ematologia, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Benedetta Neri
- Ematologia, Ospedale S. Eugenio, Dipartimento di Biomedicina e Prevenzione, Roma, Italy
| | - Chiara Sarlo
- Ematologia, Policlinico Universitario-Campus Biomedico, Roma, Italy
| | - Patrizia Zappasodi
- Divisione di Ematologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Michelina Dargenio
- Ematologia e Trapianto di Cellule Staminali, Ospedale Vito Fazzi, Lecce, Italy
| | - Mariagiovanna Cefalo
- Ematologia, Ospedale S. Eugenio, Dipartimento di Biomedicina e Prevenzione, Roma, Italy
| | | | - Consuelo Conti
- Ematologia, Dipartimento di Onco-Ematologia, Fondazione Policlinico Tor Vergata,Roma, Italy
| | - Giovangiacinto Paterno
- Hematology Unit, Department of Biomedicine and Prevention, University tor Vergata of Rome,Rome,Italy
| | - Gottardo De Angelis
- Hematology Unit, Department of Biomedicine and Prevention, University tor Vergata of Rome,Rome,Italy
| | - Mariarita Sciumè
- UOC di Ematologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Irene Della Starza
- Ematologia, Dipartimento di Medicina di Precisione e Traslazionale, Universita' Sapienza, Roma
| | - Adriano Venditti
- Hematology Unit, Department of Biomedicine and Prevention, University tor Vergata of Rome, Italy
| | - Robin Foà
- Ematologia, Dipartimento di Medicina di Precisione e Traslazionale, Universita' Sapienza, Roma
| | | |
Collapse
|
8
|
Del Principe MI, Gatti A, Johansson U, Buccisano F, Brando B. ESCCA
/
ISCCA
protocol for the analysis of cerebrospinal fluid by multiparametric flow‐cytometry in hematological malignancies. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 100:269-281. [DOI: 10.1002/cyto.b.21981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/14/2020] [Accepted: 11/27/2020] [Indexed: 02/06/2023]
Affiliation(s)
| | - Arianna Gatti
- Blood Transfusion Center Legnano General Hospital Legnano Italy
| | - Ulrika Johansson
- SI‐HMDS University Hospitals Bristol and Weston NHS Foundation Trust Bristol United Kingdom
| | - Francesco Buccisano
- Hematology, Department of BioMedicine and Prevention University of Rome “Tor Vergata” Rome Italy
| | - Bruno Brando
- Blood Transfusion Center Legnano General Hospital Legnano Italy
| |
Collapse
|
9
|
Nam AS, Giorgadze T, Tam W, Chadburn A. Assessment of the Utility of Cytology and Flow Cytometry of Cerebrospinal Fluid Samples in Clinical Practice. Acta Cytol 2018; 62:130-136. [PMID: 29510385 DOI: 10.1159/000487070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/19/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We sought to assess the utility and limitations of both flow cytometry (FC) and cytology for the analysis of cerebrospinal fluid (CSF) in a practical clinical setting. METHODS A total of 393 consecutive CSF samples from 171 patients submitted for both cytomorphologic and FC assessments were analyzed. RESULTS Both FC and cytology findings were negative for malignancy in 315/393 samples (80%), and either positive (POS) or suspicious/atypical (SUSP/AT) in 7% of samples. This resulted in high agreement between FC and cytology (87%). Minor discrepancies were present in 4% of the cases. In 28 samples, an abnormal population was detected by FC but not by cytology. CONCLUSIONS FC and cytology are important complementary methods for analyzing CSF samples. In cases where cytology is SUSP/AT and FC is inconclusive or negative, additional specimens should be submitted for immunostaining, cytogenetics, and/or molecular studies.
Collapse
Affiliation(s)
- Anna S Nam
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Tamara Giorgadze
- Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Wayne Tam
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
10
|
Del Principe MI, Buccisano F, Soddu S, Maurillo L, Cefalo M, Piciocchi A, Consalvo MI, Paterno G, Sarlo C, De Bellis E, Zizzari A, De Angelis G, Fraboni D, Divona M, Voso MT, Sconocchia G, Del Poeta G, Lo-Coco F, Arcese W, Amadori S, Venditti A. Involvement of central nervous system in adult patients with acute myeloid leukemia: Incidence and impact on outcome. Semin Hematol 2018; 55:209-214. [PMID: 30502849 DOI: 10.1053/j.seminhematol.2018.02.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/23/2017] [Accepted: 02/17/2018] [Indexed: 12/21/2022]
Abstract
Incidence and effect on outcome of central nervous system (CNS) involvement in adult patients with acute myeloid leukemia (AML) is not clearly defined. To address this issue, 103 consecutive adult patients with newly diagnosed AML, regardless of neurologic symptoms, were submitted to a routine explorative lumbar puncture. Cerebrospinal fluid (CSF) samples were collected from 65 males and 38 females. All 103 CSF samples were examined by conventional cytology (CC) whereas 95 (92%) also by flow cytometry (FCM). At diagnosis, 70 patients (68%) were CNS negative (CNS-), whereas 33 (32%) were CNS positive (CNS+). In 11 of 33 (33%), CNS infiltration was documented either by CC or FCM , in 21 (67%) only by FCM. CNS positivity was significantly associated with a M4-M5 phenotype of the underlying AML (P = .0003) and with high levels of lactate dehydrogenase (P = .006). Overall, 80 of 103 (78%) achieved complete remission with no significant differences between CNS+ and CNS- patients. Five-year disease-free survival and overall survival were found to be shorter in CNS+ patients than in those CNS- (18% vs 50%, P = .006 and 19% vs 46%, P = .02, respectively). In multivariate analysis, CNS status and age were found to affect independently overall survival. In conclusion, the incidence of CNS involvement in adult patients with newly diagnosed AML is higher than expected. Regardless of neurologic symptoms, it should always be searched at diagnosis; CSF samples should routinely be investigated by FCM since a certain proportion of CNS involvements might remain undetected if examination is exclusively CC based.
