|
1
|
Ally F, Chen X. Acute Myeloid Leukemia: Diagnosis and Evaluation by Flow Cytometry. Cancers (Basel) 2024; 16:3855. [PMID: 39594810 PMCID: PMC11592599 DOI: 10.3390/cancers16223855] [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: 10/21/2024] [Revised: 11/13/2024] [Accepted: 11/15/2024] [Indexed: 11/28/2024] Open
Abstract
With recent technological advances and significant progress in understanding the pathogenesis of acute myeloid leukemia (AML), the updated fifth edition WHO Classification (WHO-HAEM5) and the newly introduced International Consensus Classification (ICC), as well as the European LeukemiaNet (ELN) recommendations in 2022, require the integration of immunophenotypic, cytogenetic, and molecular data, alongside clinical and morphologic findings, for accurate diagnosis, prognostication, and guiding therapeutic strategies in AML. Flow cytometry offers rapid and sensitive immunophenotyping through a multiparametric approach and is a pivotal laboratory tool for the classification of AML, identification of therapeutic targets, and monitoring of measurable residual disease (MRD) post therapy. The association of immunophenotypic features and recurrent genetic abnormalities has been recognized and applied in informing further diagnostic evaluation and immediate therapeutic decision-making. Recently, the evolving role of machine learning models in assisting flow cytometric data analysis for the automated diagnosis and prediction of underlying genetic alterations has been illustrated.
Collapse
Affiliation(s)
- Feras Ally
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA;
| | - Xueyan Chen
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA;
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| |
Collapse
|
|
2
|
Frazzetto S, Gullo L, Sapuppo G, Fazio M, Lo Faro C, Giunta G, Caravotta I, Mauro E, Parisi MS, Triolo AM, Parrinello NL, Consoli ML, També L, Cambria D, Marino S, Scuderi G, Di Raimondo F. Three-Way Translocation t(12;15;17) (p13;q24;q21) Found in Acute Promyelocytic Leukemia with Basophilic Differentiation. Hematol Rep 2024; 16:367-374. [PMID: 38921185 PMCID: PMC11203485 DOI: 10.3390/hematolrep16020037] [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: 04/13/2024] [Revised: 05/29/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024] Open
Abstract
Acute promyelocytic leukemia is a rare form of acute myeloid leukemia in which immature promyelocytes abnormally proliferate in the bone marrow. In most cases, the disease is characterised by the translocation t(15;17) (q24;q21), which causes the formation of PML::RARA, an oncogenic fusion protein responsible for blocking myeloid differentiation and survival advantage. Here, we present a case of acute promyelocytic leukemia with two unusual features: basophilic differentiation and a three-way translocation involving chromosomes 12, 15 and 17. In the few cases reported, basophilic differentiation was associated with a poor prognosis. In contrast, our patient responded promptly to the standard treatment with all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) and obtained complete remission. To our knowledge, this is the first report of basophilic acute promyelocytic leukemia with the three-way translocation t(12;17;15) (p13; q24;q21).
Collapse
Affiliation(s)
- Sara Frazzetto
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Lara Gullo
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Gabriele Sapuppo
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Manlio Fazio
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Cristina Lo Faro
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Giuliana Giunta
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Ignazio Caravotta
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Elisa Mauro
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Marina Silvia Parisi
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Anna Maria Triolo
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Nunziatina Laura Parrinello
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Maria Letizia Consoli
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Loredana També
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Daniela Cambria
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Sara Marino
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Grazia Scuderi
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Francesco Di Raimondo
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| |
Collapse
|
|
3
|
Ghimire A, Liesveld J, Wallace D, Zhao J, Burack R, Bennett J. Case of acute promyelocytic leukemia with basophilic differentiation and an ETV6 mutation. J Hematop 2021. [DOI: 10.1007/s12308-021-00469-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
|
4
|
Berger AE, Durrieu C, Dzviga C, Perrot JL, Lambert C. Human peripheral basophils extended phenotype shows a high expression of CD244 immuno-regulatory receptor. J Immunol Methods 2021; 492:112951. [PMID: 33493550 DOI: 10.1016/j.jim.2020.112951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Basophils play a major physio-pathological role in hypersensitivity related diseases. Basophils express high affinity Immunoglobulin (Ig) E receptors (FcεRI), IgG and complement regulatory. Basophils also have immunoregulatory activity through interaction with T cells. The aim of this study was to look for the expression of markers reflecting the activation status of peripheral Basophil in healthy donors. METHOD the study was performed on 29 healthy donors, 62% females with a mean age of 50.1 + 17.0 years. Basophils were identified on their expression of CD123 without HLA-DR and/or CD193 in two 8 colors panels including CD46, CD55, CD59, CD203c, CD32 (FcγRII), CD64 (FcγRIII), CD163, CD137L (4-1BBL), CD252 (OX40L), CD244 (2B4) and CD3 on whole blood. Basophil activation with anti IgE was performed on 14 donors. RESULTS AND DISCUSSION Our results confirmed the Basophil expression of CD123, CD193 and CD203 (the latter is strongly increased under stimulation). Complement regulatory proteins (CD46, CD55, CD59) were expressed at the same levels as on other leukocytes; CD46, CD59 expression being slightly increased under stimulation. CD32 and CD163 scavenger were slightly higher than on lympho and not influenced by activation. CD252 or CD137L were expressed at low levels and significantly induced by stimulation. Most of all, CD244 was highly expressed on Basophils as compared to any other leukocytes in fresh peripheral blood. CONCLUSIONS Our study shows that human resting Basophils express IgE and IgG Fc receptors and check point receptor CD244 that could potentially play a role in their previously reported immunoregulatory activity in sensitization and even in tumor immune escape.
