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Karapetyan K, Gizhlaryan M, Kalinovskaia O, Hovhannisyan A, Tadevosyan G, Matinyan L, Tamamyan G, Ghazaryan N. Investigating residual leukemic cells in acute lymphoblastic leukemia: a practical approach using a streamlined interphase fluorescence in situ hybridization method on cerebrospinal fluid. Mol Cytogenet 2023; 16:17. [PMID: 37501073 PMCID: PMC10375734 DOI: 10.1186/s13039-023-00649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION A precise diagnosis of central nervous system involvement in acute lymphoblastic leukemia (ALL) requires comprehensive knowledge of morphological analysis, with a focus on the quantity and quality of cells being examined. Some research has utilized techniques such as immunocytochemistry, flow cytometry, polymerase chain reaction (PCR), and interphase fluorescence in situ hybridization (iFISH) on cerebrospinal fluid (CSF) cytospin samples to detect any remaining leukemic cells in the CSF. To obtain reliable results using immunocytochemistry and flow cytometry, it is essential to use freshly collected specimens within a limited timeframe. At the same time, PCR requires a sufficient number of cells for DNA extraction. On the other hand, the iFISH procedure on CSF cytospin samples can be challenging and requires practice. Therefore, there is a need for a fast, easy method that will be affordable and marketable in laboratories where the above methods are not available, or the sample is insufficient to use those methods. METHODS The samples were prepared by centrifugation of 1 mL aliquots of CSF collected into EDTA tubes. The CSF sample was centrifuged at 3000 rpm for 3 min, the supernatant was removed, and the pellet was placed in KCl hypotonic solution for 5 min at 37 °C. Other steps (fixation, hybridization, wash steps, and analysis) were the same as in the standard protocol for blood samples. The BCR-ABL1 rearrangements were performed and evaluated in 200 interphase cells. RESULTS 90% of Ph(+) cells were found in CSF. CONCLUSION We propose a significantly streamlined iFISH method for detecting blast/residual leukemic cells in acute lymphoblastic leukemia using CSF as a complementary test option.
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Affiliation(s)
- Knarik Karapetyan
- Department of Molecular Biology, Hematology Center After Prof. R.H.Yeolyan, Yerevan, Armenia
| | - Mane Gizhlaryan
- Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center After Prof. R.H: Yeolyan, Yerevan, Armenia
- Department of Pediatric Oncology and Hematology, Yerevan State Medical University, Yerevan, Armenia
| | - Olga Kalinovskaia
- Department of Molecular Biology, Hematology Center After Prof. R.H.Yeolyan, Yerevan, Armenia
| | - Anna Hovhannisyan
- Department of Molecular Biology, Hematology Center After Prof. R.H.Yeolyan, Yerevan, Armenia
- Department of Medical Genetics, Yerevan State Medical University, Yerevan, Armenia
| | - Gohar Tadevosyan
- Department of Molecular Biology, Hematology Center After Prof. R.H.Yeolyan, Yerevan, Armenia
| | - Lilit Matinyan
- Department of Molecular Biology, Hematology Center After Prof. R.H.Yeolyan, Yerevan, Armenia
| | - Gevorg Tamamyan
- Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center After Prof. R.H: Yeolyan, Yerevan, Armenia
- Department of Hematology, Yerevan State Medical University, Yerevan, Armenia
- Department of Pediatric Oncology and Hematology, Yerevan State Medical University, Yerevan, Armenia
| | - Narine Ghazaryan
- Department of Molecular Biology, Hematology Center After Prof. R.H.Yeolyan, Yerevan, Armenia.
- Laboratory of Toxinology and Molecular Systematics, Institute of Physiology, Yerevan, Armenia.