Collapse
Affiliation(s)
- Maria Ilaria Del Principe
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
| | - Francesco Buccisano
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | | | - Luca Maurillo
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Mariagiovanna Cefalo
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | | | - Maria Irno Consalvo
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Giovangiacinto Paterno
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Chiara Sarlo
- Hematology, University Campus Biomedico, Rome, Italy
| | - Eleonora De Bellis
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Annagiulia Zizzari
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Gottardo De Angelis
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Daniela Fraboni
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Mariadomenica Divona
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Maria Teresa Voso
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Giuseppe Sconocchia
- Laboratoy of Tumor Immunology and Immunotherapy, Institute of Translation Pharmacology, Department of Medicine, National Research Council of Italy (CNR), Rome, Italy
| | - Giovanni Del Poeta
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Francesco Lo-Coco
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy; Laboratory of Neuro-Oncohematology Unit, Santa Lucia Foundation, Rome, Italy
| | - William Arcese
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Sergio Amadori
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Adriano Venditti
- Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| |
Collapse
|
11
|
Verheul C, Kleijn A, Lamfers MLM. Cerebrospinal fluid biomarkers of malignancies located in the central nervous system. HANDBOOK OF CLINICAL NEUROLOGY 2018; 146:139-169. [PMID: 29110768 DOI: 10.1016/b978-0-12-804279-3.00010-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CNS malignancies include primary tumors that originate within the CNS as well as secondary tumors that develop as a result of metastatic cancer. The delicate nature of the nervous systems makes tumors located in the CNS notoriously difficult to reach, which poses several problems during diagnosis and treatment. CSF can be acquired relatively easy through lumbar puncture and offers an important compartment for analysis of cells and molecules that carry information about the malignant process. Such techniques have opened up a new field of research focused on the identification of specific biomarkers for several types of CNS malignancies, which may help in diagnosis and monitoring of tumor progression or treatment response. Biomarkers are sought in DNA, (micro)RNA, proteins, exosomes and circulating tumor cells in the CSF. Techniques are rapidly progressing to assess these markers with increasing sensitivity and specificity, and correlations with clinical parameters are being investigated. It is expected that these efforts will, in the near future, yield clinically relevant markers that aid in diagnosis, monitoring and (tailored) treatment of patients bearing CNS tumors. This chapter provides a summary of the current state of affairs of the field of biomarkers of different types of CNS tumors.
Collapse
Affiliation(s)
- Cassandra Verheul
- Department of Neurosurgery, Brain Tumor Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Anne Kleijn
- Department of Neurosurgery, Brain Tumor Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Martine L M Lamfers
- Department of Neurosurgery, Brain Tumor Center, Erasmus Medical Center, Rotterdam, the Netherlands.
| |
Collapse
|
12
|
Cancela CSP, Murao M, Assumpção JG, Souza MEDL, de Macedo AV, Viana MB, De Oliveira BM. Immunophenotyping of the cerebrospinal fluid as a prognostic factor at diagnosis of acute lymphoblastic leukemia in children and adolescents. Pediatr Hematol Oncol 2017; 34:53-65. [PMID: 28548878 DOI: 10.1080/08880018.2017.1313920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study aimed at evaluating the use of immunophenotyping (IMP) in the identification of blast cells in the cerebrospinal fluid (CSF) of children and adolescents with acute lymphoblastic leukemia (ALL). Sixty-seven patients aged 18 years or younger were included. Fifty-five CSF samples were analyzed at initial diagnosis and 17 at the time of relapse. A cytological analysis (CA) was performed in all 72 samples, while IMP was done in 63. Blasts were identified in only three samples by CA, whereas all three samples were found negative by IMP, one of which had no isolation of nucleated cells after centrifugation. Among the samples analyzed by IMP, 11 showed a positive blast count, two of which had been inconclusive using CA. No equivalence was found between CA and IMP results (p = 0.55). CSF IMP positivity was not associated with other risk factors for ALL relapse. Among the 55 patients included at the time of diagnosis of ALL, eight relapsed during follow-up. Considering the cases of central nervous system (CNS) relapse, one of the patients belonged to the CSF IMP-positive group (11%) at diagnosis, and the other two cases, to the IMP-negative (5%) group. Detection of CSF blast cells using IMP was associated with a worse overall (p < 0.0001) and event-free survival (p < 0.0001). These results show that CSF IMP may be a useful additional method to conventional CA in the diagnosis of CNS involvement in ALL, and for the identification of high-risk subgroups that would benefit from an intensified therapy.
