1
|
Chen X, Johansson U, Cherian S. Flow Cytometric Assessment of Myelodysplastic Syndromes/Neoplasms. Clin Lab Med 2023; 43:521-547. [PMID: 37865501 DOI: 10.1016/j.cll.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Myelodysplastic syndromes/neoplasms (MDS) are a heterogeneous class of hematopoietic stem cell neoplasms characterized by ineffective hematopoiesis leading to peripheral cytopenias. This group of diseases is typically diagnosed using a combination of clinical, morphologic, and genetic criteria. Many studies have described the value of multiparametric flow cytometry (MFC) in the diagnosis, classification, and prognostication of MDS. This review summarizes the approach to MDS diagnosis and immunophenotypic characterization using MFC and describes the current state while highlighting future opportunities and potential pitfalls.
Collapse
Affiliation(s)
- Xueyan Chen
- Translational Science and Therapeutics Division, Fred Hutch Cancer Center, Seattle, WA, USA; Department of Laboratory Medicine and Pathology, University of Washington, 825 Eastlake Avenue East, Seattle, WA 98109, USA
| | - Ulrika Johansson
- SI-HMDS, Haematology, UHBW NHS Foundation Trust, Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Sindhu Cherian
- Department of Laboratory Medicine and Pathology, University of Washington, 825 Eastlake Avenue East, Seattle, WA 98109, USA.
| |
Collapse
|
2
|
Bauer K, Machherndl-Spandl S, Kazianka L, Sadovnik I, Gültekin S, Suessner S, Proell J, Lauf J, Hoermann G, Eisenwort G, Häfner N, Födermayr-Mayrleitner M, Schmolke AS, van der Kouwe E, Platzbecker U, Lion T, Weltermann A, Zach O, Webersinke G, Germing U, Gabriel C, Sperr WR, Béné MC, Staber PB, Bettelheim P, Valent P. CAR virus receptor mediates erythroid differentiation and migration and is downregulated in MDS. Leukemia 2023; 37:2250-2260. [PMID: 37673973 DOI: 10.1038/s41375-023-02015-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
Myelodysplastic syndromes (MDS) are myeloid neoplasms presenting with dysplasia in the bone marrow (BM) and peripheral cytopenia. In most patients anemia develops. We screened for genes that are expressed abnormally in erythroid progenitor cells (EP) and contribute to the pathogenesis of MDS. We found that the Coxsackie-Adenovirus receptor (CAR = CXADR) is markedly downregulated in CD45low/CD105+ EP in MDS patients compared to control EP. Correspondingly, the erythroblast cell lines HEL, K562, and KU812 stained negative for CAR. Lentiviral transduction of the full-length CXADR gene into these cells resulted in an increased expression of early erythroid antigens, including CD36, CD71, and glycophorin A. In addition, CXADR-transduction resulted in an increased migration against a serum protein gradient, whereas truncated CXADR variants did not induce expression of erythroid antigens or migration. Furthermore, conditional knock-out of Cxadr in C57BL/6 mice resulted in anemia and erythroid dysplasia. Finally, decreased CAR expression on EP was found to correlate with high-risk MDS and decreased survival. Together, CAR is a functionally relevant marker that is down-regulated on EP in MDS and is of prognostic significance. Decreased CAR expression may contribute to the maturation defect and altered migration of EP and thus their pathologic accumulation in the BM in MDS.
Collapse
Affiliation(s)
- Karin Bauer
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Sigrid Machherndl-Spandl
- Department of Internal Medicine I, Ordensklinikum, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Lukas Kazianka
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Irina Sadovnik
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Sinan Gültekin
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | | | - Johannes Proell
- Medical Faculty, Johannes Kepler University, Linz, Austria
- Department of Molecular Biology, Transfusion Service of Upper Austria, Linz, Austria
| | | | - Gregor Hoermann
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - Gregor Eisenwort
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Norman Häfner
- Department of Gynaecology and Obstetrics, Jena University Hospital, Jena, Germany
| | | | - Ann-Sofie Schmolke
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Emiel van der Kouwe
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Uwe Platzbecker
- Division of Hematology, University of Dresden, Dresden, Germany
- Medical Clinic and Polyclinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Lion
- Children´s Cancer Research Institute Vienna und Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Otto Zach
- Laboratory for Molecular and Genetic Diagnostics, Ordensklinikum, Linz, Austria
| | - Gerald Webersinke
- Laboratory for Molecular and Genetic Diagnostics, Ordensklinikum, Linz, Austria
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Medical University of Düsseldorf, Düsseldorf, Germany
| | - Christian Gabriel
- Department of Molecular Biology, Transfusion Service of Upper Austria, Linz, Austria
| | - Wolfgang R Sperr
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Marie C Béné
- Hematology Laboratory, CHU de Nantes, Nantes, France
| | - Philipp B Staber
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Peter Bettelheim
- Labor Europaplatz, Linz, Austria
- Laboratory for Molecular and Genetic Diagnostics, Ordensklinikum, Linz, Austria
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
3
|
Sorigue M. Diagnosis of erythroid dysplasia by flow cytometry: a review. Expert Rev Hematol 2023; 16:1049-1062. [PMID: 38018383 DOI: 10.1080/17474086.2023.2289534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION The diagnosis of myelodysplastic syndrome (MDS) is complex. Flow cytometric analysis of the myelomonocytic compartment can be helpful, but it is highly subjective and reproducibility by non-specialized groups is unclear. Analysis of the erythroid lineage by flow cytometry is emerging as potentially more reproducible and easier to conduct, while keeping a high diagnostic performance. AREAS COVERED We review the evidence in this area, including 1) the use of well-established markers - CD71 and CD36 - and other less well-established markers and parameters; 2) the use of flow cytometric scores for the erythroid lineage; and 3) additional aspects, including the emergence of computational tools and the roles of flow cytometry beyond diagnosis. Finally, we discuss the limitations with the current evidence, including 1) the impact of the sample processing protocol and reagents on the results, 2) the lack of a standard gating strategy, and 3) conceptualization and design issues in the available publications. EXPERT OPINION We end by offering our recommendations for the current use - and our personal take on the value - of the analysis of erythroid lineage by flow cytometry.
Collapse
Affiliation(s)
- Marc Sorigue
- Medical Department, Trialing Health, Barcelona, Spain
| |
Collapse
|
4
|
Johansson U, Rolf N, Futhee N, Stewart A. Erythroid side scatter: A parameter that improves diagnostic accuracy of flow cytometry myelodysplastic syndrome scoring. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2023; 104:151-161. [PMID: 35388621 DOI: 10.1002/cyto.b.22067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/23/2022] [Accepted: 03/22/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Flow cytometry immunophenotyping (FCM) is a benchmark test for integrated diagnosis of myelodysplastic syndromes (MDS). Our department's FCM-MDS-score follows international guidelines and additionally includes the maturing erythroid (mEry) side scatter (SSC)/lymphocyte SSC ratio (mErySSCr), often increased in MDS patients. A recent exploratory computational flow analysis study highlighted mErySSC as the top feature for separating MDS from non-MDS. Thus, we sought to systematically evaluate the diagnostic accuracy of mErySSCr in conventional diagnostic FCM as used currently in-house. METHODS Historical MDS (n = 93), chronic myelomonocytic leukemia (CMML; n = 27) and non-neoplastic cytopenia (n = 57) cohorts were created. Differences between these cohorts and LG-MDS entities were mapped and the mErySSCr cut-off was refined. Prospective bone marrows (n = 213) received for marrow failure work-up were used to determine the sensitivity and specificity of mErySSCr, both as a sole parameter and as a component of the MDS-score. RESULTS Low-grade (LG)-MDS mErySSCr differed more prominently from controls (p = <0.0001) than high-grade (HG)-MDS (p = 0.024). CMML and controls had a similar mErySSCr. As sole parameter, mErySSCr specificity was 91.1% (n = 112 non-MDS diagnoses) and sensitivity was 36% for LG-MDS (n = 36) and 25% for new HG-MDS diagnoses (n = 16). The specificity of the MDS-score was similar if mErySSCr was omitted (81.3% with and 82.1% without). The MDS-score sensitivity for new HG-MDS diagnoses and CMML (n = 17) was 100%, and was not affected by mErySSCr. The score sensitivity for LG-MDS however, dropped from 86.1% to 72.2% when mErySSCr was excluded. CONCLUSION mErySSCr increases the diagnostic accuracy of flow-based MDS scoring in our setting, particularly for LG-MDS.
Collapse
Affiliation(s)
- Ulrika Johansson
- SI-HMDS, University Hospitals and Weston NHS Foundation Trust, Bristol, UK
| | - Nina Rolf
- University of British Columbia, BC Children's Hospital Research Institute, Michael Cuccione Childhood Cancer Research Program, Vancouver, British Columbia, Canada
| | - Natasha Futhee
- SI-HMDS, University Hospitals and Weston NHS Foundation Trust, Bristol, UK
| | - Andrew Stewart
- SI-HMDS, University Hospitals and Weston NHS Foundation Trust, Bristol, UK
- Department of Haematology, University Hospitals and Weston NHS Foundation Trust, Bristol, UK
| |
Collapse
|
5
|
Porwit A, Béné MC, Duetz C, Matarraz S, Oelschlaegel U, Westers TM, Wagner-Ballon O, Kordasti S, Valent P, Preijers F, Alhan C, Bellos F, Bettelheim P, Burbury K, Chapuis N, Cremers E, Della Porta MG, Dunlop A, Eidenschink-Brodersen L, Font P, Fontenay M, Hobo W, Ireland R, Johansson U, Loken MR, Ogata K, Orfao A, Psarra K, Saft L, Subira D, Te Marvelde J, Wells DA, van der Velden VHJ, Kern W, van de Loosdrecht AA. Multiparameter flow cytometry in the evaluation of myelodysplasia: Analytical issues: Recommendations from the European LeukemiaNet/International Myelodysplastic Syndrome Flow Cytometry Working Group. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2023; 104:27-50. [PMID: 36537621 PMCID: PMC10107708 DOI: 10.1002/cyto.b.22108] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/20/2022] [Accepted: 11/29/2022] [Indexed: 01/18/2023]
Abstract
Multiparameter flow cytometry (MFC) is one of the essential ancillary methods in bone marrow (BM) investigation of patients with cytopenia and suspected myelodysplastic syndrome (MDS). MFC can also be applied in the follow-up of MDS patients undergoing treatment. This document summarizes recommendations from the International/European Leukemia Net Working Group for Flow Cytometry in Myelodysplastic Syndromes (ELN iMDS Flow) on the analytical issues in MFC for the diagnostic work-up of MDS. Recommendations for the analysis of several BM cell subsets such as myeloid precursors, maturing granulocytic and monocytic components and erythropoiesis are given. A core set of 17 markers identified as independently related to a cytomorphologic diagnosis of myelodysplasia is suggested as mandatory for MFC evaluation of BM in a patient with cytopenia. A myeloid precursor cell (CD34+ CD19- ) count >3% should be considered immunophenotypically indicative of myelodysplasia. However, MFC results should always be evaluated as part of an integrated hematopathology work-up. Looking forward, several machine-learning-based analytical tools of interest should be applied in parallel to conventional analytical methods to investigate their usefulness in integrated diagnostics, risk stratification, and potentially even in the evaluation of response to therapy, based on MFC data. In addition, compiling large uniform datasets is desirable, as most of the machine-learning-based methods tend to perform better with larger numbers of investigated samples, especially in such a heterogeneous disease as MDS.