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BCR-ABL Translocation in Pediatric Acute Lymphoblastic Leukemia in Southern India. Indian J Hematol Blood Transfus 2011; 28:37-41. [PMID: 23449388 DOI: 10.1007/s12288-011-0096-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 07/07/2011] [Indexed: 10/18/2022] Open
Abstract
Cytogenetics and polymerase chain reaction (PCR) based assays provide important information regarding biologically defined and prognostically relevant subgroups in acute leukemias. We utilized karyotyping and molecular analysis by reverse transcriptase PCR for the BCR-ABL translocation, in addition to morphological study, cytochemistry and immunophenotyping, to study 24 cases of pediatric acute lymphoblastic leukemia (ALL). Our objective was to determine the frequency of the BCRABL translocation in childhood ALL from southern India. Karyotyping showed one case of hyperdiploidy, one case of t (12; 21) translocation and one case of 46, XY-21+mar. The BCR-ABL translocation was found in 8.3% of these cases. One of these was a cryptic translocation, the karyotype being normal. BCR-ABL positivity in ALL is associated with aggressive disease and has been shown to be a poor prognostic factor, especially in children.
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Fullmer A, O'Brien S, Kantarjian H, Jabbour E. Emerging therapy for the treatment of acute lymphoblastic leukemia. Expert Opin Emerg Drugs 2010; 15:1-11. [PMID: 20055690 DOI: 10.1517/14728210903456026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
IMPORTANCE OF THE FIELD Over the last few decades, advances in acute lymphoblastic leukemia (ALL) therapy have led to long-term survival rates of > 80% in children; however, comparable rates have yet to be achieved in adults, and a large majority of patients relapse from their disease. AREAS COVERED IN THIS REVIEW The review describes historical therapy and advancements in ALL treatment over the past few decades, while providing a concise review of the future direction of ALL therapy. Literature was collected through peer reviewed journals and the Pharmaprojects drug profile for ALL. WHAT THE READER WILL GAIN Current information regarding prognostic factors for relapse, salvage therapy options and emerging drugs are provided in the review. TAKE HOME MESSAGE Development of new drugs with novel mechanisms, unique formulations of existing medications, as well as manipulation of current combinations of drugs remain vital to the success in adult ALL.
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Affiliation(s)
- Amber Fullmer
- The University of Texas, MD Anderson Cancer Center, Department of Leukemia, 1515 Holcombe Blvd. Box 428. Houston, TX 77030, USA
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[Immunoglobulin genes and T-cell receptors as molecular markers in children with acute lymphoblastic leukaemia]. SRP ARK CELOK LEK 2009; 137:384-90. [PMID: 19764592 DOI: 10.2298/sarh0908384l] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Acute lymphoblastic leukaemia (ALL) is a malignant clonal disease, one of the most common malignancies in childhood. Contemporary protocols ensure high remission rate and long term free survival. The ability of molecular genetic methods help to establish submicroscopic classification and minimal residual disease (MRD) follow up, in major percent responsible for relapse. OBJECTIVE The aim of the study was to detect the frequency of IgH and TCR gene rearrangements and their correlation with clinical parameters. METHODS Forty-one children with ALL were enrolled in the study group, with initial diagnosis of IgH and TCR gene rearrangements by polimerase chain reaction (PCR). MRD follow-up was performed in induction phase when morphological remission was expected, and after intensive chemiotherapy. RESULTS In the study group IgH rearrangement was detected in 82.9% of children at the diagnosis, while TCR rearrangement was seen in 56.1%. On induction day 33, clonal IgH rearrangements persisted in 39% and TCR rearrangements in 36.5% of children. CONCLUSION Molecular analysis of genetic alterations and their correlation with standard prognostic parameters show the importance of risk stratification revision which leads to new therapy intensification approach. MRD stands out as a precise predictive factor for the relapse of disease.
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Ravandi F, Faderl S, Kebriaei P, Kantarjian H. Modern treatment programs for adults with acute lymphoblastic leukemia. Curr Hematol Malig Rep 2007; 2:169-75. [DOI: 10.1007/s11899-007-0023-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Much progress has been made in understanding the biology of and therapy for acute lymphoblastic leukemia (ALL). This progress has translated into the recognition of several subgroups of ALL and the institution of risk-adapted therapies. New therapies are emerging based on the definition of specific cytogenetic-molecular abnormalities. Changes in the pathologic classification of ALL have led to therapeutic consequences. Adaptation of successful treatment strategies in children with ALL has resulted in similar complete remission rates in adults. Prognosis has Improved especially in mature B-cell ALL and T-cell lineage ALL. However, regardless of ALL subgroup, long-term survival in adults is still inferior to that in children. Development of new drugs and agents tailored to subset-specific cytogenetic-molecular characteristics is vital to the therapeutic success in adult ALL.