Collapse
Affiliation(s)
- Camila Silva Peres Cancela
- a Faculdade de Medicina/Departamento de Pediatria, Bairro Santa Efigenia , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Mitiko Murao
- b Hospital das Clinicas da Universidade Federal de Minas Gerais , Serviço de Hematologia , Belo Horizonte , Brazil
| | | | | | - Antonio Vaz de Macedo
- d Hospital das Clinicas da Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | | | | |
Collapse
|
13
|
Shin SY, Lee ST, Kim HJ, Oh YL, Kim SJ, Kim WS, Kim SH. Usefulness of Flow Cytometric Analysis for Detecting Leptomeningeal Diseases in Non-Hodgkin Lymphoma. Ann Lab Med 2017; 36:209-14. [PMID: 26915608 PMCID: PMC4773260 DOI: 10.3343/alm.2016.36.3.209] [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: 08/01/2015] [Revised: 10/06/2015] [Accepted: 12/23/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The clinical usefulness of flow cytometry (FCM) for the diagnosis of leptomeningeal diseases (LMD) in non-Hodgkin lymphomas has been suggested in previous studies but needs to be further validated. With this regards, we evaluated the use of FCM for LMD in a series of Korean patients with non-Hodgkin lymphoma. METHODS FCM and cytomorphology were conducted using samples obtained from clinically suspected LMD patients, follow-up LMD patients, and those with high risk of developing tumorigenic diseases. We then compared results of FCM and cytomorphology. In total, 55 and 47 CSF samples were analyzed by FCM and cytomorphology, respectively. RESULTS Of the samples analyzed, 25.5% (14/55) and 12.8% (6/47) were positive by FCM and cytomorphology, respectively. No samples were determined as negative by FCM but positive by cytomorphology. Seven patients were positive only by FCM and negative by cytomorphology, and six among them were clinically confirmed to have LMD either by follow-up cytomorphology or imaging study. CONCLUSIONS We observed a high detection rate of tumor cells by FCM compared with cytomorphology. FCM study can be useful in early sensitive detection of LMD.
Collapse
Affiliation(s)
- Sang Yong Shin
- Department of Laboratory Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.,Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Tae Lee
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.
| | - Hee Jin Kim
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Patholgy, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Hee Kim
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
14
|
Korfel A, Nowosielski M, Pardo-Moreno J, Penalver FJ, Buda G, Bennani H, Costopoulos M, Le Garff-Tavernier M, Soussain C, Schmid M, Orfao JA, Glantz M. How to facilitate early diagnosis of CNS involvement in malignant lymphoma. Expert Rev Hematol 2016; 9:1081-1091. [PMID: 27677656 DOI: 10.1080/17474086.2016.1242405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Making the diagnosis of secondary CNS involvement in lymphoma can be difficult due to unspecific signs and symptoms, limited accessibility of brain/myelon parenchyma and low sensitivity and/or specifity of imaging and cerebrospinal fluid (CSF) examination currently available. Areas covered: MRI of the total neuroaxis followed by CSF cytomorphology and flow cytometry are methods of choice when CNS lymphoma (CNSL) is suspected. To reduce the numerous pitfalls of these examinations several aspects should be considered. New CSF biomarkers might be of potential diagnostic value. Attempts to standardize response criteria are presented. Expert commentary: Diagnosing CNSL remains challenging. Until diagnostic methods combining high sensitivity with high specifity are routinely introduced, high level of awareness and optimal utilization of examinations currently available are needed to early diagnose this potentially devastating disease.