Collapse
Affiliation(s)
- Anna Porwit
- Division of Oncology and Pathology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Marie C Béné
- Hematology Biology, Nantes University Hospital, CRCINA Inserm 1232, Nantes, France
| | - Carolien Duetz
- Department of Hematology, Amsterdam UMC, VU University Medical Center Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Sergio Matarraz
- Cancer Research Center (IBMCC-USAL/CSIC), Department of Medicine and Cytometry Service, Institute for Biomedical Research of Salamanca (IBSAL) and CIBERONC, University of Salamanca, Salamanca, Spain
| | - Uta Oelschlaegel
- Department of Internal Medicine, University Hospital Carl-Gustav-Carus, TU Dresden, Dresden, Germany
| | - Theresia M Westers
- Department of Hematology, Amsterdam UMC, VU University Medical Center Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Orianne Wagner-Ballon
- Department of Hematology and Immunology, Assistance Publique-Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
- Inserm U955, Université Paris-Est Créteil, Créteil, France
| | | | - Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology and Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Frank Preijers
- Laboratory of Hematology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Canan Alhan
- Department of Hematology, Amsterdam UMC, VU University Medical Center Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Peter Bettelheim
- Department of Hematology, Ordensklinikum Linz, Elisabethinen, Linz, Austria
| | - Kate Burbury
- Department of Haematology, Peter MacCallum Cancer Centre, & University of Melbourne, Melbourne, Australia
| | - Nicolas Chapuis
- Laboratory of Hematology, Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris, Cochin Hospital, Paris, France
- Institut Cochin, INSERM U1016, CNRS UMR, Université de Paris, Paris, France
| | - Eline Cremers
- Division of Hematology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Matteo G Della Porta
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alan Dunlop
- Department of Haemato-Oncology, Royal Marsden Hospital, London, UK
| | | | - Patricia Font
- Department of Hematology, Hospital General Universitario Gregorio Marañon-IiSGM, Madrid, Spain
| | - Michaela Fontenay
- Laboratory of Hematology, Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris, Cochin Hospital, Paris, France
- Institut Cochin, INSERM U1016, CNRS UMR, Université de Paris, Paris, France
| | - Willemijn Hobo
- Department of Internal Medicine I, Division of Hematology & Hemostaseology and Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Robin Ireland
- Department of Haematology and SE-HMDS, King's College Hospital NHS Foundation Trust, London, UK
| | - Ulrika Johansson
- Laboratory Medicine, SI-HMDS, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Kiyoyuki Ogata
- Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Alberto Orfao
- Cancer Research Center (IBMCC-USAL/CSIC), Department of Medicine and Cytometry Service, Institute for Biomedical Research of Salamanca (IBSAL) and CIBERONC, University of Salamanca, Salamanca, Spain
| | - Katherina Psarra
- Department of Immunology - Histocompatibility, Evangelismos Hospital, Athens, Greece
| | - Leonie Saft
- Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital and Institute Solna, Stockholm, Sweden
| | - Dolores Subira
- Department of Hematology, Flow Cytometry Unit, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Jeroen Te Marvelde
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Vincent H J van der Velden
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Arjan A van de Loosdrecht
- Department of Hematology, Amsterdam UMC, VU University Medical Center Cancer Center Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
6
|
Chauhan R, Singh J, Sharma C, Dange P, Chopra A, Mahapatra M, Pati H. The utility of a single tube 10-color flow cytometry for quantitative and qualitative analysis in myelodysplastic syndrome- a pilot study. Leuk Res 2021; 107:106651. [PMID: 34218155 DOI: 10.1016/j.leukres.2021.106651] [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: 12/13/2020] [Revised: 06/19/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Assessment of myelodysplasia (MDS) by flow cytometry (FCM) includes elaborate panels, and interpretation is observer-dependent. This study evaluates single tube 10-color FCM in a test cohort of clinically suspected MDS patients. METHODS We analyzed fifty-six bone marrow (BM) samples from clinically suspected MDS patients in a morphology-blinded manner along with controls using a 10-color single tube flow cytometry. We analyzed the reproducibility of Ogata score and modified FCM scores, additionally incorporating the proportion of CD15, CD11b, CD56, and CD38MFI on CD34+CD19-cluster for each patient. Patients were grouped as proven-MDS, suspected-MDS, and non-MDS groups based on morphology and cytogenetics. Optimized multi-axial radar-plots were also used to analyze maturation patterns in the granulocytic, monocytic, and blast progenitor compartments of proven-MDS cases and controls. RESULTS Flow cytometric abnormalities ≥3 were present in proven-MDS (n = 23) with a sensitivity and specificity of 78 % and 94 %, respectively, as per Ogata score. The addition of CD38 MFI to the score yielded sensitivity and specificity of 82 % and 88 %, respectively. Additional analysis of aberrant expression of CD15, CD11b, and CD56 increased the diagnostic power of the FCM score. A qualitative analysis of data also showed differences in maturation patterns in proven-MDS compared to the control group. CONCLUSION Single tube 10-color FCM scoring, including Ogata score, modified-FCM scores, and radar plots pattern analysis, showed significant abnormalities in proven-MDS cases in this pilot study. Large databases, including FCM-scoring and pattern-based analysis for normal BM maturation, could be further validated and standardized for screening MDS.
Collapse
Affiliation(s)
- Richa Chauhan
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Jay Singh
- Department of Laboratory Oncology, B.R.A.I.R.C.H., AIIMS, New Delhi, India
| | - Charu Sharma
- Department of Mathematics, Shiv Nadar University, Noida, U.P, India
| | - Prasad Dange
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Chopra
- Department of Laboratory Oncology, B.R.A.I.R.C.H., AIIMS, New Delhi, India.
| | - Manoranjan Mahapatra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Haraparasad Pati
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
7
|
de Winter DTC, Langerak AW, Te Marvelde J, Dworzak MN, De Moerloose B, Starý J, Locatelli F, Hasle H, de Vries ACH, Schmugge M, Niemeyer CM, van den Heuvel-Eibrink MM, van der Velden VHJ. The variable biological signature of refractory cytopenia of childhood (RCC), a retrospective EWOG-MDS study. Leuk Res 2021; 108:106652. [PMID: 34301409 DOI: 10.1016/j.leukres.2021.106652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Demi T C de Winter
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Anton W Langerak
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jeroen Te Marvelde
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Michael N Dworzak
- Department of Pediatrics, St. Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - Barbara De Moerloose
- Department of Pediatric Hematology and Oncology, Ghent University Hospital, Ghent, Belgium; Cancer Research Institute Ghent, Belgium
| | - Jan Starý
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Sapienza, University of Rome, Italy
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Andrica C H de Vries
- Department of Pediatric Hematology and Oncology, Erasmus MC, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Markus Schmugge
- Department of Hematology and Oncology, University Children's Hospital, Zurich, Switzerland
| | - Charlotte M Niemeyer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, University of Freiburg, Freiburg, Germany
| | | | | |
Collapse
|
8
|
Violidaki D, Axler O, Jafari K, Bild F, Nilsson L, Mazur J, Ehinger M, Porwit A. Analysis of erythroid maturation in the nonlysed bone marrow with help of radar plots facilitates detection of flow cytometric aberrations in myelodysplastic syndromes. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 98:399-411. [DOI: 10.1002/cyto.b.21931] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/12/2020] [Accepted: 05/27/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Despoina Violidaki
- Department of Clinical Genetics and Pathology Skåne University Hospital Lund Sweden
- Department of Clinical Sciences Oncology and Pathology, Lund University Lund Sweden
| | - Olof Axler
- Department of Clinical Genetics and Pathology Skåne University Hospital Lund Sweden
| | - Katayoon Jafari
- Department of Pathology University of Saskatchewan, Royal University Hospital Saskatoon Saskatchewan Canada
| | - Filippa Bild
- Department of Clinical Genetics and Pathology Skåne University Hospital Lund Sweden
| | - Lars Nilsson
- Department of Hematology, Oncology and Radiation Physics Skåne University Hospital Lund Sweden
| | - Joanna Mazur
- Department of Humanization of Medicine and Sexology Collegium Medicum University of Zielona Gora Zielona Gora Poland
| | - Mats Ehinger
- Department of Clinical Genetics and Pathology Skåne University Hospital Lund Sweden
- Department of Clinical Sciences Oncology and Pathology, Lund University Lund Sweden
| | - Anna Porwit
- Department of Clinical Genetics and Pathology Skåne University Hospital Lund Sweden
- Department of Clinical Sciences Oncology and Pathology, Lund University Lund Sweden
| |
Collapse
|
9
|
Sanz-De Pedro M, Wang W, Kanagal-Shamanna R, Khoury JD. Myelodysplastic Syndromes: Laboratory Workup in the Context of New Concepts and Classification Criteria. Curr Hematol Malig Rep 2019; 13:467-476. [PMID: 30338456 DOI: 10.1007/s11899-018-0483-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review provides a comprehensive update of myelodysplastic syndromes (MDS) and their diagnostic criteria, with emphasis on novel concepts and state-of-the-art laboratory workup, including multiparameter/multicolor flow cytometry, chromosome analysis, and mutation profiling. RECENT FINDINGS Recent advances in genetics and molecular technologies have provided unprecedented insights into the pathogenic mechanisms and genomic landscape of MDS and its precursor lesions. This has resulted in revised diagnostic criteria in the World Health Organization (WHO) classification and proposed new terminology for early lesions such as clonal hematopoiesis of indeterminate potential (CHIP). Against this landscape, a thorough understanding of the advantages and limitations of laboratory tests employed in the evaluation of patients with cytopenia has gained unprecedented importance. Healthcare providers involved in the care of patients with hematologic diseases should be aware of the intricacies of laboratory workup of such patients, particularly in view of the novel concepts and classification criteria of MDS.