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Affiliation(s)
- Elias J Jabbour
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA
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Shachaf CM, Felsher DW. Rehabilitation of cancer through oncogene inactivation. Trends Mol Med 2005; 11:316-21. [PMID: 15955741 DOI: 10.1016/j.molmed.2005.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/09/2005] [Accepted: 05/31/2005] [Indexed: 02/06/2023]
Abstract
The inactivation of the MYC oncogene alone can reverse tumorigenesis. Upon MYC inactivation, tumors stereotypically reverse, undergoing proliferative arrest, cellular differentiation and/or apoptosis. The precise consequences of MYC inactivation appear to depend upon both genetic and epigenetic parameters. In some types of cancer following MYC inactivation, tumor cells become well differentiated and biologically and histologically normal, inducing sustained tumor regression. However, in some cases, these normal-appearing cells are actually dormant tumor cells and upon MYC reactivation they rapidly recover their tumorigenic properties. Future therapies to treat cancer will need to address the possibility that tumor cells can camouflage a normal phenotype following treatment, resting in a dormant, latently cancerous state.
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Affiliation(s)
- Catherine M Shachaf
- Division of Oncology, Departments of Medicine and Pathology, Stanford University, 269 Campus Drive, Stanford, CA 94305-5151, USA
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Foà R, Vitale A, Chiaretti S, Guarini A. A broad and integrated diagnostic work-up for a modern management of Acute Lymphoblastic Leukemia (ALL). ACTA ACUST UNITED AC 2005; 10 Suppl 1:55-62. [PMID: 16188637 DOI: 10.1080/10245330512331390041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Robin Foà
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, University La Sapienza of Rome, Italy.
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Riley RS, Idowu M, Chesney A, Zhao S, McCarty J, Lamb LS, Ben-Ezra JM. Hematologic aspects of myeloablative therapy and bone marrow transplantation. J Clin Lab Anal 2005; 19:47-79. [PMID: 15756708 PMCID: PMC6807857 DOI: 10.1002/jcla.20055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The transplantation of bone marrow cells or isolated hematopoietic stem cells from the bone marrow or peripheral blood is a widely utilized form of therapy for patients with incurable diseases of the hematopoietic and immune systems. Successful engraftment of the transplanted stem cells in an adequately prepared recipient normally leads to bone marrow reconstitution over a period of several weeks, accompanied by more gradual reconstitution of the immune system. Since the recipient is profoundly ill during the initial treatment period, laboratory data is critical for monitoring engraftment, detecting residual/recurrent disease, and identifying problems that may delay bone marrow reconstitution or lead to other medical complications. Accurate blood cell counts are imperative, and most bone marrow transplantation patients undergo periodic monitoring with bone marrow aspirates and biopsies with cytogenetic, molecular, and multiparametric flow cytometric studies. The potential complications of bone marrow transplantation include engraftment failure and delayed engraftment, infection, residual bone marrow disease, acute and chronic graft versus host disease, myelofibrosis, therapy-related acute leukemia, post-transplant lympho-proliferative disorders, and toxic myelopathy.
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Affiliation(s)
- Roger S Riley
- Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia 23298-0250, USA.
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Abstract
Upon MYC inactivation, tumors variously undergo proliferative arrest, cellular differentiation, and apoptosis and in some cases, apparently permanently revoking tumorigenesis. In liver tumor cells, we recently showed that MYC inactivation uncovers stem cell properties and triggers differentiation, but in this case, their neoplastic properties are restorable by MYC reactivation. Thus, whereas oncogene inactivation can push cancer to the brink of normalcy, some cells retain the latent capacity to turn cancerous again, arguing that they may exist in a state of tumor dormancy.