Collapse
Affiliation(s)
- Agnieszka Korfel
- a Department of Hematology, Oncology and Tumor Immunology , Charite University Medicine Berlin , Berlin , Germany
| | - Martha Nowosielski
- b Department of Neurology , Medical University Innsbruck , Innsbruck , Austria
| | - Javier Pardo-Moreno
- c Department of Neurology , University Hospital King Juan Carlos , Madrid , Spain
| | | | - Gabriele Buda
- e Department of Hematology and Oncology , University of Pisa , Pisa , Italy
| | - Hind Bennani
- f Department of Biology , Hôpital Foch , Suresnes , France
| | - Myrto Costopoulos
- g Department of Biological Hematology , Pitie Salpetriere Hospital , Paris , France
| | | | - Carole Soussain
- h Department of Hematology , Institut Curie - Hôpital René Huguenin , Paris , France
| | - Mathias Schmid
- i Department of Hematology and Oncology , Stadtspital Triemli Zürich , Zürich , Switzerland
| | - Jose Alberto Orfao
- j Department of Medicine and Cytometry Service , University of Salamanca , Salamanca , Spain
| | | |
Collapse
|
15
|
Canovi S, Campioli D. Accuracy of flow cytometry and cytomorphology for the diagnosis of meningeal involvement in lymphoid neoplasms: A systematic review. Diagn Cytopathol 2016; 44:841-56. [PMID: 27458077 DOI: 10.1002/dc.23539] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/21/2016] [Accepted: 07/06/2016] [Indexed: 11/07/2022]
Abstract
Central nervous system (CNS) involvement by lymphoid neoplasms is a relatively infrequent event that demands accurate identification. The purpose of this article is to review studies comparing diagnostic accuracy of flow cytometry (FCM) and cytomorphology (CM) for meningeal involvement from lymphoid neoplasms. Primary publications from the last 26 years were identified searching MedLine, Scopus, and Web of Science and systematically scanning bibliographies of identified articles. Only studies reporting complete results were included. We assessed study quality using the QUADAS-2 tool. For each study, we extracted informations regarding study population, technical details about sample preparation, data analysis, and results. Twenty-seven studies were included. A great heterogeneity regarding study populations and analytical procedures was observed among studies. Percentages of samples giving a positive result with both FCM and CM range from 0.3% to 42.9% among studies, whereas double negative samples go from 0% to 96.3%. Samples with positive FCM but negative CM are reported by 89% (24/27) of the studies with rates ranging from 3.5% to 61.5% of total specimens. On the contrary, samples with positive CM and negative FCM are found in 48% (13/27) of the studies with percentages ranging from 0.5% to 10%. Despite all the differences observed among studies, almost all of them state that employing flow cytometry along with conventional cytology increases the number of positive CSF samples for lymphoma involvement, although a few cases remain in whom only morphology can correctly identify malignant cells. Diagn. Cytopathol. 2016;44:841-856. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Simone Canovi
- Department of Laboratory Medicine, University Hospital Policlinico Di Modena, Modena, Italy.
| | - Daniele Campioli
- Department of Laboratory Medicine, University Hospital Policlinico Di Modena, Modena, Italy
| |
Collapse
|
16
|
Roriz M, Lopes A, Jarrin I, Lechtman S, Polivka M, Bergmann JF, Sène D, Mouly S. [Central nervous system lymphoma revealed by lymphocytic meningitis in a patient with systemic lupus erythematosus: An unusual association]. Rev Med Interne 2016; 38:269-273. [PMID: 27363932 DOI: 10.1016/j.revmed.2016.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/16/2016] [Accepted: 05/28/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We report an unusual observation of central nervous system (CNS) lymphoma in a 60-year-old woman with systemic lupus erythematosus and fatal outcome. OBSERVATION The patient had systemic erythematosus lupus for 7 years, treated with mycophenolate mofetil and developed lymphocytic meningitis in 2015 associated to the presence of EBV in the cerebrospinal fluid and a necrotic vermis' lesion. Diagnosis of large B-cell lymphoma was histologically confirmed from stereotaxic biopsy, shortly before she died from neurological complications. CONCLUSION Even though the current association is unusual, lymphocytic meningitis with hypoglycorrachia in patients with systemic lupus erythematosus may reveal CNS lymphoma and diagnosis confirmation requires stereotaxic biopsy in order not to delay specific therapeutic management.
Collapse
Affiliation(s)
- M Roriz
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; UMR-S1144, UFR de médecine Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France.
| | - A Lopes
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - I Jarrin
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - S Lechtman
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; UMR-S1144, UFR de médecine Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
| | - M Polivka
- Service d'anatomopathologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - J-F Bergmann
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; UMR-S1144, UFR de médecine Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
| | - D Sène
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; UMR-S1144, UFR de médecine Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
| | - S Mouly
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; UMR-S1144, UFR de médecine Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
| |
Collapse
|
17
|
Ranta S, Nilsson F, Harila-Saari A, Saft L, Tani E, Söderhäll S, Porwit A, Hultdin M, Noren-Nyström U, Heyman M. Detection of central nervous system involvement in childhood acute lymphoblastic leukemia by cytomorphology and flow cytometry of the cerebrospinal fluid. Pediatr Blood Cancer 2015; 62:951-6. [PMID: 25545289 DOI: 10.1002/pbc.25363] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 10/27/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Therapy directed at the central nervous system (CNS) is an essential part of the treatment for childhood acute lymphoblastic leukemia (ALL). The current evaluation of CNS involvement based on cytomorphological examination of the cerebrospinal fluid (CSF) alone is not as sensitive with low cell counts as flow cytometric immunophenotyping (FCI) of the CSF. However, the importance of low CSF blasts counts at diagnosis is uncertain. We sought to determine the significance of FCI in relation to conventional morphological examination. PROCEDURE We retrospectively compared FCI of the CSF with cytomorphology at diagnosis or relapse of childhood ALL. All patients were diagnosed 2000-2012 in Stockholm or Umeå, Sweden. Clinical data were collected from medical records and the Nordic leukemia registry. Treatment assignment was based on morphological examination only. RESULTS The cohort was comprised of 214 patients with ALL. CSF involvement was detected by both methods in 20 patients, in 17 by FCI alone, and in one patient by cytomorphology alone. The relapse rate was higher for patients with negative cytology but positive FCI compared to those without CNS involvement using both methods. The difference was especially marked in the current protocol. However, none of the patients with negative CSF cytology but positive FCI had a CNS relapse. CONCLUSIONS FCI of the CSF increased the detection rate of CNS involvement of ALL approximately two times compared to cytomorphology. Patients with low-level CNS involvement may benefit from additional intensified systemic or CNS-directed therapy, but larger studies are needed.