Collapse
Affiliation(s)
- Anne-Emmanuelle Berger
- Immunology laboratory, University Hospital Saint-Etienne, 42055 Saint-Etienne, Cedex 2, France
| | - Coralie Durrieu
- Immunology laboratory, University Hospital Saint-Etienne, 42055 Saint-Etienne, Cedex 2, France
| | - Charles Dzviga
- Allergology unit, University Hospital Saint-Etienne, 42055 Saint-Etienne, Cedex 2, France
| | - Jean-Luc Perrot
- Dermatology department, University Hospital Saint-Etienne, 42055 Saint-Etienne, Cedex 2, France
| | - Claude Lambert
- Immunology laboratory, University Hospital Saint-Etienne, 42055 Saint-Etienne, Cedex 2, France; Allergology unit, University Hospital Saint-Etienne, 42055 Saint-Etienne, Cedex 2, France.
| |
Collapse
|
|
5
|
Zhang Z, Zhang R, Qi J, Miao W, Fang K, Ruan C, Wu D, Han Y. The prognostic value of plasma fibrinogen level in patients with acute myeloid leukemia: a systematic review and meta-analysis. Leuk Lymphoma 2020; 61:2682-2691. [PMID: 32605403 DOI: 10.1080/10428194.2020.1780587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Increasing evidence has revealed that plasma fibrinogen levels may serve as prognostic indicators in patients with acute myeloid leukemia (AML), yet the exact association is still elusive. We conducted a systematic review and meta-analysis of all available studies concerning the relationship between plasma fibrinogen level and survival in AML patients. The pooled hazard ratio (HR) and 95% confidence intervals (CIs) for overall survival (OS) were calculated to evaluate the effect. A random-effect model was applied and the robustness of the pooled results was confirmed by subgroup and sensitivity analysis. A total of 9 studies were eligible to assess the association between plasma fibrinogen level and prognosis in AML. Among these investigations above, 5 studies adopted OS as their outcome indicator and were selected for the final meta-analysis. The pooled result suggested that plasma fibrinogen level was significantly relevant to increased mortality risk in AML patients (HR = 1.21, 95% CI: 1.01-1.44, p = .000, I2=85.4%). In conclusion, high plasma fibrinogen level may independently predict worse OS in patients with AML.
Collapse
Affiliation(s)
- Ziyan Zhang
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Suzhou, China.,National Clinical Research Center for Hematologic Diseases, Suzhou, China
| | - Rui Zhang
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China
| | - Jiaqian Qi
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Suzhou, China.,National Clinical Research Center for Hematologic Diseases, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China
| | - Wenjing Miao
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China
| | - Kun Fang
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Suzhou, China.,National Clinical Research Center for Hematologic Diseases, Suzhou, China
| | - Changgeng Ruan
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Suzhou, China.,National Clinical Research Center for Hematologic Diseases, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China.,State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China
| | - Depei Wu
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Suzhou, China.,National Clinical Research Center for Hematologic Diseases, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China.,State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China
| | - Yue Han
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Suzhou, China.,National Clinical Research Center for Hematologic Diseases, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China.,State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China
| |
Collapse
|
|
6
|
Shameli A, Jamani K. Acute promyelocytic leukemia presenting with atypical basophils. Clin Case Rep 2020; 8:584-585. [PMID: 32185069 PMCID: PMC7069876 DOI: 10.1002/ccr3.2686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/05/2019] [Accepted: 01/02/2020] [Indexed: 11/25/2022] Open
Abstract
We describe a case of acute promyelocytic leukemia with circulating aberrant basophils. Recent studies have shown that basophilic differentiation is not uncommon in APL and likely under-recognized in morphologic and immunophenotypic assessments.