Collapse
Affiliation(s)
- Maria Sanz-De Pedro
- Department of Laboratory Medicine, La Paz University Hospital, Madrid, Spain
| | - Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, MS-072, Houston, TX, 77030, USA
| | - Rashmi Kanagal-Shamanna
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, MS-072, Houston, TX, 77030, USA
| | - Joseph D Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, MS-072, Houston, TX, 77030, USA.
| |
Collapse
|
10
|
Gardikas N, Vikentiou M, Konsta E, Kontos CK, Papageorgiou SG, Spathis A, Bazani E, Bouchla A, Kapsimali V, Psarra K, Foukas P, Dimitriadis G, Pappa V. Immunophenotypic Profile of CD34+ Subpopulations and Their Role in the Diagnosis and Prognosis of Patients with De-Novo, Particularly Low-Grade Myelodysplastic Syndromes. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 96:73-82. [DOI: 10.1002/cyto.b.21725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/20/2018] [Accepted: 06/29/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Nikolaos Gardikas
- Second Department of Internal Medicine and Research Institute; University General Hospital Attikon; Haidari Greece
| | - Myrofora Vikentiou
- Second Department of Internal Medicine and Research Institute; University General Hospital Attikon; Haidari Greece
| | - Evgenia Konsta
- Second Department of Internal Medicine and Research Institute; University General Hospital Attikon; Haidari Greece
| | - Christos K. Kontos
- Department of Biochemistry and Molecular Biology; National and Kapodistrian University of Athens; Panepistimiopolis, Athens Greece
| | - Sotirios G. Papageorgiou
- Second Department of Internal Medicine and Research Institute; University General Hospital Attikon; Haidari Greece
| | - Aris Spathis
- 2nd Department of Pathology, School of Medicine; University of Athens, University General Hospital Attikon; Haidari Greece
| | - Efthimia Bazani
- Second Department of Internal Medicine and Research Institute; University General Hospital Attikon; Haidari Greece
| | - Anthi Bouchla
- Second Department of Internal Medicine and Research Institute; University General Hospital Attikon; Haidari Greece
| | - Violetta Kapsimali
- Department of Dermatology and Venereology; HIV/AIDS Unit, Andreas Syggros Hospital; Athens Greece
| | - Katherina Psarra
- Department of Immunology and Histocompatibility; Evangelismos Hospital; Athens Greece
| | - Periklis Foukas
- 2nd Department of Pathology, School of Medicine; University of Athens, University General Hospital Attikon; Haidari Greece
| | - George Dimitriadis
- Second Department of Internal Medicine and Research Institute; University General Hospital Attikon; Haidari Greece
| | - Vasiliki Pappa
- Second Department of Internal Medicine and Research Institute; University General Hospital Attikon; Haidari Greece
| |
Collapse
|
11
|
van Gammeren AJ, van Rijckevorsel M, Bras AE, Brandt-Hagens C, Te Marvelde JG, de Visser C, Joosen AMCP, Ermens AAM, van der Velden VHJ. Usability of femoral head bone marrow to verify reference ranges for the assessment of myelodysplasia by flow cytometry. Int J Lab Hematol 2018; 40:726-733. [PMID: 30173422 DOI: 10.1111/ijlh.12911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/30/2018] [Accepted: 07/10/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND A flow cytometry score (FCS) based on four parameters has been proposed for analysis of myelodysplastic syndromes patients with <5% blasts. We evaluated whether bone marrow aspirate samples isolated from femoral heads could be used for verification of cutoff values of the individual parameters score (IPS), contributing to the FCS and compared the applicability of FCS parameters in two centers. STUDY DESIGN AND METHODS Bone marrow cells were obtained from femoral heads of patients who underwent hip replacement surgery. The score of the 4 individual parameters of the cell samples were obtained independently in two centers, using their own facilities and methods. Flow cytometry data files were subsequently exchanged and reanalyzed in the other center. The resulting four data sets were compared to assess reproducibility and outcomes in both centers. RESULTS Twenty-nine of 40 bone marrow samples contained sufficient cells for analysis. Proposed cutoff values for 3 of 4 individual parameters were appropriate. All 29 samples showed a positive individual parameters score (IPS:1) in 1 of the 4 obtained data sets. Most differences in IPS scores were a result of reanalyzing the data file in the other center, rather than data acquisition. FCS: ≥2 were observed in 11 samples. CONCLUSION Bone marrow samples from femoral heads are appropriate for verification of the proposed reference cutoff values of the individual parameters. Proposed reference cutoff values needed to be adjusted for reliable interpretation. Standardization of both data acquisition and data analysis is necessary for obtaining uniform results.
Collapse
Affiliation(s)
- Adriaan J van Gammeren
- Department of Clinical Chemistry and Hematology, Amphia Hospital, Breda, the Netherlands
| | - M van Rijckevorsel
- Department of Clinical Chemistry and Hematology, Amphia Hospital, Breda, the Netherlands
| | - Anne E Bras
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Claudia Brandt-Hagens
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Jeroen G Te Marvelde
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Carin de Visser
- Department of Clinical Chemistry and Hematology, Amphia Hospital, Breda, the Netherlands
| | - Annemiek M C P Joosen
- Department of Clinical Chemistry and Hematology, Amphia Hospital, Breda, the Netherlands
| | - Anton A M Ermens
- Department of Clinical Chemistry and Hematology, Amphia Hospital, Breda, the Netherlands
| | - Vincent H J van der Velden
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
12
|
Magalhães SMM, Niero-Melo L, Chauffaille MDLLF, Velloso EDRP, Lorand-Metze I, Buzzini R, Bernardo WM. Guidelines on myelodysplastic syndromes: Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Hematol Transfus Cell Ther 2018; 40:255-261. [PMID: 30128435 PMCID: PMC6098189 DOI: 10.1016/j.htct.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/22/2018] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Lígia Niero-Melo
- Faculdade de Medicina de Botucatu da Universidade Estadual Paulista (FMB Unesp), Botucatu, SP, Brazil
| | | | - Elvira Deolinda Rodrigues Pereira Velloso
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC FMUSP), São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Irene Lorand-Metze
- Instituto Nacional de Ciência e Tecnologia do Sangue da Universidade Estadual de Campinas (Hemocentro Unicamp), Campinas, SP, Brazil
| | - Renata Buzzini
- Associação Médica Brasileira (AMB), São Paulo, SP, Brazil
| | - Wanderley Marques Bernardo
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC FMUSP), São Paulo, SP, Brazil; Associação Médica Brasileira (AMB), São Paulo, SP, Brazil
| |
Collapse
|
13
|
Valent P, Büsche G, Theurl I, Uras IZ, Germing U, Stauder R, Sotlar K, Füreder W, Bettelheim P, Pfeilstöcker M, Oberbauer R, Sperr WR, Geissler K, Schwaller J, Moriggl R, Béné MC, Jäger U, Horny HP, Hermine O. Normal and pathological erythropoiesis in adults: from gene regulation to targeted treatment concepts. Haematologica 2018; 103:1593-1603. [PMID: 30076180 PMCID: PMC6165792 DOI: 10.3324/haematol.2018.192518] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/30/2018] [Indexed: 12/12/2022] Open
Abstract
Pathological erythropoiesis with consequent anemia is a leading cause of symptomatic morbidity in internal medicine. The etiologies of anemia are complex and include reactive as well as neoplastic conditions. Clonal expansion of erythroid cells in the bone marrow may result in peripheral erythrocytosis and polycythemia but can also result in anemia when clonal cells are dysplastic and have a maturation arrest that leads to apoptosis and hinders migration, a constellation typically seen in the myelodysplastic syndromes. Rarely, clonal expansion of immature erythroid blasts results in a clinical picture resembling erythroid leukemia. Although several mechanisms underlying normal and abnormal erythropoiesis and the pathogenesis of related disorders have been deciphered in recent years, little is known about specific markers and targets through which prognosis and therapy could be improved in anemic or polycythemic patients. In order to discuss new markers, targets and novel therapeutic approaches in erythroid disorders and the related pathologies, a workshop was organized in Vienna in April 2017. The outcomes of this workshop are summarized in this review, which includes a discussion of new diagnostic and prognostic markers, the updated WHO classification, and an overview of new drugs used to stimulate or to interfere with erythropoiesis in various neoplastic and reactive conditions. The use and usefulness of established and novel erythropoiesis-stimulating agents for various indications, including myelodysplastic syndromes and other neoplasms, are also discussed.
Collapse
Affiliation(s)
- Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria .,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Austria
| | - Guntram Büsche
- Institute of Pathology, Medizinische Hochschule Hannover, Germany
| | - Igor Theurl
- Department of Internal Medicine II, Medical University Innsbruck, Austria
| | - Iris Z Uras
- Institute of Pharmacology and Toxicology, University of Veterinary Medicine, Vienna, Austria
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - Reinhard Stauder
- Department of Internal Medicine V, Medical University Innsbruck, Austria
| | - Karl Sotlar
- Institute of Pathology, Paracelsus Medical University Salzburg, Austria
| | - Wolfgang Füreder
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria
| | - Peter Bettelheim
- First Department of Internal Medicine, Elisabethinen Hospital, Linz, Austria
| | - Michael Pfeilstöcker
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Austria.,3Medical Department, Hanusch Hospital, Vienna, Austria
| | - Rainer Oberbauer
- Department of Nephrology and Dialysis, Medical University of Vienna, Austria
| | - Wolfgang R Sperr
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Austria
| | - Klaus Geissler
- 5Medical Department for Hematology and Oncology, Hospital Hietzing, Vienna, Austria
| | - Jürg Schwaller
- Department of Biomedicine, University Children's Hospital Basel, Switzerland
| | - Richard Moriggl
- Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria.,Department of Biomedical Science, Institute of Animal Breeding and Genetics, University of Veterinary Medicine, Vienna, Austria
| | - Marie C Béné
- Hematology Biology, University Hospital, Nantes, France
| | - Ulrich Jäger
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Austria
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilian University, Munich, Germany
| | - Olivier Hermine
- Imagine Institute, INSERM U 1163, CNRS 8654, Université Paris Descartes, Sorbonne, Paris Cité, France
| |
Collapse
|
14
|
Revising flow cytometric mini-panel for diagnosing low-grade myelodysplastic syndromes: Introducing a parameter quantifying CD33 expression on CD34+ cells. Leuk Res 2018; 71:75-81. [DOI: 10.1016/j.leukres.2018.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 11/18/2022]
|
15
|
Valent P. ICUS, IDUS, CHIP and CCUS: Diagnostic Criteria, Separation from MDS and Clinical Implications. Pathobiology 2018; 86:30-38. [PMID: 29860246 DOI: 10.1159/000489042] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/09/2018] [Indexed: 01/28/2023] Open
Abstract
Various myeloid neoplasms, including the myelodysplastic syndromes (MDS), bear a certain risk of progression to secondary acute myeloid leukemia (sAML). The evolution from low-risk to high-risk MDS and finally to sAML suggests that leukemogenesis is a multistep process. However, even before an overt neoplasm, such as an MDS, develops, "prediagnostic" clonal conditions may be identified. With the advent of large-scale genomic screens, such conditions may be detected quite frequently and early in apparently healthy individuals. Recent data suggest that these conditions increase with age and are indeed associated with an increased risk of the occurrence of MDS or another myeloid neoplasm. In other patients, unexplained cytopenia may be detected and may precede MDS. More recently, diagnostic criteria for potential pre-MDS conditions, including idiopathic cytopenia of uncertain significance and clonal hematopoiesis with indeterminate potential, have been proposed. The current article provides an overview of pre-MDS states and related criteria through which these conditions can be discriminated from each other and from MDS. In addition, the clinical implications and management of pre-MDS states are discussed.
Collapse
Affiliation(s)
- Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, .,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna,
| |
Collapse
|
16
|
Bento LC, Correia RP, Pitangueiras Mangueira CL, De Souza Barroso R, Rocha FA, Bacal NS, Marti LC. The Use of Flow Cytometry in Myelodysplastic Syndromes: A Review. Front Oncol 2017; 7:270. [PMID: 29188193 PMCID: PMC5694750 DOI: 10.3389/fonc.2017.00270] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/26/2017] [Indexed: 12/04/2022] Open
Abstract
Myelodysplastic syndromes (MDSs) are a heterogeneous group of hematopoietic stem cell diseases categorized by dysplasia in one or more hematopoietic cell lineages, as well as cytopenia and functional abnormalities in bone marrow cells. Several MDS classification methods have been proposed to categorize the disease and help professionals better plan in patients’ treatment. The World Health Organization classification, released in 2008 and revised in 2016, is the currently and the most used classification method worldwide. Recent advances in MDS molecular biology and innovations in flow cytometry have enabled the development of new parameters for MDS diagnosis and classification. Several groups have published flow cytometry scores and guidelines useful for the diagnosis and/or prognosis of MDS, which are mostly based on detecting immunophenotypic abnormalities in granulocyte, monocyte, and lymphoid lineages. Here, we review the current literature and discuss the main parameters that should be analyzed by flow cytometry with the aim of refining MDS diagnosis and prognosis. Furthermore, we discuss the critical role of flow cytometry and molecular biology in MDS diagnosis and prognosis, as well as the current challenges and future perspectives involving these techniques.