Collapse
Affiliation(s)
- Susanna Ranta
- Childhood Cancer Research Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Inmunofenotipo en el líquido cefalorraquídeo de niños con leucemia linfoblástica aguda. GACETA MEXICANA DE ONCOLOGÍA 2015. [DOI: 10.1016/j.gamo.2015.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
19
|
Central nervous system involvement in adult acute lymphoblastic leukemia: diagnostic tools, prophylaxis, and therapy. Mediterr J Hematol Infect Dis 2014; 6:e2014075. [PMID: 25408861 PMCID: PMC4235468 DOI: 10.4084/mjhid.2014.075] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 10/23/2014] [Indexed: 12/25/2022] Open
Abstract
In adult patients with acute lymphoblastic leukemia (ALL), Central Nervous System (CNS) involvement is associated with a very poor prognosis. The diagnostic assessment of this condition relies on the use of neuroradiology, conventional cytology (CC) and flow cytometry (FCM). Among these approaches, which is the gold standard it is still a matter of debate. Neuroradiology and CC have a limited sensitivity with a higher rate of false negative results. FCM demonstrated a superior sensitivity over CC, particularly when low levels of CNS infiltrating cells are present. Although prospective studies of a large series of patients are still awaited, a positive finding by FCM appears to anticipate an adverse outcome even if CC shows no infiltration. Current strategies for adult ALL CNS-directed prophylaxis or therapy involve systemic and intrathecal chemotherapy and radiation therapy. An early and frequent intrathecal injection of cytostatic combined with systemic chemotherapy is the most effective strategy to reduce the frequency of CNS involvement. In patients with CNS overt ALL, at diagnosis or upon relapse, allogeneic hematopoietic stem cell transplantation might be considered. This review discusses risk factors, diagnostic techniques for identification of CNS infiltration and modalities of prophylaxis and therapy to manage it.
Collapse
|
20
|
Kovach AE, DeLelys ME, Kelliher AS, Dillon LJ, Hasserjian RP, Ferry JA, Preffer FI, Sohani AR. Diagnostic utility of cerebrospinal fluid flow cytometry in patients with and without prior hematologic malignancy. Am J Hematol 2014; 89:978-84. [PMID: 25042070 DOI: 10.1002/ajh.23806] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/06/2014] [Accepted: 07/11/2014] [Indexed: 02/06/2023]
Abstract
Flow cytometry (FCM) is an adjunct study to routine analysis of cerebrospinal fluid (CSF) to investigate for involvement by a hematologic malignancy. However, in our experience, FCM only infrequently detects abnormalities in CSF. To help optimize resources without forfeiting clinically important data, we sought to determine evidence-based indications and criteria for performing FCM on CSF. FCM results of 316 consecutive CSF specimens were retrospectively reviewed and correlated with clinical history, total nucleated cell (TNC) counts, and results of concurrent cytologic review. Of 255 samples adequate for analysis, 54% were from patients with a prior history of hematologic malignancy, of which 12% (17 cases) were abnormal by FCM. Corresponding TNC counts among samples with abnormal FCM ranged from 0-1050 cells/µL, and only 44% showed abnormal morphology on concurrent cytology. Of the remaining 46% of samples from patients with no known history of hematologic malignancy who had CSF sampling for neurological indications, only one (1%) was abnormal by FCM. This specimen had an elevated TNC count (39 cells/µL) but lacked clearly abnormal findings on concurrent cytology. These results support the use of CSF FCM only in patients with a history of hematologic malignancy or, in the absence of such a history, in samples showing pleocytosis. If these criteria were applied to the current cohort using a TNC count cut-off of >5 cells/µL, 23% of samples would have been deferred from testing, resulting in decreased cost, improved efficiency, and reduction in the need for unnecessary testing without a negative impact on clinical care.
