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Ma L, Xu LP, Wang Y, Zhang XH, Chen H, Chen YH, Wang FR, Han W, Sun YQ, Yan CH, Lv M, Tang FF, Mo XD, Wang ZD, Jiang Q, Lu J, Jiang H, Liu YR, Liu KY, Chang YJ, Huang XJ. Effects of isolated central nervous system involvement evaluated by multiparameter flow cytometry prior to allografting on outcomes of patients with acute lymphoblastic leukemia. Front Oncol 2023; 13:1166990. [PMID: 37251948 PMCID: PMC10209422 DOI: 10.3389/fonc.2023.1166990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a major strategy to cure patients with acute lymphoblastic leukemia (ALL). The aim of this study was to evaluate whether isolated flow cytometry (FCM)-positive central nervous system (CNS) involvement before allo-HSCT is clinically significant. Methods The effects of isolated FCM-positive CNS involvement prior to transplantation on the outcomes of 1406 ALL patients with complete remission (CR) were retrospectively investigated. Results Patients were classified into isolated FCM-positive CNS involvement (n=31), cytology-positive CNS involvement (n = 43), and negative CNS involvement (n = 1332) groups. Among the three groups, the 5-year cumulative incidence of relapse (CIR) values were 42.3%, 48.8%, and 23.4%, respectively (P<0.001). The 5-year leukemia-free survival (LFS) values were 44.7%, 34.9%, and 60.8%, respectively (P<0.001). Compared with the negative CNS group (n=1332), the 5-year CIR of the pre-HSCT CNS involvement group (n=74) was higher (46.3% vs. 23.4%, P<0.001], and the 5-year LFS was inferior (39.1% vs. 60.8%, P<0.001). Multivariate analysis indicated that four variables, T-cell ALL, in second complete remission or beyond (CR2+) at HSCT, pre-HSCT measurable residual disease positivity, and pre-HSCT CNS involvement, were independently associated with a higher CIR and inferior LFS. A new scoring system was developed using the following four variables: low-risk, intermediate-risk, high-risk, and extremely high-risk groups. The 5-year CIR values were 16.9%, 27.8%, 50.9%, and 66.7%, respectively (P<0.001), while the 5-year LFS values were 67.6%, 56.9%, 31.0%, and 13.3%, respectively (P<0.001). Conclusion Our results suggest that ALL patients with isolated FCM-positive CNS involvement are at a higher risk of recurrence after transplantation. Patients with pre-HSCT CNS involvement had higher CIR and inferior survival outcomes.
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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
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Thastrup M, Marquart HV, Schmiegelow K. Flow Cytometric Detection of Malignant Blasts in Cerebrospinal Fluid: A Biomarker of Central Nervous System Involvement in Childhood Acute Lymphoblastic Leukemia. Biomolecules 2022; 12:biom12060813. [PMID: 35740938 PMCID: PMC9221543 DOI: 10.3390/biom12060813] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 02/06/2023] Open
Abstract
Despite the excellent prognosis for children and adolescents with acute lymphoblastic lymphoma (ALL), the involvement of the central nervous system (CNS) represents a major therapeutic challenge. Patients who develop CNS relapse have a very poor prognosis, and since current methods cannot reliably identify patients with CNS involvement or patients at high risk of CNS relapse, all children with ALL receive CNS-directed treatment. The current golden standard for detecting CNS involvement is the assessment of cytomorphology on cytospin slides of cerebrospinal fluid (CSF). This technique is inadequate due to low sensitivity and reproducibility. Flow cytometric analysis of CSF represent a novel, highly specific and sensitive technique for the detection of leukemic cells in the CNS. In prospective studies, CSF flow cytometry demonstrated two to three times higher rates of CNS involvement at diagnosis of childhood ALL than conventional cytospin, and especially demonstrated superior sensitivity in detecting low-level CNS disease. CNS involvement determined via flow cytometry has been linked to a higher risk of CNS relapse and poor outcomes in several studies. In this review, we discuss the central analytical concepts of CSF flow cytometry and summarize the current evidence supporting the use of flow cytometric detection of malignant blasts as a biomarker of CNS involvement in childhood ALL.