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Affiliation(s)
- Catherine M Shachaf
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California 94305, USA
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Bassan R, Gatta G, Tondini C, Willemze R. Adult acute lymphoblastic leukaemia. Crit Rev Oncol Hematol 2005; 50:223-61. [PMID: 15182827 DOI: 10.1016/j.critrevonc.2003.11.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2003] [Indexed: 11/22/2022] Open
Abstract
Acute lymphoblastic leukaemia (ALL) in adults is a relatively rare neoplasm with a curability rate around 30% at 5 years. This consideration makes it imperative to dissect further the biological mechanisms of disease, in order to selectively implement an hitherto unsatisfactory success rate. The recognition of discrete ALL subtypes (some of which deserve specific therapeutic approaches, like T-lineage ALL (T-ALL) and mature B-lineage ALL (B-ALL)) is possible through an accurate combination of cytomorphology, immunophenotytpe and cytogenetic assays and has been a major result of clinical research studies conducted over the past 20 years. Two-three major prognostic groups are now easily identifiable, with a survival probability ranging from <10 to 20% (Philadelphia-positive ALL) to about 50-60% (low-risk T-ALL and selected patients with B-lineage ALL). These issues are extensively reviewed and form the basis of current knowledge. The second major point relates to the emerging importance of studies that reveal a dysregulated gene activity and its clinical counterpart. It is now clear that prognostication is a complex matter ranging from patient-related issues to cytogenetics to molecular biology, including the evaluation of minimal residual disease (MRD) and possibly gene array tests. On these bases, the role of a correct, highly personalised therapeutic choice will soon become fundamental. Therapeutic progress may be obtainable through a careful integration of chemotherapy, stem cell transplantation, and the new targeted treatments with highly specific metabolic inhibitors and humanised monoclonal antibodies.
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Abstract
BACKGROUND Much progress has been made in understanding the biology of acute lymphoblastic leukemia (ALL). This has translated into the recognition of several subgroups of ALL and the institution of risk-adapted therapies. New therapies are emerging based on the definition of specific cytogenetic-molecular abnormalities. METHODS A review from the English literature, including original articles and related reviews from Medline (Pubmed) and abstracts based on publication of meeting material, was performed. RESULTS Changes in the pathologic classification of ALL have led to therapeutic consequences. Adaptation of successful treatment strategies in children with ALL has resulted in similar complete response rates in adults. Prognosis has especially improved in mature-B-cell and T-lineage ALL. The role of tyrosine kinase inhibitors in Philadelphia chromosome-positive ALL was evaluated in the current study. However, regardless of the ALL subgroup, long-term survival of adults is still inferior to that in children. CONCLUSIONS Intense clinical and laboratory research is attempting to close the gap in outcome between children and adults with ALL. Investigations are focusing on 1) refinement of the basic treatment stratagem of induction, consolidation, and maintenance; 2) expansion of risk-based, subgroup-oriented therapies; 3) assessment of minimal residual disease, its impact on disease recurrence, and its practical implications in clinical practice; 4) salvage strategies; 5) the role of stem cell transplantation in ALL; and 6) the development of new drugs based on a better understanding of disease biology.