Collapse
Affiliation(s)
- Alexandra E. Kovach
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital and Department of Pathology; Harvard Medical School; Boston Massachusetts
| | - Michelle E. DeLelys
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital and Department of Pathology; Harvard Medical School; Boston Massachusetts
| | - Abigail S. Kelliher
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital and Department of Pathology; Harvard Medical School; Boston Massachusetts
| | - Laura J. Dillon
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital and Department of Pathology; Harvard Medical School; Boston Massachusetts
| | - Robert P. Hasserjian
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital and Department of Pathology; Harvard Medical School; Boston Massachusetts
| | - Judith A. Ferry
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital and Department of Pathology; Harvard Medical School; Boston Massachusetts
| | - Frederic I. Preffer
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital and Department of Pathology; Harvard Medical School; Boston Massachusetts
| | - Aliyah R. Sohani
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital and Department of Pathology; Harvard Medical School; Boston Massachusetts
| |
Collapse
|
21
|
High sensitivity of flow cytometry improves detection of occult leptomeningeal disease in acute lymphoblastic leukemia and lymphoblastic lymphoma. Ann Hematol 2014; 93:1509-13. [DOI: 10.1007/s00277-014-2080-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 04/08/2014] [Indexed: 11/27/2022]
|
22
|
Collie AMB, Hill BT, Stevens GHJ, Fenner K, Gazdick E, Hsi ED. Flow cytometric analysis of cerebrospinal fluid has low diagnostic yield in samples without atypical morphology or prior history of hematologic malignancy. Am J Clin Pathol 2014; 141:515-21. [PMID: 24619752 DOI: 10.1309/ajcp8ib8frqdvpxl] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To identify pretest characteristics of cerebrospinal fluid (CSF) specimens that will allow the rational use of flow cytometric analysis (FCA) in the diagnosis of hematologic malignancy. METHODS Retrospective data were collected on 501 consecutive CSF samples submitted for FCA. RESULTS A positive diagnosis of hematologic malignancy was made in 41 specimens (8.2%). Blasts or atypical lymphocytes were noted on Wright-stained slides in 98% of FCA-positive specimens (40/41), and a history of a hematologic malignancy was present in 89% of specimens (34/38). All FCA-positive specimens had atypical morphology or history of hematologic malignancy. Four hundred six specimens (81%) were FCA negative. Of FCA-negative specimens, 7% (30/406) had atypical morphology, and 3% (12/404) had future central nervous system involvement seen within 30 days. CONCLUSIONS These data support a policy in which FCA of CSF is actively discouraged unless atypical lymphocytes or blasts are seen or a history of hematologic malignancy is present.
Collapse
Affiliation(s)
- Angela M. B. Collie
- Pathology and Laboratory Medicine Institute, Department of Clinical Pathology, The Cleveland Clinic, Cleveland, OH
| | - Brian T. Hill
- Taussig Cancer Institute, Department of Hematologic Oncology and Blood Disorders, The Cleveland Clinic, Cleveland, OH
| | - Glen H. J. Stevens
- Brain Tumor and Neuro-Oncology Center, The Cleveland Clinic, Cleveland, OH
| | - Kathleen Fenner
- Taussig Cancer Institute, Department of Hematologic Oncology and Blood Disorders, The Cleveland Clinic, Cleveland, OH
| | - Elizabeth Gazdick
- Taussig Cancer Institute, Department of Hematologic Oncology and Blood Disorders, The Cleveland Clinic, Cleveland, OH
| | - Eric D. Hsi
- Pathology and Laboratory Medicine Institute, Department of Clinical Pathology, The Cleveland Clinic, Cleveland, OH
| |
Collapse
|
23
|
Fletcher CD, Kahl BS. Central nervous system involvement in diffuse large B-cell lymphoma: an analysis of risks and prevention strategies in the post-rituximab era. Leuk Lymphoma 2014; 55:2228-40. [DOI: 10.3109/10428194.2013.869326] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
24
|
Davis IR, Westerman DA. Cerebrospinal fluid analysis by flow cytometry in acute lymphoblastic leukemia: is it all that it is cracked up to be? Leuk Lymphoma 2013; 55:1441-3. [PMID: 24354685 DOI: 10.3109/10428194.2013.876499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ian R Davis
- Department of Pathology, Peter MacCallum Cancer Centre , East Melbourne, Victoria , Australia
| | | |
Collapse
|
25
|
Scott BJ, Douglas VC, Tihan T, Rubenstein JL, Josephson SA. A systematic approach to the diagnosis of suspected central nervous system lymphoma. JAMA Neurol 2013; 70:311-9. [PMID: 23319132 DOI: 10.1001/jamaneurol.2013.606] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Central nervous system (CNS) lymphoma can present a diagnostic challenge. Currently, there is no consensus regarding what presurgical evaluation is warranted or how to proceed when lesions are not surgically accessible. We conducted a review of the literature on CNS lymphoma diagnosis (1966 to October 2011) to determine whether a common diagnostic algorithm can be generated. We extracted data regarding the usefulness of brain and body imaging, serum and cerebrospinal fluid (CSF) studies, ophthalmologic examination, and tissue biopsy in the diagnosis of CNS lymphoma. Contrast enhancement on imaging is highly sensitive at the time of diagnosis: 98.9% in immunocompetent lymphoma and 96.1% in human immunodeficiency virus-related CNS lymphoma. The sensitivity of CSF cytology is low (2%-32%) but increases when combined with flow cytometry. Cerebrospinal fluid lactate dehydrogenase isozyme 5, β2-microglobulin, and immunoglobulin heavy chain rearrangement studies have improved sensitivity over CSF cytology (58%-85%) but have only moderate specificity (85%). New techniques of proteomics and microRNA analysis have more than 95% specificity in the diagnosis of CNS lymphoma. Positive CSF cytology, vitreous biopsy, or brain/leptomeningeal biopsy remain the current standard for diagnosis. A combined stepwise systematic approach outlined here may facilitate an expeditious, comprehensive presurgical evaluation for cases of suspected CNS lymphoma.