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Affiliation(s)
- Maria Thastrup
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark;
| | - Hanne Vibeke Marquart
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark;
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark;
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
- Correspondence:
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The influence of fixation of biological samples on cell count and marker expression stability in flow cytometric analyses. Cent Eur J Immunol 2021; 45:206-213. [PMID: 33456333 PMCID: PMC7792444 DOI: 10.5114/ceji.2020.95858] [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: 06/26/2019] [Accepted: 10/11/2019] [Indexed: 11/24/2022] Open
Abstract
The most common applications of flow cytometry (FC) include diagnostics of haemato-oncological disorders, based on analysis of bone marrow, peripheral blood (PB), or cerebrospinal fluid (CSF) samples. A proper diagnostic process requires standardisation in setting the optimal time frame between material collection and the assay. Unfortunately, this might be difficult to achieve in daily practice due to unintended shipment delays, which might compromise large-scale multicentre studies. Thus, material fixation should be considered as a solution. The most widely used fixative agents are: paraformaldehyde, TransFix®, Cyto-Chex®, and serum-containing media. In this review, we attempted to summarise the literature data on the influence of sample storage under different temperatures and times combined with different fixation conditions on the cell count and marker expression levels. Based on the findings of several extensive studies employing fixed PB samples, it can be concluded that the performance of particular fixative greatly depends on the analysed marker and specific PB cell population expressing a given antigen. Preservation of absolute cell count was usually better in Cyto-Chex®-fixed PB samples, whereas TransFix® tended to better stabilise marker expression levels. CSF-based studies reveal that both serum-containing media and TransFix® can prevent cellular loss and enhance FC-based detection of leptomeningeal localisations of haematological malignancies, the latter being more available and having longer shelf-life. As both cell count and marker expression level are the main determinants of quality of biological samples dedicated to FC analyses, it remains to be addressed by the investigators which is the fixative of choice for their specific research aims.
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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).
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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
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Nachmias B, Sandler V, Slyusarevsky E, Pogrebijski G, Kritchevsky S, Ben-Yehuda D, Goldschmidt N, Gatt ME. Evaluation of cerebrospinal clonal gene rearrangement in newly diagnosed non-Hodgkin's lymphoma patients. Ann Hematol 2019; 98:2561-2567. [PMID: 31515574 DOI: 10.1007/s00277-019-03798-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/08/2019] [Indexed: 11/24/2022]
Abstract
Overt central nervous system (CNS) involvement in aggressive non-Hodgkin's lymphoma (NHL) is rare at diagnosis. Much effort is put to identify risk factors for occult CNS involvement, and the risk assessment of CNS relapse. Prophylactic treatment carries risk of adverse events and its efficacy is not clear. Detection of cerebrospinal fluid molecular gene rearrangement (GRR) as a method to detect occult disease has been studied in acute leukemia and primary CNS lymphoma. To date, the capacity of a positive GRR in newly diagnosed NHL patients to predict CNS relapse has not been addressed. We retrospectively studied the prognostic value of GRR in cerebrospinal fluid samples of 148 newly diagnosed patients with high grade NHL. We demonstrate that positive GRR at diagnosis does not affect PFS or OS and did not predict CNS relapse. However, although numbers were small, repeated positive samples (≥ 2) correlated with a higher risk for CNS relapse (p = 0.048), possibly stressing the need for an aggressive preventive approach.
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Affiliation(s)
- Boaz Nachmias
- Hematology Department, Hadassah Hebrew University Medical Center, POB 12000, Jerusalem, Israel.
| | - Veronica Sandler
- Hematology Department, Hadassah Hebrew University Medical Center, POB 12000, Jerusalem, Israel
| | - Elena Slyusarevsky
- Hematology Department, Hadassah Hebrew University Medical Center, POB 12000, Jerusalem, Israel
| | - Galina Pogrebijski
- Hematology Department, Hadassah Hebrew University Medical Center, POB 12000, Jerusalem, Israel
| | - Svetlana Kritchevsky
- Hematology Department, Hadassah Hebrew University Medical Center, POB 12000, Jerusalem, Israel
| | - Dina Ben-Yehuda
- Hematology Department, Hadassah Hebrew University Medical Center, POB 12000, Jerusalem, Israel
| | - Neta Goldschmidt
- Hematology Department, Hadassah Hebrew University Medical Center, POB 12000, Jerusalem, Israel
| | - Moshe E Gatt
- Hematology Department, Hadassah Hebrew University Medical Center, POB 12000, Jerusalem, Israel
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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.