Collapse
Affiliation(s)
- Laiz Cameirão Bento
- Hospital Israelita Albert Einstein-Clinical Pathology Laboratory, São Paulo, Brazil
| | | | | | | | | | | | | |
Collapse
|
17
|
Mortera-Blanco T, Dimitriou M, Woll PS, Karimi M, Elvarsdottir E, Conte S, Tobiasson M, Jansson M, Douagi I, Moarii M, Saft L, Papaemmanuil E, Jacobsen SEW, Hellström-Lindberg E. SF3B1-initiating mutations in MDS-RSs target lymphomyeloid hematopoietic stem cells. Blood 2017; 130:881-890. [PMID: 28634182 PMCID: PMC5572789 DOI: 10.1182/blood-2017-03-776070] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/13/2017] [Indexed: 12/12/2022] Open
Abstract
Mutations in the RNA splicing gene SF3B1 are found in >80% of patients with myelodysplastic syndrome with ring sideroblasts (MDS-RS). We investigated the origin of SF3B1 mutations within the bone marrow hematopoietic stem and progenitor cell compartments in patients with MDS-RS. Screening for recurrently mutated genes in the mononuclear cell fraction revealed mutations in SF3B1 in 39 of 40 cases (97.5%), combined with TET2 and DNMT3A in 11 (28%) and 6 (15%) patients, respectively. All recurrent mutations identified in mononuclear cells could be tracked back to the phenotypically defined hematopoietic stem cell (HSC) compartment in all investigated patients and were also present in downstream myeloid and erythroid progenitor cells. While in agreement with previous studies, little or no evidence for clonal (SF3B1 mutation) involvement could be found in mature B cells, consistent involvement at the pro-B-cell progenitor stage was established, providing definitive evidence for SF3B1 mutations targeting lymphomyeloid HSCs and compatible with mutated SF3B1 negatively affecting lymphoid development. Assessment of stem cell function in vitro as well as in vivo established that only HSCs and not investigated progenitor populations could propagate the SF3B1 mutated clone. Upon transplantation into immune-deficient mice, SF3B1 mutated MDS-RS HSCs differentiated into characteristic ring sideroblasts, the hallmark of MDS-RS. Our findings provide evidence of a multipotent lymphomyeloid HSC origin of SF3B1 mutations in MDS-RS patients and provide a novel in vivo platform for mechanistically and therapeutically exploring SF3B1 mutated MDS-RS.
Collapse
Affiliation(s)
- Teresa Mortera-Blanco
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Marios Dimitriou
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Petter S Woll
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Haematopoietic Stem Cell Biology Laboratory, MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Mohsen Karimi
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Edda Elvarsdottir
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Simona Conte
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Magnus Tobiasson
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Monika Jansson
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Iyadh Douagi
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Matahi Moarii
- Memorial Sloan Kettering Cancer Center, New York, NY; and
| | - Leonie Saft
- Division of Hematopathology, Department of Pathology, Karolinska University Hospital, Solna, Sweden
| | | | - Sten Eirik W Jacobsen
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Haematopoietic Stem Cell Biology Laboratory, MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Eva Hellström-Lindberg
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| |
Collapse
|
18
|
Valent P, Orazi A, Steensma DP, Ebert BL, Haase D, Malcovati L, van de Loosdrecht AA, Haferlach T, Westers TM, Wells DA, Giagounidis A, Loken M, Orfao A, Lübbert M, Ganser A, Hofmann WK, Ogata K, Schanz J, Béné MC, Hoermann G, Sperr WR, Sotlar K, Bettelheim P, Stauder R, Pfeilstöcker M, Horny HP, Germing U, Greenberg P, Bennett JM. Proposed minimal diagnostic criteria for myelodysplastic syndromes (MDS) and potential pre-MDS conditions. Oncotarget 2017; 8:73483-73500. [PMID: 29088721 PMCID: PMC5650276 DOI: 10.18632/oncotarget.19008] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/26/2017] [Indexed: 12/13/2022] Open
Abstract
Myelodysplastic syndromes (MDS) comprise a heterogeneous group of myeloid neoplasms characterized by peripheral cytopenia, dysplasia, and a variable clinical course with about 30% risk to transform to secondary acute myeloid leukemia (AML). In the past 15 years, diagnostic evaluations, prognostication, and treatment of MDS have improved substantially. However, with the discovery of molecular markers and advent of novel targeted therapies, new challenges have emerged in the complex field of MDS. For example, MDS-related molecular lesions may be detectable in healthy individuals and increase in prevalence with age. Other patients exhibit persistent cytopenia of unknown etiology without dysplasia. Although these conditions are potential pre-phases of MDS they may also transform into other bone marrow neoplasms. Recently identified molecular, cytogenetic, and flow-based parameters may add in the delineation and prognostication of these conditions. However, no generally accepted integrated classification and no related criteria are as yet available. In an attempt to address this challenge, an international consensus group discussed these issues in a working conference in July 2016. The outcomes of this conference are summarized in the present article which includes criteria and a proposal for the classification of pre-MDS conditions as well as updated minimal diagnostic criteria of MDS. Moreover, we propose diagnostic standards to delineate between ´normal´, pre-MDS, and MDS. These standards and criteria should facilitate diagnostic and prognostic evaluations in clinical studies as well as in clinical practice.
Collapse
Affiliation(s)
- Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - Attilio Orazi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - David P Steensma
- Division of Hematological Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Benjamin L Ebert
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Detlef Haase
- Clinic of Hematology and Medical Oncology, Universitymedicine Göttingen, Göttingen, Germany
| | - Luca Malcovati
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Arjan A van de Loosdrecht
- Department of Hematology Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Theresia M Westers
- Department of Hematology Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | - Alberto Orfao
- Servicio Central de Citometría, Centro de Investigación del Cáncer (IBMCC, CSIC-USAL) and IBSAL, Universidad de Salamanca, Salamanca, Spain
| | - Michael Lübbert
- Department of Medicine I, Medical Center-University of Freiburg, Freiburg, Germany
| | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Kiyoyuki Ogata
- Metropolitan Research and Treatment Center for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Julie Schanz
- Clinic of Hematology and Medical Oncology, Universitymedicine Göttingen, Göttingen, Germany
| | - Marie C Béné
- Laboratoire d'Hématologie CHU de Nantes, Nantes, France
| | - Gregor Hoermann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Wolfgang R Sperr
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - Karl Sotlar
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Reinhard Stauder
- Department of Internal Medicine V (Haematology and Oncology) Innsbruck Medical University, Innsbruck, Austria
| | | | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilians University, Munich, Germany
| | - Ulrich Germing
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - John M Bennett
- Department of Pathology, Hematopathology Unit and James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA
| |
Collapse
|
19
|
Diagnostic Utility of Flow Cytometry in Myelodysplastic Syndromes. Mediterr J Hematol Infect Dis 2017; 9:e2017017. [PMID: 28293405 PMCID: PMC5333741 DOI: 10.4084/mjhid.2017.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/20/2017] [Indexed: 12/19/2022] Open
Abstract
The pathological hallmark of myelodysplastic syndromes (MDS) is marrow dysplasia, which represents the basis of the WHO classification of these disorders. This classification provides clinicians with a useful tool for defining the different subtypes of MDS and individual prognosis. The WHO proposal has raised some concern regarding minimal diagnostic criteria particularly in patients with normal karyotype without robust morphological markers of dysplasia (such as ring sideroblasts or excess of blasts). Therefore, there is clearly need to refine the accuracy to detect marrow dysplasia. Flow cytometry (FCM) immunophenotyping has been proposed as a tool to improve the evaluation of marrow dysplasia. The rationale for the application of FCM in the diagnostic work up of MDS is that immunophenotyping is an accurate method for quantitative and qualitative evaluation of hematopoietic cells and that MDS have been found to have abnormal expression of several cellular antigens. To become applicable in clinical practice, FCM analysis should be based on parameters with sufficient specificity and sensitivity, data should be reproducible between different operators, and the results should be easily understood by clinicians. In this review, we discuss the most relevant progresses in detection of marrow dysplasia by FCM in MDS
Collapse
|
20
|
Westers TM, Cremers EMP, Oelschlaegel U, Johansson U, Bettelheim P, Matarraz S, Orfao A, Moshaver B, Brodersen LE, Loken MR, Wells DA, Subirá D, Cullen M, Te Marvelde JG, van der Velden VHJ, Preijers FWMB, Chu SC, Feuillard J, Guérin E, Psarra K, Porwit A, Saft L, Ireland R, Milne T, Béné MC, Witte BI, Della Porta MG, Kern W, van de Loosdrecht AA. Immunophenotypic analysis of erythroid dysplasia in myelodysplastic syndromes. A report from the IMDSFlow working group. Haematologica 2016; 102:308-319. [PMID: 27758818 DOI: 10.3324/haematol.2016.147835] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 09/22/2016] [Indexed: 01/08/2023] Open
Abstract
Current recommendations for diagnosing myelodysplastic syndromes endorse flow cytometry as an informative tool. Most flow cytometry protocols focus on the analysis of progenitor cells and the evaluation of the maturing myelomonocytic lineage. However, one of the most frequently observed features of myelodysplastic syndromes is anemia, which may be associated with dyserythropoiesis. Therefore, analysis of changes in flow cytometry features of nucleated erythroid cells may complement current flow cytometry tools. The multicenter study within the IMDSFlow Working Group, reported herein, focused on defining flow cytometry parameters that enable discrimination of dyserythropoiesis associated with myelodysplastic syndromes from non-clonal cytopenias. Data from a learning cohort were compared between myelodysplasia and controls, and results were validated in a separate cohort. The learning cohort comprised 245 myelodysplasia cases, 290 pathological, and 142 normal controls; the validation cohort comprised 129 myelodysplasia cases, 153 pathological, and 49 normal controls. Multivariate logistic regression analysis performed in the learning cohort revealed that analysis of expression of CD36 and CD71 (expressed as coefficient of variation), in combination with CD71 fluorescence intensity and the percentage of CD117+ erythroid progenitors provided the best discrimination between myelodysplastic syndromes and non-clonal cytopenias (specificity 90%; 95% confidence interval: 84-94%). The high specificity of this marker set was confirmed in the validation cohort (92%; 95% confidence interval: 86-97%). This erythroid flow cytometry marker combination may improve the evaluation of cytopenic cases with suspected myelodysplasia, particularly when combined with flow cytometry assessment of the myelomonocytic lineage.