Collapse
Affiliation(s)
- Brian J Scott
- Department of Neurology, University of California-San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA.
| | | | | | | | | |
Collapse
|
26
|
Galati D, Di Noto R, Del Vecchio L. Diagnostic strategies to investigate cerebrospinal fluid involvement in haematological malignancies. Leuk Res 2013; 37:231-7. [PMID: 23287431 DOI: 10.1016/j.leukres.2012.11.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 11/15/2012] [Accepted: 11/26/2012] [Indexed: 12/01/2022]
Abstract
Central nervous system (CNS) involvement is a fatal complication of certain haematological malignancies with an incidence as high as 25% in specific leukaemia/lymphoma subtypes. It is often accompanied by 'occult' cerebrospinal fluid (CSF) involvement at diagnosis, which is frequently missed by conventional cytology examination. Unfortunately, a diagnostic gold standard is yet unavailable since CSF morphology may be negative for malignant cells in up to 45% of patients with suspected meningeal involvement. New technologies such as flow cytometry, molecular genetics and newer biomarkers may improve sensitivity and specificity facilitating the diagnosis of CNS involvement as well as effective prophylaxis and successful treatment.
Collapse
Affiliation(s)
- Domenico Galati
- Dipartimento Ematologico, Istituto Nazionale Tumori, IRCCS "Fondazione Pascale", Naples, Italy
| | | | | |
Collapse
|
27
|
Alvarez R, Dupuis J, Plonquet A, Christov C, Copie-Bergman C, Hemery F, Gaillard I, El Gnaoui T, Kuhnowski F, Bedoui M, Belhadj K, Brugières P, Haioun C. Clinical relevance of flow cytometric immunophenotyping of the cerebrospinal fluid in patients with diffuse large B-cell lymphoma. Ann Oncol 2012; 23:1274-1279. [PMID: 21965472 DOI: 10.1093/annonc/mdr436] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Central nervous system (CNS) relapse is an uncommon but dramatic complication of diffuse large B-cell lymphoma (DLBCL). Several studies have demonstrated the superiority of cerebrospinal fluid (CSF) flow cytometry (FCM), as compared with conventional cytology (CC), in detecting occult leptomeningeal disease. The clinical relevance of a positive FCM still has to be clarified. PATIENTS AND METHODS We analyzed CSF from 114 DLBCL patients at diagnosis (n = 95) or at relapse (n = 19) by FCM and CC. Most patients received meningeal prophylaxis. FCM results did not influence treatment strategies. RESULTS Fourteen samples were FCM+, versus one CC+ (also FCM+). Within all patients without neurological symptoms (n = 101), four (4%) relapsed in the CNS, with a median time to relapse of 5.2 months. Only one-fourth (25%) was FCM+ before relapse. More than one extranodal disease site and elevated lactate dehydrogenase levels were associated with an increased risk of CNS relapse. CONCLUSIONS FCM gives far more positive results than CC. However, a positive FCM result did not translate into a significant increase in CNS relapse rate in this histologically uniform population receiving CNS prophylaxis.