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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
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Arber DA, Borowitz MJ, Cessna M, Etzell J, Foucar K, Hasserjian RP, Rizzo JD, Theil K, Wang SA, Smith AT, Rumble RB, Thomas NE, Vardiman JW. Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology. Arch Pathol Lab Med 2017; 141:1342-1393. [PMID: 28225303 DOI: 10.5858/arpa.2016-0504-cp] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - A complete diagnosis of acute leukemia requires knowledge of clinical information combined with morphologic evaluation, immunophenotyping and karyotype analysis, and often, molecular genetic testing. Although many aspects of the workup for acute leukemia are well accepted, few guidelines have addressed the different aspects of the diagnostic evaluation of samples from patients suspected to have acute leukemia. OBJECTIVE - To develop a guideline for treating physicians and pathologists involved in the diagnostic and prognostic evaluation of new acute leukemia samples, including acute lymphoblastic leukemia, acute myeloid leukemia, and acute leukemias of ambiguous lineage. DESIGN - The College of American Pathologists and the American Society of Hematology convened a panel of experts in hematology and hematopathology to develop recommendations. A systematic evidence review was conducted to address 6 key questions. Recommendations were derived from strength of evidence, feedback received during the public comment period, and expert panel consensus. RESULTS - Twenty-seven guideline statements were established, which ranged from recommendations on what clinical and laboratory information should be available as part of the diagnostic and prognostic evaluation of acute leukemia samples to what types of testing should be performed routinely, with recommendations on where such testing should be performed and how the results should be reported. CONCLUSIONS - The guideline provides a framework for the multiple steps, including laboratory testing, in the evaluation of acute leukemia samples. Some aspects of the guideline, especially molecular genetic testing in acute leukemia, are rapidly changing with new supportive literature, which will require on-going updates for the guideline to remain relevant.
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Dass J, Dayama A, Mishra PC, Mahapatra M, Seth T, Tyagi S, Pati HP, Saxena R. Higher rate of central nervous system involvement by flow cytometry than morphology in acute lymphoblastic leukemia. Int J Lab Hematol 2017. [PMID: 28649769 DOI: 10.1111/ijlh.12694] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Central nervous system (CNS) involvement in acute lymphoblastic leukemia (ALL) is diagnosed traditionally by cytopathology (CP) of the cerebrospinal fluid (CSF). Role of flow cytometry (FC) to diagnose CNS involvement has not been extensively investigated. METHODS We aimed to detect CNS involvement in 42 ALL patients (33 B-ALL, nine T-ALL) at diagnosis by FC and comparing it with CP and to correlate it with known risk factors for CNS disease like Lactate dehydrogenase (LDH). A receiver operating characteristic curve was used to determine the cutoff of LDH to predict CSF involvement. For the analysis of categorical/quantitative variables, Fisher's exact test was used. For the analysis of continuous variables, Mann-Whitney test was used. A P value of <.05 was taken as significant. RESULTS CP and FC were positive in five (11.9%) and 11 patients (26.14%) respectively with FC detecting a significantly higher level of involvement (P=.001). All CP-positive cases were FC positive. A LDH value of >472 U/L had a sensitivity of 61% and specificity of 62.5% for diagnosis of CSF involvement by FC. CONCLUSIONS CSF FC detects CNS disease in ALL patients at diagnosis at a rate double than CP alone and is statistically associated with an elevated LDH level. It should be incorporated in the evaluation of CSF to detect CNS involvement.
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Affiliation(s)
- J Dass
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - A Dayama
- Department of Hematology, Fortis Memorial Research Institute, Gurgaon, India
| | - P C Mishra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - M Mahapatra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - T Seth
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - S Tyagi
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - H P Pati
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - R Saxena
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
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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.
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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
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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.
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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
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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
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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.