Collapse
Affiliation(s)
- Afshin Shameli
- Division of HematologyAlberta Precision Laboratories, and Department of Pathology and Laboratory MedicineUniversity of CalgaryCalgaryABCanada
| | - Kareem Jamani
- Division of Hematology and Hematological MalignanciesDepartment of MedicineUniversity of CalgaryCalgaryABCanada
| |
Collapse
|
|
7
|
Orfao A, Matarraz S, Pérez-Andrés M, Almeida J, Teodosio C, Berkowska MA, van Dongen JJ. Immunophenotypic dissection of normal hematopoiesis. J Immunol Methods 2019; 475:112684. [DOI: 10.1016/j.jim.2019.112684] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
|
|
8
|
Kárai B, Habók M, Reményi G, Rejtő L, Ujfalusi A, Kappelmayer J, Hevessy Z. A novel flow cytometric method for enhancing acute promyelocytic leukemia screening by multidimensional dot-plots. Ann Hematol 2019; 98:1413-1420. [PMID: 30830246 PMCID: PMC6511347 DOI: 10.1007/s00277-019-03642-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 02/19/2019] [Indexed: 11/17/2022]
Abstract
Acute promyelocytic leukemia (APL) is generally characterized by t(15;17)(q24;q21). In some cases, the classic translocation cannot be identified by conventional methods, since the PML-RARA fusion protein results from complex, variant, or cryptic translocation. The diagnostic algorithm of APL starts with screening methods, such as flow cytometry (FC), followed by fluorescence in situ hybridization or polymerase chain reaction to confirm the diagnosis. Our aim was to develop a novel protocol for analyzing APL samples based on multidimensional dot-plots that can provide comprehensive information about several markers at the same time. The protocol included four optimized multidimensional dot-plots, which were tested by retrospective reanalysis of FC results in APL (n = 8) and non-APL (n = 12) acute myeloid leukemia (AML) cases. After predicting the potential position of hypergranular- and microgranular-type aberrant promyelocytes, the percentages of blast populations were examined within the gates in all AML cases. The percentage of blasts in each predefined gate was well above the cut-off value (95%) in APL cases in all tubes. In non-APL AML cases, the percentage of blasts in the same gates never reached the cut-off value in all investigated tubes, and even when it did in a single tube, the pattern was markedly different from that observed in APL cases. In conclusion, multidimensional dot-plots can be used for screening APL even in cryptic APL cases, although reproducibility across several laboratories would require standardization of antibodies and fluorochromes. This easy-to-use and quick method can support the diagnosis of APL and the prompt initiation of the appropriate treatment.
Collapse
MESH Headings
- Adult
- Aged
- Antigens, CD/analysis
- Antigens, Neoplasm/analysis
- Biomarkers, Tumor/analysis
- Bone Marrow/pathology
- Chromosome Banding
- Chromosomes, Human, Pair 15/genetics
- Chromosomes, Human, Pair 15/ultrastructure
- Chromosomes, Human, Pair 17/genetics
- Chromosomes, Human, Pair 17/ultrastructure
- Data Display
- Early Detection of Cancer/methods
- Factor XIII/analysis
- Female
- Flow Cytometry/instrumentation
- Flow Cytometry/methods
- Fluorescent Dyes
- Humans
- Immunophenotyping/instrumentation
- Immunophenotyping/methods
- In Situ Hybridization, Fluorescence
- Leukemia, Promyelocytic, Acute/blood
- Leukemia, Promyelocytic, Acute/diagnosis
- Leukemia, Promyelocytic, Acute/genetics
- Male
- Middle Aged
- Neoplastic Stem Cells/pathology
- Oncogene Proteins, Fusion/genetics
- Retrospective Studies
- Translocation, Genetic
Collapse
Affiliation(s)
- Bettina Kárai
- Department of Laboratory Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary.
| | - Mira Habók
- Department of Laboratory Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary
| | - Gyula Reményi
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Rejtő
- Department of Hematology, Jósa András County Hospital, Nyíregyháza, Hungary
| | - Anikó Ujfalusi
- Department of Laboratory Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary
| | - János Kappelmayer
- Department of Laboratory Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary
| | - Zsuzsanna Hevessy
- Department of Laboratory Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary
| |
Collapse
|