Collapse
Affiliation(s)
| | | | - A Plonquet
- Immunology Laboratory, Centre Hospitalo-Universitaire Henri Mondor, Assistance Publique - Hôpitaux de Paris, Paris; Université Paris-Est Créteil, Créteil
| | | | - C Copie-Bergman
- Université Paris-Est Créteil, Créteil; Department of Pathology
| | | | | | | | | | | | | | - P Brugières
- Department of Neuroradiology, Centre Hospitalo-Universitaire Henri Mondor, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - C Haioun
- Lymphoid Malignancies Unit; Université Paris-Est Créteil, Créteil
| |
Collapse
|
28
|
Stacchini A, Aliberti S, Demurtas A, Benevolo G, Godio L. Ten antibodies, six colors, twelve parameters: A multiparameter flow cytometric approach to evaluate leptomeningeal disease in B-cell non-Hodgkin's lymphomas. CYTOMETRY PART B-CLINICAL CYTOMETRY 2012; 82:139-44. [DOI: 10.1002/cyto.b.21001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 11/03/2011] [Accepted: 11/10/2011] [Indexed: 01/08/2023]
|
29
|
|
30
|
Ahluwalia MS, Wallace PK, Peereboom DM. Flow cytometry as a diagnostic tool in lymphomatous or leukemic meningitis. Cancer 2011; 118:1747-53. [DOI: 10.1002/cncr.26335] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 05/19/2011] [Accepted: 05/19/2011] [Indexed: 11/08/2022]
|
31
|
Miniaturized flow cytometry-based BCR-ABL immunoassay in detecting leptomeningeal disease. Leuk Res 2011; 35:1290-3. [DOI: 10.1016/j.leukres.2011.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/05/2011] [Accepted: 05/12/2011] [Indexed: 11/21/2022]
|
32
|
Flow cytometric detection of BCR-ABL in cerebrospinal fluid. Leuk Res 2011; 35:1286-7. [DOI: 10.1016/j.leukres.2011.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 06/04/2011] [Accepted: 06/04/2011] [Indexed: 11/22/2022]
|
33
|
Abstract
PURPOSE OF REVIEW This review will summarize recent advances in the understanding and treatment of primary central nervous system lymphoma (PCNSL). RECENT FINDINGS The molecular and genetic characteristics that distinguish PCNSL are beginning to be elucidated. New tools such as flow cytometry and PET are improving the diagnosis and management of PCNSL. Although the current standard of care is high-dose methotrexate-based chemotherapy alone or in combination with whole brain radiotherapy, multiple questions remain regarding the optimal treatment of PCNSL, in general, and unusual variants of PCNSL. SUMMARY Although recent advances have improved our understanding of PCNSL, the need for additional collaborative research is critical.
Collapse
|
34
|
Cesana C, Klersy C, Scarpati B, Brando B, Faleri M, Bertani G, Gatti A, Volpato E, Barba C, Ferri U, Scampini L, Grillo G, Lando G, Nosari A, Morra E, Cairoli R. Flow cytometry and cytomorphology evaluation of hematologic malignancy in cerebrospinal fluids: comparison with retrospective clinical outcome. Ann Hematol 2011; 90:827-35. [PMID: 21212952 DOI: 10.1007/s00277-010-1145-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 12/17/2010] [Indexed: 11/24/2022]
Abstract
An independent clinical assessment was compared with flow cytometry (FCM) and cytomorphology results obtained on 227 cerebrospinal fluids investigated for hematologic malignancy, in a retrospective longitudinal study with a median observation time of 11 months. A combined method assessment (CMA), defining "positive" a sample if at least one method gave "positive" results, was also tested. Eleven out of 55 screening samples and 53 out of 166 follow-up samples resulted positive at clinical evaluation. FCM and CM were concordant with positive clinical assessment in 68.5% and 51.5% of cases, respectively. According to CMA, 10.5% of samples (resulting false negative by either FCM or cytomorphology) were rescued as true positive. FCM retained significantly higher accuracy than cytomorphology (p=0.0065) and 100% sensitivity when at least 220 leukocytes were acquired. CMA accuracy was higher than FCM accuracy and significantly higher than cytomorphology accuracy in the analysis of all samples (p<0.0001), samples from mature B/T cell neoplasms (p=0.0021), and samples drawn after intrathecal treatment (p=0.0001). When acquiring ≤220 leukocytes, FCM accuracy was poor, and combining cytomorphology added statistically significant diagnostic advantage (p=0.0043). Although FCM is the best diagnostic tool for evaluating CSF, morphology seems helpful especially when clinically positive follow-up samples are nearly acellular.
Collapse
Affiliation(s)
- Clara Cesana
- Department of Transfusion Medicine and Division of Hematology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Flow cytometry vs cytomorphology for the detection of hematologic malignancy in body cavity fluids. Leuk Res 2010; 34:1027-34. [DOI: 10.1016/j.leukres.2010.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 02/08/2010] [Accepted: 02/09/2010] [Indexed: 11/22/2022]
|
36
|
Sayed D, Badrawy H, Ali AM, Shaker S. Immunophenotyping and immunoglobulin heavy chain gene rearrangement analysis in cerebrospinal fluid of pediatric patients with acute lymphoblastic leukemia. Leuk Res 2008; 33:655-61. [PMID: 18996593 DOI: 10.1016/j.leukres.2008.09.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 09/29/2008] [Accepted: 09/30/2008] [Indexed: 10/21/2022]
Abstract
The study aimed to assess the diagnostic accuracy of Flow cytometry (FCM) immunophenotyping and IgH gene rearrangements (IGHRs) by real-time PCR in comparison with classic cytology for diagnosing CNS infiltration in pediatric ALL. We concluded that the diagnostic value of FCM and IGHR are two to three times more than that of cytology. Therefore, immunophenotyping by FCM is recommended for routine diagnosis of CSF infiltration. Furthermore, IGHR analysis by real-time PCR appears to be a useful addition in evaluation of CNS infiltration.
Collapse
Affiliation(s)
- Douaa Sayed
- Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
| | | | | | | |
Collapse
|