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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]
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15
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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
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de Jongste AH, Kraan J, van den Broek PD, Brooimans RA, Bromberg JE, van Montfort KA, Smitt PAS, Gratama JW. Use of TransFix™ cerebrospinal fluid storage tubes prevents cellular loss and enhances flow cytometric detection of malignant hematological cells after 18 hours of storage. CYTOMETRY PART B-CLINICAL CYTOMETRY 2013; 86:272-9. [DOI: 10.1002/cyto.b.21097] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/02/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Adriaan H. de Jongste
- Department of Medical Oncology; Erasmus University Medical Center/Daniel Den Hoed Cancer Center; Groene Hilledijk 301 3075 EA Rotterdam The Netherlands
- Department of Neurology; Erasmus University Medical Center; Rotterdam's-Gravendijkwal 230 3015 CE Rotterdam The Netherlands
| | - Jaco Kraan
- Department of Medical Oncology; Erasmus University Medical Center/Daniel Den Hoed Cancer Center; Groene Hilledijk 301 3075 EA Rotterdam The Netherlands
| | - Patricia D. van den Broek
- Department of Medical Oncology; Erasmus University Medical Center/Daniel Den Hoed Cancer Center; Groene Hilledijk 301 3075 EA Rotterdam The Netherlands
| | - Rik A. Brooimans
- Department of Medical Oncology; Erasmus University Medical Center/Daniel Den Hoed Cancer Center; Groene Hilledijk 301 3075 EA Rotterdam The Netherlands
| | - Jacoline E. Bromberg
- Department of Neurology; Erasmus University Medical Center; Rotterdam's-Gravendijkwal 230 3015 CE Rotterdam The Netherlands
| | - Kees A. van Montfort
- Department of Medical Statistics; Erasmus University Medical Center/Daniel Den Hoed Cancer Center; Groene Hilledijk 301 3075 EA Rotterdam The Netherlands
| | - Peter A. Sillevis Smitt
- Department of Neurology; Erasmus University Medical Center; Rotterdam's-Gravendijkwal 230 3015 CE Rotterdam The Netherlands
| | - Jan W. Gratama
- Department of Medical Oncology; Erasmus University Medical Center/Daniel Den Hoed Cancer Center; Groene Hilledijk 301 3075 EA Rotterdam The Netherlands
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Abstract
Cerebrospinal fluid-acute leukemia (CSF-acute leukemia) is a frequent and serious complication in patients with acute leukemia. One of the major problems of this complication is the diagnosis process itself. CSF cytology is currently considered the gold standard for establishing the diagnosis, a technique which presents various processing limitations, seriously impacting the predictive values. In the last 11 years, studies of CSF flow cytometry analysis done in patients with acute leukemia have demonstrated superiority in comparison with CSF cytology. Although comparative studies between these two techniques have been reported since 2001, no new consensus or formal changes to the gold standard have been established for the CSF acute leukemia diagnosis. The evidence suggests that positive flow cytometry cases, considered as indeterminate cases, will behave like disease in the central nervous system (CNS). Nevertheless, we think there are some variables and considerations that must be first evaluated under research protocols before CNS relapse can be established with only one positive flow cytometry analysis in the setting of indeterminate CSF samples. This paper proposes a diagnostic algorithm and complementary strategies.
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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.
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Affiliation(s)
- Domenico Galati
- Dipartimento Ematologico, Istituto Nazionale Tumori, IRCCS "Fondazione Pascale", Naples, Italy
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de Graaf MT, de Jongste AHC, Kraan J, Boonstra JG, Smitt PAES, Gratama JW. Flow cytometric characterization of cerebrospinal fluid cells. CYTOMETRY PART B-CLINICAL CYTOMETRY 2011; 80:271-81. [DOI: 10.1002/cyto.b.20603] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 04/12/2011] [Accepted: 04/16/2011] [Indexed: 12/12/2022]
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20
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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.
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Affiliation(s)
- Clara Cesana
- Department of Transfusion Medicine and Division of Hematology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy,
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Perske C, Nagel I, Nagel H, Strik H. CSF cytology-the ongoing dilemma to distinguish neoplastic and inflammatory lymphocytes. Diagn Cytopathol 2010; 39:621-6. [DOI: 10.1002/dc.21510] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 07/03/2010] [Indexed: 11/09/2022]
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Strik H, Prömmel P. Diagnosis and individualized therapy of neoplastic meningitis. Expert Rev Anticancer Ther 2010; 10:1137-48. [PMID: 20645702 DOI: 10.1586/era.10.86] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neoplastic meningitis is a diffuse dissemination of tumor cells into the cerebrospinal fluid (CSF) and/or leptomeninges. It occurs in approximately 5-10% of malignant diseases, most often in breast cancer, lung cancer, melanoma or B-cell lymphoma. Symptoms of neoplastic meningitis are head or back pain, cranial nerve palsies, diffuse radicular symptoms or psychiatric disturbances. MRI shows nodular contrast enhancement lining CSF spaces. Positive CSF cytology requires optimal sampling and processing. Treatment must be individually shaped: the CSF dissemination may be treated with intrathecal chemotherapy with methotrexate or cytarabinoside (Ara-C). Liposomal Ara-C is distributed over the entire CSF space even after lumbar application and maintains cytotoxic levels for at least 2 weeks. Radiotherapy should be applied only to symptomatic solid spinal manifestations or fast progressing cranial nerve palsies. Systemic chemotherapy is needed to control solid manifestations or, in the case of substances entering the CSF, to support intrathecal chemotherapy.
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Affiliation(s)
- Herwig Strik
- Department of Neurology, Phillips University, Rudolf Bultmann Strasse 8, D-35039 Marburg, Germany.
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