Collapse
Affiliation(s)
- Theresia M Westers
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - Eline M P Cremers
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - Uta Oelschlaegel
- Department of Internal Medicine, Universitätsklinikum "Carl-Gustav-Carus", Dresden, Germany
| | - Ulrika Johansson
- Department of Haematology, University Hospitals NHS Foundation Trust, Bristol, UK
| | | | - Sergio Matarraz
- Servicio Central de Citometría (NUCLEUS) and Department of Medicine, Centro de Investigación del Cáncer, Instituto de Biologia Celular y Molecular del Cáncer, (CSIC/USAL and IBSAL), Universidad de Salamanca, Spain
| | - Alberto Orfao
- Servicio Central de Citometría (NUCLEUS) and Department of Medicine, Centro de Investigación del Cáncer, Instituto de Biologia Celular y Molecular del Cáncer, (CSIC/USAL and IBSAL), Universidad de Salamanca, Spain
| | | | | | | | | | - Dolores Subirá
- Department of Hematology, Hospital Universitario de Guadalajara, Spain
| | | | - Jeroen G Te Marvelde
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | | | - Frank W M B Preijers
- Department of Laboratory Medicine - Laboratory for Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sung-Chao Chu
- Department of Hematology and Oncology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan
| | - Jean Feuillard
- Laboratoire d'Hématologie, CHU Dupuytren, Limoges, France
| | - Estelle Guérin
- Laboratoire d'Hématologie, CHU Dupuytren, Limoges, France
| | - Katherina Psarra
- Department of Immunology-Histocompatibility, Evangelismos Hospital, Athens, Greece
| | - Anna Porwit
- Department of Pathobiology and Laboratory Medicine, University of Toronto, University Health Network, Toronto General Hospital, ON, Canada.,Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Leonie Saft
- Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Marie C Béné
- Laboratoire d'Hématologie, CHU de Nantes, France
| | - Birgit I Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Matteo G Della Porta
- Department of Hematology and Oncology, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Italy
| | | | | | | |
Collapse
|
21
|
Cremers EMP, Westers TM, Alhan C, Cali C, Visser-Wisselaar HA, Chitu DA, van der Velden VHJ, Te Marvelde JG, Klein SK, Muus P, Vellenga E, de Greef GE, Legdeur MCCJC, Wijermans PW, Stevens-Kroef MJPL, Silva-Coelho PD, Jansen JH, Ossenkoppele GJ, van de Loosdrecht AA. Implementation of erythroid lineage analysis by flow cytometry in diagnostic models for myelodysplastic syndromes. Haematologica 2016; 102:320-326. [PMID: 27658438 DOI: 10.3324/haematol.2016.147843] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 09/14/2016] [Indexed: 12/17/2022] Open
Abstract
Flow cytometric analysis is a recommended tool in the diagnosis of myelodysplastic syndromes. Current flow cytometric approaches evaluate the (im)mature myelo-/monocytic lineage with a median sensitivity and specificity of ~71% and ~93%, respectively. We hypothesized that the addition of erythroid lineage analysis could increase the sensitivity of flow cytometry. Hereto, we validated the analysis of erythroid lineage parameters recommended by the International/European LeukemiaNet Working Group for Flow Cytometry in Myelodysplastic Syndromes, and incorporated this evaluation in currently applied flow cytometric models. One hundred and sixty-seven bone marrow aspirates were analyzed; 106 patients with myelodysplastic syndromes, and 61 cytopenic controls. There was a strong correlation between presence of erythroid aberrancies assessed by flow cytometry and the diagnosis of myelodysplastic syndromes when validating the previously described erythroid evaluation. Furthermore, addition of erythroid aberrancies to two different flow cytometric models led to an increased sensitivity in detecting myelodysplastic syndromes: from 74% to 86% for the addition to the diagnostic score designed by Ogata and colleagues, and from 69% to 80% for the addition to the integrated flow cytometric score for myelodysplastic syndromes, designed by our group. In both models the specificity was unaffected. The high sensitivity and specificity of flow cytometry in the detection of myelodysplastic syndromes illustrates the important value of flow cytometry in a standardized diagnostic approach. The trial is registered at www.trialregister.nl as NTR1825; EudraCT n.: 2008-002195-10.
Collapse
Affiliation(s)
- Eline M P Cremers
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - Theresia M Westers
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - Canan Alhan
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - Claudia Cali
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | | | - Dana A Chitu
- HOVON Data Center, Erasmus MC Cancer Institute, Clinical Trial Center, Rotterdam, The Netherlands
| | | | - Jeroen G Te Marvelde
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Saskia K Klein
- Department of Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands
| | - Petra Muus
- Department of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Edo Vellenga
- Department of Hematology, University Medical Center Groningen, The Netherlands
| | - Georgina E de Greef
- Department of Hematology Erasmus MC Cancer Institute Rotterdam, The Netherlands
| | | | - Pierre W Wijermans
- Department of Internal Medicine, Haga Ziekenhuis, The Hague, The Netherlands
| | | | - Pedro da Silva-Coelho
- Laboratory of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Joop H Jansen
- Laboratory of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gert J Ossenkoppele
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | | | | |
Collapse
|
22
|
Aanei CM, Picot T, Tavernier E, Guyotat D, Campos Catafal L. Diagnostic Utility of Flow Cytometry in Myelodysplastic Syndromes. Front Oncol 2016; 6:161. [PMID: 27446807 PMCID: PMC4921489 DOI: 10.3389/fonc.2016.00161] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/14/2016] [Indexed: 12/20/2022] Open
Abstract
Myelodysplastic syndromes (MDSs) are clonal disorders of hematopoiesis that exhibit heterogeneous clinical presentation and morphological findings, which complicates diagnosis, especially in early stages. Recently, refined definitions and standards in the diagnosis and treatment of MDS were proposed, but numerous questions remain. Multiparameter flow cytometry (MFC) is a helpful tool for the diagnostic workup of patients with suspected MDS, and various scores using MFC data have been developed. However, none of these methods have achieved the sensitivity that is required for a reassuring diagnosis in the absence of morphological abnormalities. One reason may be that each score evaluates one or two lineages without offering a broad view of the dysplastic process. The combination of two scores (e.g., Ogata and Red Score) improved the sensitivity from 50-60 to 88%, but the positive (PPV) and negative predictive values (NPV) must be improved. There are prominent differences between study groups when these scores are tested. Further research is needed to maximize the sensitivity of flow cytometric analysis in MDS. This review focuses on the application of flow cytometry for MDS diagnosis and discusses the advantages and limitations of different approaches.
Collapse
Affiliation(s)
- Carmen Mariana Aanei
- CNRS UMR5239, Université de Lyon, Saint-Etienne, France
- Laboratoire d’Hématologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - Tiphanie Picot
- CNRS UMR5239, Université de Lyon, Saint-Etienne, France
- Laboratoire d’Hématologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - Emmanuelle Tavernier
- CNRS UMR5239, Université de Lyon, Saint-Etienne, France
- Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France
| | - Denis Guyotat
- CNRS UMR5239, Université de Lyon, Saint-Etienne, France
- Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France
| | - Lydia Campos Catafal
- CNRS UMR5239, Université de Lyon, Saint-Etienne, France
- Laboratoire d’Hématologie, CHU de Saint-Etienne, Saint-Etienne, France
| |
Collapse
|
23
|
Somasundaram V, Soni S, Chopra A, Rai S, Mahapatra M, Kumar R, Pati H. Value of Quantitative assessment of Myeloid Nuclear Differentiation Antigen expression and other flow cytometric parameters in the diagnosis of Myelodysplastic syndrome. Int J Lab Hematol 2016; 38:141-50. [DOI: 10.1111/ijlh.12458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/17/2015] [Indexed: 11/30/2022]
Affiliation(s)
- V. Somasundaram
- Department of Haematology; IRCH; All India Institute of Medical Sciences; New Delhi India
| | - S. Soni
- Department of Laboratory Oncology; IRCH; All India Institute of Medical Sciences; New Delhi India
| | - A. Chopra
- Department of Laboratory Oncology; IRCH; All India Institute of Medical Sciences; New Delhi India
| | - S. Rai
- Department of Laboratory Oncology; IRCH; All India Institute of Medical Sciences; New Delhi India
| | - M. Mahapatra
- Department of Haematology; IRCH; All India Institute of Medical Sciences; New Delhi India
| | - R. Kumar
- Department of Laboratory Oncology; IRCH; All India Institute of Medical Sciences; New Delhi India
| | - H. Pati
- Department of Haematology; IRCH; All India Institute of Medical Sciences; New Delhi India
| |
Collapse
|
24
|
The shadowlands of MDS: idiopathic cytopenias of undetermined significance (ICUS) and clonal hematopoiesis of indeterminate potential (CHIP). Hematology 2015; 2015:299-307. [DOI: 10.1182/asheducation-2015.1.299] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AbstractThe WHO classification provides the best diagnostic approach to myelodysplastic syndromes (MDS). However, biologic and analytic limitations have emerged in the criteria currently adopted to establish the diagnosis and to classify MDS. The provisional category of idiopathic cytopenia of undetermined significance (ICUS) has been proposed to describe patients in whom MDS is possible but not proven. To formulate a diagnosis of ICUS, a thorough diagnostic work-up is required and repeated tests should be performed to reach a conclusive diagnosis. Recent studies provided consistent evidence of age-related hematopoietic clones (clonal hematopoiesis of indeterminate potential; CHIP), driven by mutations of genes that are recurrently mutated in myeloid neoplasms and associated with increase in the risk of hematologic cancer. A subset of mutated genes, mainly involved in epigenetic regulation, are likely initiating lesions driving the expansion of a premalignant clone. However, in a fraction of subjects the detected clone may be a small malignant clone expanding under the drive of the detected and additional undetected mutations. In addition, several experimental evidences suggest the potential relevance of an abnormal bone marrow environment in the selection and evolution of hematopoietic clones in MDS. The spreading of massively parallel sequencing techniques is offering translational opportunities in the clinical approach to myeloid neoplasms. Although several issues remain to be clarified, targeted gene sequencing may be of potential value in the dissection between clonal myelodysplasia, nonclonal cytopenia, and clonal hematopoiesis arising upon aging or in the context of acquired marrow failure.
Collapse
|
25
|
Importance of classical morphology in the diagnosis of myelodysplastic syndrome. Mediterr J Hematol Infect Dis 2015; 7:e2015035. [PMID: 25960863 PMCID: PMC4418392 DOI: 10.4084/mjhid.2015.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 04/23/2015] [Indexed: 01/16/2023] Open
Abstract
Myelodysplastic syndromes (MDS) are hematopoietic stem cell disorders characterized by dysplastic, ineffective, clonal and neoplastic hematopoiesis. MDS represent a complex hematological problem: differences in disease presentation, progression and outcome have necessitated the use of classification systems to improve diagnosis, prognostication, and treatment selection. However, since a single biological or genetic reliable diagnostic marker has not yet been discovered for MDS, quantitative and qualitative dysplastic morphological alterations of bone marrow precursors and peripheral blood cells are still fundamental for diagnostic classification. In this paper, World Health Organization (WHO) classification refinements and current minimal diagnostic criteria proposed by expert panels are highlighted, and related problematic issues are discussed. The recommendations should facilitate diagnostic and prognostic evaluations in MDS and selection of patients for new effective targeted therapies. Although, in the future, morphology should be supplemented with new molecular techniques, the morphological approach, at least for the moment, is still the cornerstone for the diagnosis and classification of these disorders.