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Affiliation(s)
- Stefan Faderl
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Affiliation(s)
- John Anastasi
- Hematopathology Section, Department of Pathology, University of Chicago, Chicago, IL 60637, USA
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Scheuring UJ, Pfeifer H, Wassmann B, Bruck P, Atta J, Petershofen EK, Gehrke B, Gschaidmeier H, Hoelzer D, Ottmann OG. Early minimal residual disease (MRD) analysis during treatment of Philadelphia chromosome/Bcr-Abl-positive acute lymphoblastic leukemia with the Abl-tyrosine kinase inhibitor imatinib (STI571). Blood 2003; 101:85-90. [PMID: 12393581 DOI: 10.1182/blood-2002-02-0360] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Abl kinase inhibitor imatinib mesylate (STI571) has significant and rapid antileukemic activity in Philadelphia chromosome/Bcr-Abl-positive acute lymphoblastic leukemia (Ph(+) ALL) but such activity is usually of short duration except for a small proportion of patients. To determine the prognostic significance of early Bcr-Abl levels and changes in peripheral blood (PB) and bone marrow (BM), serial samples of 56 patients with relapsed or refractory Ph(+) ALL treated in phase 2 trials of imatinib were analyzed by quantitative polymerase chain reaction (PCR). Imatinib induced a complete hematologic response (CHR) or complete marrow response (marrow-CR) in 40 patients (good responders) and a partial (n = 2) or no (n = 14) remission in the remaining patients (poor responders). Compared with baseline, the median Bcr-Abl/glyceraldehyde-3-phosphate dehydrogenase (GAPDH) ratios decreased significantly in PB by 2.65, 2.64, and 3.11 log steps after 2 weeks, 4 weeks, and at the time of best response, respectively. In BM, the decline of median Bcr-Abl/GAPDH was 0.75, 1.37, and 2.78 logs, respectively. Thus, Bcr-Abl levels decreased more rapidly in PB than in BM (median time to best level 31 vs 39 days). Low Bcr-Abl/GAPDH ratios below 10(-4) in PB and below 10(-2) in BM after 2 weeks were significantly associated with good responses after 4 weeks. Moreover, Bcr-Abl levels (< 10(-2)) in BM of good responders after 4 weeks discriminated between 2 groups of patients with significantly different median time to progression (139 vs 22 days). The data show that Bcr-Abl levels in PB and BM after 2 weeks of imatinib treatment and in BM after 4 weeks have predictive relevance and may guide the application of additional therapies.
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Affiliation(s)
- Urban J Scheuring
- Medizinische Klinik III, Abteilung für Hämatologie und Onkologie of the Johann Wolfgang Goethe-Universität, Frankfurt, Germany.
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Foa R, Vitale A. Towards an integrated classification of adult acute lymphoblastic leukemia. REVIEWS IN CLINICAL AND EXPERIMENTAL HEMATOLOGY 2002; 6:181-99; discussion 200-2. [PMID: 12196215 DOI: 10.1046/j.1468-0734.2002.00070.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acute lymphoblastic leukemia (ALL) represents a biologically and clinically heterogeneous group of diseases characterized by the abnormal proliferation and accumulation of immature lymphoid cells within the bone marrow and lymphoid tissues. Following a diagnostic work-up, prognostic data are routinely achieved through physical examination, serum biochemical profiles, peripheral blood count and bone marrow morphology. Over the years, information obtained through karyotype, molecular genetics, extensive immunophenotype, multidrug resistance and, more recently, genomic profiling is progressively contributing to a better understanding of the biology of this complex disease, to the identification of subgroups of patients with a different clinical outcome, to the more precise monitoring of minimal residual disease, to the use of different therapeutic protocols based on prognostic indicators and, recently, also to the design of innovative and specific treatment strategies. In the present review, we will discuss how an integrated approach is now mandatory for the optimal management of adult ALL.
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Affiliation(s)
- Robin Foa
- Dipartimento di Biotecnologie Cellulari ed Ematologia, University La Sapienza, Rome, Italy.
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Riley RS, Massey D, Jackson-Cook C, Idowu M, Romagnoli G. Immunophenotypic analysis of acute lymphocytic leukemia. Hematol Oncol Clin North Am 2002; 16:245-99, v. [PMID: 12094473 DOI: 10.1016/s0889-8588(02)00004-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is one of the most common hematologic malignancies. Flow cytometry is an integral part of ALL diagnosis and also provides significant patient prognostic information. This article is a practical review of the basic principles of the flow cytometric evaluation of acute leukemias, the interpretation of flow cytometric data, and the management of practical problems such as aberrant antigen, hematogones, bone marrow regeneration, and minimal residual disease.
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Affiliation(s)
- Roger S Riley
- Department of Pathology, Medical College of Virginia, Hospitals of Virginia Commonwealth University, 403 North 13th Street, Richmond, VA 23298-0250, USA.
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