Collapse
|
26
|
Bardet V, Wagner-Ballon O, Guy J, Morvan C, Debord C, Trimoreau F, Benayoun E, Chapuis N, Freynet N, Rossi C, Mathis S, Gourin MP, Toma A, Béné MC, Feuillard J, Guérin E. Multicentric study underlining the interest of adding CD5, CD7 and CD56 expression assessment to the flow cytometric Ogata score in myelodysplastic syndromes and myelodysplastic/myeloproliferative neoplasms. Haematologica 2015; 100:472-8. [PMID: 25637056 DOI: 10.3324/haematol.2014.112755] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Although numerous recent publications have demonstrated interest in multiparameter flow cytometry in the investigation of myelodysplastic disorders, it is perceived by many laboratory hematologists as difficult and expensive, requiring a high level of expertise. We report a multicentric open real-life study aimed at evaluating the added value of the technically simple flow cytometry score described by the Ogata group for the diagnosis of myelodysplastic syndromes. A total of 652 patients were recruited prospectively in four different centers: 346 myelodysplastic syndromes, 53 myelodysplastic/myeloproliferative neoplasms, and 253 controls. The Ogata score was assessed using CD45 and CD34 staining, with the addition of CD10 and CD19. Moreover, labeling of CD5, CD7 and CD56 for the evaluation of myeloid progenitors and monocytes was tested on a subset of 294 patients. On the whole series, the specificity of Ogata score reached 89%. Respective sensitivities were 54% for low-risk myelodysplastic syndromes, 68% and 84% for type 1 and type 2 refractory anemia with excess of blasts, and 72% for myelodysplastic/myeloproliferative neoplasms. CD5 expression was poorly informative. When adding CD56 or CD7 labeling to the Ogata score, sensitivity rose to 66% for low-risk myelodysplastic syndromes, to 89% for myelodysplastic/myeloproliferative neoplasms and to 97% for refractory anemia with excess of blasts. This large multicenter study confirms the feasibility of Ogata scoring in routine flow cytometry diagnosis but highlights its poor sensitivity in low-risk myelodysplastic syndromes. The addition of CD7 and CD56 in flow cytometry panels improves the sensitivity but more sophisticated panels would be more informative.
Collapse
Affiliation(s)
- Valérie Bardet
- Service d'Hématologie Biologique, Hôpitaux Universitaires Paris Centre-Cochin, Faculté de Médecine Paris Descartes, INSERM U1016, UMR 8104, Paris
| | - Orianne Wagner-Ballon
- Département d'Hématologie et d'Immunologie Biologiques, Hôpitaux Universitaires Henri Mondor, APHP, Faculté de Médecine UPEC, Créteil
| | - Julien Guy
- Service d'Hématologie Biologique, CHU de Dijon
| | - Céline Morvan
- Service d'Hématologie Biologique, Hôpital Dupuytren, CHU de Limoges, Faculté de Médecine et UMR CNRS 7276, Limoges
| | - Camille Debord
- Service d'Hématologie Biologique, Hôpitaux Universitaires Paris Centre-Cochin, Faculté de Médecine Paris Descartes, INSERM U1016, UMR 8104, Paris
| | - Franck Trimoreau
- Service d'Hématologie Biologique, Hôpital Dupuytren, CHU de Limoges, Faculté de Médecine et UMR CNRS 7276, Limoges
| | - Emmanuel Benayoun
- Département d'Hématologie et d'Immunologie Biologiques, Hôpitaux Universitaires Henri Mondor, APHP, Faculté de Médecine UPEC, Créteil
| | - Nicolas Chapuis
- Service d'Hématologie Biologique, Hôpitaux Universitaires Paris Centre-Cochin, Faculté de Médecine Paris Descartes, INSERM U1016, UMR 8104, Paris
| | - Nicolas Freynet
- Département d'Hématologie et d'Immunologie Biologiques, Hôpitaux Universitaires Henri Mondor, APHP, Faculté de Médecine UPEC, Créteil
| | | | - Stéphanie Mathis
- Service d'Hématologie Biologique, Hôpitaux Universitaires Paris Centre-Cochin, Faculté de Médecine Paris Descartes, INSERM U1016, UMR 8104, Paris
| | | | - Andréa Toma
- Service d'Hématologie Clinique, Hôpitaux Universitaires Henri Mondor, APHP, Créteil
| | - Marie C Béné
- Service d'Hématologie Biologique, CHU de Nantes, France
| | - Jean Feuillard
- Service d'Hématologie Biologique, Hôpital Dupuytren, CHU de Limoges, Faculté de Médecine et UMR CNRS 7276, Limoges
| | - Estelle Guérin
- Service d'Hématologie Biologique, Hôpital Dupuytren, CHU de Limoges, Faculté de Médecine et UMR CNRS 7276, Limoges
| | | | | |
Collapse
|
27
|
Eidenschink Brodersen L, Menssen AJ, Wangen JR, Stephenson CF, de Baca ME, Zehentner BK, Wells DA, Loken MR. Assessment of erythroid dysplasia by "difference from normal" in routine clinical flow cytometry workup. CYTOMETRY PART B-CLINICAL CYTOMETRY 2014; 88:125-35. [PMID: 25490867 DOI: 10.1002/cyto.b.21199] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 09/25/2014] [Accepted: 10/17/2014] [Indexed: 01/06/2023]
Abstract
INTRODUCTION While multidimensional flow cytometry (MDF) has great utility in diagnostic workups of patients with suspected myelodysplastic syndromes (MDS), only the myeloid lineage has demonstrated reproducible abnormalities from multiple laboratories. With the effects of ammonium chloride (NH4 Cl) lysis on erythroid progenitors previously described, we applied this protocol to a patient cohort with diagnosed MDS to investigate phenotypic abnormalities that indicate erythroid dysplasia. METHOD Bone marrow specimens [39 MDS, 9 acute myeloid leukemia (AML), 7 JAK2(V617F) positive myeloproliferative neoplasms (MPN), and 5 nutritional deficiencies] were processed by NH4 Cl lysis and Ficoll preparation and evaluated by MDF using a difference from normal algorithm. RESULTS For the MDS cohort, phenotypic abnormalities on the mature erythroid progenitors were frequent for CD71 and CD36 (36% for each antigen); abnormalities for CD235a (8%) were observed. Among immature erythroid progenitors, abnormal maturation patterns (≤5%), and increased CD105 intensity (9%) were seen. Increased frequency of CD105 bright cells was observed (18%). While antigenic abnormalities correlated between NH4 Cl lysis and Ficoll preparation, the lysis method demonstrated the most consistent quantitative antigen intensities. Mean erythroid phenotypic abnormalities and prognostic cytogenetic subgroups correlated strongly. Morphologic and erythroid phenotypic abnormalities correlated, as did increasing FCSS and number of erythroid abnormalities, albeit without further increase for AML patients. DISCUSSION These data expand the understanding of erythropoiesis and define immunophenotypic abnormalities that indicate dyserythropoiesis in MDS using a lysis protocol practical for routine implementation in clinical flow cytometric workup. Preliminary studies also indicate strong correlation between phenotypic erythroid dysplasia and poor prognosis, as classified cytogenetically.
Collapse
|
28
|
Aalbers AM, van den Heuvel-Eibrink MM, Baumann I, Dworzak M, Hasle H, Locatelli F, De Moerloose B, Schmugge M, Mejstrikova E, Nováková M, Zecca M, Zwaan CM, Te Marvelde JG, Langerak AW, van Dongen JJM, Pieters R, Niemeyer CM, van der Velden VHJ. Bone marrow immunophenotyping by flow cytometry in refractory cytopenia of childhood. Haematologica 2014; 100:315-23. [PMID: 25425683 DOI: 10.3324/haematol.2014.107706] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Refractory cytopenia of childhood is the most common type of childhood myelodysplastic syndrome. Because the majority of children with refractory cytopenia have a normal karyotype and a hypocellular bone marrow, differentiating refractory cytopenia from the immune-mediated bone marrow failure syndrome (very) severe aplastic anemia can be challenging. Flow cytometric immunophenotyping of bone marrow has been shown to be a valuable diagnostic tool in differentiating myelodysplastic syndrome from non-clonal cytopenias in adults. Here, we performed the first comprehensive flow cytometric analysis of immature myeloid, lymphoid cells and erythroid cells, and granulocytes, monocytes, and lymphoid cells in bone marrow obtained from a large prospective cohort of 81 children with refractory cytopenia. Children with refractory cyotopenia had a strongly reduced myeloid compartment, but not as severe as children with aplastic anemia. Furthermore, the number of flow cytometric abnormalities was significantly higher in children with refractory cytopenia than in healthy controls and in children with aplastic anemia, but lower than in advanced myelodysplastic syndrome. We conclude that flow cytometric immunophenotyping could be a relevant addition to histopathology in the diagnosis of refractory cytopenia of childhood. (The multi-center studies EWOG-MDS RC06 and EWOG-MDS 2006 are registered at clinicaltrials.gov identifiers 00499070 and 00662090, respectively).
Collapse
Affiliation(s)
- Anna M Aalbers
- Department of Immunology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Pediatric Oncology/Hematology, Sophia Children's Hospital - Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Department of Pediatric Oncology/Hematology, Sophia Children's Hospital - Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Irith Baumann
- Department of Pathology, Clinical Centre South West, Böblingen Clinics, Germany
| | - Michael Dworzak
- St. Anna Children's Hospital and Children's Cancer Research Institute, Department of Pediatrics, Medical University of Vienna, Austria
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Franco Locatelli
- Department of Pediatric Hematology-Oncology, IRCCS Ospedale Bambino Gesù, Rome, University of Pavia, Italy
| | - Barbara De Moerloose
- Department of Pediatric Hematology/Oncology, Ghent University Hospital, Ghent, Belgium
| | - Markus Schmugge
- Department of Hematology, University Children's Hospital, Zurich, Switzerland
| | - Ester Mejstrikova
- Department of Pediatric Hematology/Oncology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Michaela Nováková
- Department of Pediatric Hematology/Oncology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Marco Zecca
- Pediatric Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Michel Zwaan
- Department of Pediatric Oncology/Hematology, Sophia Children's Hospital - Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jeroen G Te Marvelde
- Department of Immunology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anton W Langerak
- Department of Immunology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jacques J M van Dongen
- Department of Immunology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rob Pieters
- Department of Pediatric Oncology/Hematology, Sophia Children's Hospital - Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Charlotte M Niemeyer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, University of Freiburg, Germany
| | | |
Collapse
|
29
|
Molteni A, Riva M, Cesana C, Speziale V, Nichelatti M, Scarpati B, Greco R, Ravano E, Cairoli R, Rossini S, Morra E. Prognostic relevance of the flow cytometric count of medullar blasts in myelodysplastic syndromes. Eur J Haematol 2014; 94:519-25. [PMID: 25307971 DOI: 10.1111/ejh.12465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The medullar blast count is a milestone in the prognostic assessment in myelodysplastic syndromes (MDS). The optical microscopy (OM) may sometimes be inaccurate in this disease. The aim of this work is to test the flow immunocytometric (FCM) determinations of medullar immature cells (CD45(±) ) and the expression, among them, of CD33, CD34, and CD117 markers, for their prognostic relevance. METHODS In a retrospective analysis of 98 patients affected by MDS, the IPSS was re-calculated by means of the FCM determination of blasts. Survival of patients at low or intermediate-1 IPSS risk was compared with the survival of patients at intermediate-2 or high IPSS risk. In the 64 cases with OM blast count lower than 5%, the survival of patients with the FCM count of medullar blasts ≤2% was compared with that of patients with FCM count >2%. RESULTS Each single marker had a prognostic weight comparable to the optical blast count. The FCM blast count was particularly efficient in distinguishing the risk of having up to 2% or more than 2% of blasts in patients without OM excess of blasts. CONCLUSION This method is interesting as prognostic tool, especially in patients without excess of blast.
Collapse
Affiliation(s)
- Alfredo Molteni
- Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Marta Riva
- Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Clara Cesana
- Immuno-Hematology and Transfusional Unit, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Valentina Speziale
- Department of General Medicine, AO Ospedale Civile di Legnano, Legnano, Italy
| | - Michele Nichelatti
- Service of Biostatistics Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Barbara Scarpati
- Immuno-Hematology and Transfusional Unit, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Rosa Greco
- Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Emanuele Ravano
- Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Roberto Cairoli
- Department of General Medicine, Oncology and Hematology, Ospedale Valduce, Como, Italy
| | - Silvano Rossini
- Immuno-Hematology and Transfusional Unit, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Enrica Morra
- Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| |
Collapse
|
30
|
Alhan C, Westers TM, Cremers EMP, Cali C, Witte BI, Ossenkoppele GJ, van de Loosdrecht AA. High flow cytometric scores identify adverse prognostic subgroups within the revised international prognostic scoring system for myelodysplastic syndromes. Br J Haematol 2014; 167:100-9. [DOI: 10.1111/bjh.12994] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/21/2014] [Indexed: 12/23/2022]
Affiliation(s)
- Canan Alhan
- Department of Haematology; Cancer Centre Amsterdam; VU University Medical Centre; Amsterdam The Netherlands
| | - Theresia M. Westers
- Department of Haematology; Cancer Centre Amsterdam; VU University Medical Centre; Amsterdam The Netherlands
| | - Eline M. P. Cremers
- Department of Haematology; Cancer Centre Amsterdam; VU University Medical Centre; Amsterdam The Netherlands
| | - Claudia Cali
- Department of Haematology; Cancer Centre Amsterdam; VU University Medical Centre; Amsterdam The Netherlands
| | - Birgit I. Witte
- Department of Epidemiology and Biostatistics; VU University Medical Centre; Amsterdam The Netherlands
| | - Gert J. Ossenkoppele
- Department of Haematology; Cancer Centre Amsterdam; VU University Medical Centre; Amsterdam The Netherlands
| | - Arjan A. van de Loosdrecht
- Department of Haematology; Cancer Centre Amsterdam; VU University Medical Centre; Amsterdam The Netherlands
| |
Collapse
|
31
|
DeZern AE, Sekeres MA. The challenging world of cytopenias: distinguishing myelodysplastic syndromes from other disorders of marrow failure. Oncologist 2014; 19:735-45. [PMID: 24899643 DOI: 10.1634/theoncologist.2014-0056] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Over the past decade, our understanding of bone marrow failure has advanced considerably. Marrow failure encompasses multiple overlapping diseases, and there is increasing availability of diagnostic tools to distinguish among the subtypes. Identification of genetic alterations that underlie marrow failure has also greatly expanded, especially for myelodysplastic syndromes. Molecular markers are increasingly used to guide the management of myelodysplasia and may distinguish this diagnosis from other marrow failure disorders. This review summarizes the current state of distinguishing among causes of marrow failure and discusses the potential uses of multiple diagnostic and prognostic indicators in the management of myelodysplastic syndromes and other bone marrow failure disorders.
Collapse
Affiliation(s)
- Amy E DeZern
- The Sidney Kimmel Comprehensive Cancer Center and Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mikkael A Sekeres
- The Sidney Kimmel Comprehensive Cancer Center and Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
32
|
Johansson U, Bloxham D, Couzens S, Jesson J, Morilla R, Erber W, Macey M. Guidelines on the use of multicolour flow cytometry in the diagnosis of haematological neoplasms. British Committee for Standards in Haematology. Br J Haematol 2014; 165:455-88. [PMID: 24620735 DOI: 10.1111/bjh.12789] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
33
|
Woo J, Baumann A, Arguello V. Recent advancements of flow cytometry: new applications in hematology and oncology. Expert Rev Mol Diagn 2013; 14:67-81. [DOI: 10.1586/14737159.2014.862153] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
34
|
Wangen JR, Eidenschink Brodersen L, Stolk TT, Wells DA, Loken MR. Assessment of normal erythropoiesis by flow cytometry: important considerations for specimen preparation. Int J Lab Hematol 2013; 36:184-96. [PMID: 24118926 DOI: 10.1111/ijlh.12151] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 07/15/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The extension of quantitative flow cytometric studies to the erythroid lineage in patients with suspected myelodysplastic syndrome has prompted a reassessment of cell surface antigen expression during normal erythropoiesis. Erythropoiesis in normal and pathologic bone marrows was studied to determine the expected antigenic relationships of maturing erythroid cells. METHODS A total of 200 bone marrow specimens were evaluated by multidimensional flow cytometry (MDF). Samples were prepared using either NH4 Cl lysis or Ficoll density gradient separation. RESULTS Normal erythroid development is described as a two-step process observable with the intensity relationships between CD235a, CD71, CD45, CD105, CD34, CD117, and CD36. The variability of these intensities (CV) was determined. A comparison of processing techniques determined lysis is the optimal analytic technique for the analysis of early-stage erythroid cells. Nucleic acid staining with DRAQ5 revealed that Ficoll allows for the analysis of reticulocytes and mature erythrocytes otherwise eliminated by lysis. CONCLUSION These data demonstrate while lysis alters the light scatter characteristics of erythroid precursors, it did not alter quantitative antigen expression or nucleic acid content. The expected variability in antigen intensities is defined. These studies provide a basis for a comparison of erythroid development between normal individuals and those with erythroid dysplasia associated with myelodysplastic syndromes.
Collapse
|
35
|
Diagnosis and treatment of primary myelodysplastic syndromes in adults: recommendations from the European LeukemiaNet. Blood 2013; 122:2943-64. [PMID: 23980065 DOI: 10.1182/blood-2013-03-492884] [Citation(s) in RCA: 478] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Within the myelodysplastic syndrome (MDS) work package of the European LeukemiaNet, an Expert Panel was selected according to the framework elements of the National Institutes of Health Consensus Development Program. A systematic review of the literature was performed that included indexed original papers, indexed reviews and educational papers, and abstracts of conference proceedings. Guidelines were developed on the basis of a list of patient- and therapy-oriented questions, and recommendations were formulated and ranked according to the supporting level of evidence. MDSs should be classified according to the 2008 World Health Organization criteria. An accurate risk assessment requires the evaluation of not only disease-related factors but also of those related to extrahematologic comorbidity. The assessment of individual risk enables the identification of fit patients with a poor prognosis who are candidates for up-front intensive treatments, primarily allogeneic stem cell transplantation. A high proportion of MDS patients are not eligible for potentially curative treatment because of advanced age and/or clinically relevant comorbidities and poor performance status. In these patients, the therapeutic intervention is aimed at preventing cytopenia-related morbidity and preserving quality of life. A number of new agents are being developed for which the available evidence is not sufficient to recommend routine use. The inclusion of patients into prospective clinical trials is strongly recommended.
Collapse
|
36
|
Liu Q, Wang M, Hu Y, Xing H, Chen X, Zhang Y, Zhu P. Significance of CD71 expression by flow cytometry in diagnosis of acute leukemia. Leuk Lymphoma 2013; 55:892-8. [PMID: 23962073 DOI: 10.3109/10428194.2013.819100] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In this study we investigated the significance of CD71 (transferrin receptor 1, TfR-1) as a flow cytometric marker in the diagnosis of acute leukemia (AL). A total of 105 patients with AL were enrolled. Poorly differentiated acute myeloid leukemias (AMLs) (including minimally differentiated AML, AML without maturation, AML with maturation, acute myelomonocytic leukemia) tended to express high levels of CD71 on leukemic cells, while partially differentiated AML (including acute promyelocytic leukemia and acute monocytic leukemia) often expressed low levels of CD71 on leukemic cells (p < 0.05, compared to poorly differentiated AML). B-cell acute lymphoblastic leukemia (B-ALL) expressed low levels of CD71 on leukemic cells, significantly lower than AML, mixed phenotype acute leukemia (MPAL) and normal bone marrow blasts (p < 0.05). In the seven cases of acute erythroid leukemia (AEL), leukemic cells rarely expressed CD71, with the mean CD71 expression level significantly lower than that of acute megakaryocytic leukemia (p < 0.05), and also lower than that of poorly differentiated AML and normal blasts but without statistical significance. CD71 may not be a specific marker for AEL leukemic cells. During the process from myeloid dysplasia to apparent leukemic cells, both CD71 and CD34 gradually increased. Consequently, the presence of leukemic cell subsets with variable levels of CD71 and CD34 may be useful for understanding the dynamic processes involved in the clonal development seen in leukemias.
Collapse
Affiliation(s)
- Qian Liu
- Department of Hematology, Peking University First Hospital , Beijing , China
| | | | | | | | | | | | | |
Collapse
|
37
|
Burbury KL, Westerman DA. Role of flow cytometry in myelodysplastic syndromes: diagnosis, classification, prognosis and response assessment. Leuk Lymphoma 2013; 55:749-60. [PMID: 23808833 DOI: 10.3109/10428194.2013.820291] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Myelodysplastic syndromes (MDS) are a heterogeneous group of myeloid neoplasms. With the emergence of therapeutic options, attempts to standardize diagnostic, prognostic and response criteria to guide treatment decisions are increasingly important. This has been achieved in part by the revised 2008 World Health Organization classification and consensus guidelines outlining refined definitions and standards. Conventional criteria have limitations in terms of sensitivity and specificity. Multiparameter flow cytometry (FC) can be used real-time, and is a highly reproducible and objective way of assessing the pattern of expression of multiple antigens on a single hematopoietic cell and defined subpopulations. By comparing antigen expression within maturing myelomonocytic populations with that identified on the equivalent normal cells, abnormalities identified may provide a diagnostic indication of stem cell dysmaturation. There are now increasingly robust data demonstrating the capacity of FC to discriminate MDS from non-clonal cytopenias and dysplasia, as well as further refine disease classification and prognostication, which will be reviewed here.
Collapse
Affiliation(s)
- Kate L Burbury
- Division of Cancer Medicine, Peter MacCallum Cancer Centre , East Melbourne, Melbourne , Australia
| | | |
Collapse
|
38
|
Flow cytometric detection of dyserythropoiesis: a sensitive and powerful diagnostic tool for myelodysplastic syndromes. Leukemia 2013; 27:1981-7. [DOI: 10.1038/leu.2013.178] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/05/2013] [Accepted: 06/10/2013] [Indexed: 01/09/2023]
|
39
|
Fajtova M, Kovarikova A, Svec P, Kankuri E, Sedlak J. Immunophenotypic profile of nucleated erythroid progenitors during maturation in regenerating bone marrow. Leuk Lymphoma 2013; 54:2523-30. [DOI: 10.3109/10428194.2013.781167] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Michaela Fajtova
- Cancer Research Institute
- Center for Molecular Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Anna Kovarikova
- Cancer Research Institute
- Center for Molecular Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Peter Svec
- 2nd Department of Pediatric Hematology and Oncology, Comenius University Children's Hospital, Bratislava, Slovakia
| | - Esko Kankuri
- Institute of Biomedicine, Pharmacology, Biomedicum, University of Helsinki, Finland
| | | |
Collapse
|
40
|
Molecular pathways of early CD105-positive erythroid cells as compared with CD34-positive common precursor cells by flow cytometric cell-sorting and gene expression profiling. Blood Cancer J 2013; 3:e100. [PMID: 23310930 PMCID: PMC3556575 DOI: 10.1038/bcj.2012.45] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Special attention has recently been drawn to the molecular network of different genes that are responsible for the development of erythroid cells. The aim of the present study was to establish in detail the immunophenotype of early erythroid cells and to compare the gene expression profile of freshly isolated early erythroid precursors with that of the CD34-positive (CD34(+)) compartment. Multiparameter flow cytometric analyses of human bone marrow mononuclear cell fractions (n=20) defined three distinct early erythroid stages. The gene expression profile of sorted early erythroid cells was analyzed by Affymetrix array technology. For 4524 genes, a differential regulation was found in CD105-positive erythroid cells as compared with the CD34(+) progenitor compartment (2362 upregulated genes). A highly significant difference was observed in the expression level of genes involved in transcription, heme synthesis, iron and mitochondrial metabolism and transforming growth factor-β signaling. A comparison with recently published data showed over 1000 genes that as yet have not been reported to be upregulated in the early erythroid lineage. The gene expression level within distinct pathways could be illustrated directly by applying the Ingenuity software program. The results of gene expression analyses can be seen at the Gene Expression Omnibus repository.
Collapse
|
41
|
De Smet D, Trullemans F, Jochmans K, Renmans W, Smet L, Heylen O, Bael AM, Schots R, Leus B, De Waele M. Diagnostic potential of CD34+ cell antigen expression in myelodysplastic syndromes. Am J Clin Pathol 2012; 138:732-43. [PMID: 23086775 DOI: 10.1309/ajcpagvo27rptotv] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The World Health Organization introduced flow cytometry as an additional criterion for diagnosis of myelodysplastic syndromes (MDS). Aberrant antigen expression on bone marrow (BM) blasts may identify "low-grade MDS." This study aimed to examine differences in antigen expression on CD34+ BM cells between patients with MDS and those with secondary cytopenia. BM aspirates of 175 patients with cytopenia were classified as MDS or secondary cytopenia. Expression of stem cell antigens (CD34, CD133), myeloid antigens (CD13, CD33), B-cell antigens (CD19, CD10), growth factor receptors (CD117, CD123), and chemokine receptor (CD184) was examined. Thirty-two normal adults and 49 patients with CD34+ acute myeloid leukemia (AML) were also examined. High percentage of CD34+ cells, CD117 and CD123 overexpression, and abnormal CD45 expression on these cells are the best markers for MDS. These phenotypic aberrancies correlate with number of blasts and degree of dysplasia, and were similar to those in CD34+ AML, thus reflecting the relationship between these disorders.
Collapse
|
42
|
van Dongen JJM, Lhermitte L, Böttcher S, Almeida J, van der Velden VHJ, Flores-Montero J, Rawstron A, Asnafi V, Lécrevisse Q, Lucio P, Mejstrikova E, Szczepański T, Kalina T, de Tute R, Brüggemann M, Sedek L, Cullen M, Langerak AW, Mendonça A, Macintyre E, Martin-Ayuso M, Hrusak O, Vidriales MB, Orfao A. EuroFlow antibody panels for standardized n-dimensional flow cytometric immunophenotyping of normal, reactive and malignant leukocytes. Leukemia 2012; 26:1908-75. [PMID: 22552007 PMCID: PMC3437410 DOI: 10.1038/leu.2012.120] [Citation(s) in RCA: 656] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 02/14/2012] [Accepted: 04/19/2012] [Indexed: 12/21/2022]
Abstract
Most consensus leukemia & lymphoma antibody panels consist of lists of markers based on expert opinions, but they have not been validated. Here we present the validated EuroFlow 8-color antibody panels for immunophenotyping of hematological malignancies. The single-tube screening panels and multi-tube classification panels fit into the EuroFlow diagnostic algorithm with entries defined by clinical and laboratory parameters. The panels were constructed in 2-7 sequential design-evaluation-redesign rounds, using novel Infinicyt software tools for multivariate data analysis. Two groups of markers are combined in each 8-color tube: (i) backbone markers to identify distinct cell populations in a sample, and (ii) markers for characterization of specific cell populations. In multi-tube panels, the backbone markers were optimally placed at the same fluorochrome position in every tube, to provide identical multidimensional localization of the target cell population(s). The characterization markers were positioned according to the diagnostic utility of the combined markers. Each proposed antibody combination was tested against reference databases of normal and malignant cells from healthy subjects and WHO-based disease entities, respectively. The EuroFlow studies resulted in validated and flexible 8-color antibody panels for multidimensional identification and characterization of normal and aberrant cells, optimally suited for immunophenotypic screening and classification of hematological malignancies.
Collapse
Affiliation(s)
- J J M van Dongen
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam (Erasmus MC), Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Hasserjian RP, Preffer FI. Flow cytometry to distinguish myelodysplastic syndromes from non-neoplastic causes of cytopenia: ready for prime time? Leuk Res 2012; 36:1089-90. [PMID: 22727507 DOI: 10.1016/j.leukres.2012.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 03/28/2012] [Accepted: 03/31/2012] [Indexed: 11/19/2022]
|
44
|
Differences in blast immunophenotypes among disease types in myelodysplastic syndromes: a multicenter validation study. Leuk Res 2012; 36:1229-36. [PMID: 22682984 DOI: 10.1016/j.leukres.2012.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 04/24/2012] [Accepted: 05/11/2012] [Indexed: 01/24/2023]
Abstract
We conducted a multicenter, flow cytometry study to validate differences in immunophenotypes among disease types in melodysplastic syndromes (MDS). The data obtained from 115 patients were combined into three groups according to disease grade, i.e., low-grade MDS, refractory anemia with excess blasts, and acute leukemia transformed from MDS (AL-MDS). The data comparison showed that with the progression of disease grade, the immunophenotypes of CD34(+) myeloblasts were more immature, with an increase and a decrease in CD7 and CD15 expression, respectively, and the percentages of CD34(+) B-progenitors among total CD34(+) cells and the granularity of granulocytes decreased. Logistic regression analyses showed that, in addition to myeloblast percentages, the expression of CD7 and B7-H1 on myeloblasts was independently associated with AL-MDS patients.
Collapse
|
45
|
Flow cytometry in myelodysplastic syndrome: analysis of diagnostic utility using maturation pattern-based and quantitative approaches. Ann Hematol 2012; 91:1351-62. [PMID: 22526362 DOI: 10.1007/s00277-012-1461-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
Abstract
Flow cytometry (FCM) is being increasingly evaluated for the diagnosis of myelodysplastic syndrome (MDS). We employed multiple FCM approaches to assess MDS. Five-color FCM, morphology blind, was done on bone marrow aspirates of 57 suspected MDS and 31 normal controls. Maturation pattern, quantitative FCM for low-grade MDS that awards FCM score, and expression of selected antigens on erythroid cells and CD34(+) blasts were evaluated. FCM results were correlated with clinical and laboratory workup. Patients (n = 57) included proven MDS (n = 14), suspected MDS (n = 13), and non-MDS (n = 30). By pattern-based approach, all proven cases were FCM positive. In suspected MDS, 11 (84.61 %) were positive including morphology-negative cases, and two (15.38 %) were intermediate. In non-MDS cases, 27 of 30 (90 %) were FCM negative, 2 of 30 (6.67 %) intermediate, and 1 of 30 (3.33 %) a hematinic-responsive case, positive. Quantitative parameters that characterized MDS included FCM score of >3, percentage CD34(+) B cells, and expression of CD11b, CD15, and CD56 on myeloblasts. CD71 MFI on CD235a(+) erythroblasts and CD38 MFI on myeloblasts were significantly lower in MDS. The former was present in FCM-intermediate suspected MDS but not FCM-intermediate non-MDS cases. Used in the overall clinical context, both maturation pattern recognition and quantitative approaches, the latter for low-grade MDS, are sensitive methods of diagnosing MDS, including cases negative by morphology and cytogenetics, especially if combined with evaluation of selected antigens, CD71 on CD235a(+) cells and CD38 on CD34(+) cells. The value of FCM in morphology-negative cases needs better definition of specificity through more extensive evaluation of secondary dyspoiesis.
Collapse
|
46
|
Xu F, Wu L, He Q, Zhang Z, Chang C, Li X. Immunophenotypic analysis of erythroid dysplasia and its diagnostic application in myelodysplastic syndromes. Intern Med J 2012; 42:401-11. [DOI: 10.1111/j.1445-5994.2011.02630.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
47
|
Della Porta MG, Picone C, Pascutto C, Malcovati L, Tamura H, Handa H, Czader M, Freeman S, Vyas P, Porwit A, Saft L, Westers TM, Alhan C, Cali C, van de Loosdrecht AA, Ogata K. Multicenter validation of a reproducible flow cytometric score for the diagnosis of low-grade myelodysplastic syndromes: results of a European LeukemiaNET study. Haematologica 2012; 97:1209-17. [PMID: 22315489 DOI: 10.3324/haematol.2011.048421] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The current World Health Organization classification of myelodysplastic syndromes is based morphological evaluation of bone marrow dysplasia. In clinical practice, the reproducibility of the recognition of dysplasia is usually poor especially in cases that lack specific markers such as ring sideroblasts and clonal cytogenetic abnormalities. DESIGN AND METHODS We aimed to develop and validate a flow cytometric score for the diagnosis of myelodysplastic syndrome. Four reproducible parameters were analyzed: CD34(+) myeloblast-related and B-progenitor-related cluster size (defined by CD45 expression and side scatter characteristics CD34(+) marrow cells), myeloblast CD45 expression and granulocyte side scatter value. The study comprised a "learning cohort" (n=538) to define the score and a "validation cohort" (n=259) to confirm its diagnostic value. RESULTS With respect to non-clonal cytopenias, patients with myelodysplastic syndrome had increased myeloblast-related cluster size, decreased B-progenitor-related cluster size, aberrant CD45 expression and reduced granulocyte side scatter (P<0.001). To define the flow cytometric score, these four parameters were combined in a regression model and the weight for each variable was estimated based on coefficients from that model. In the learning cohort a correct diagnosis of myelodysplastic syndrome was formulated in 198/281 cases (sensitivity 70%), while 18 false-positive results were noted among 257 controls (specificity 93%). Sixty-five percent of patients without specific markers of dysplasia (ring sideroblasts and clonal cytogenetic abnormalities) were correctly classified. A high value of the flow cytometric score was associated with multilineage dysplasia (P=0.001), transfusion dependency (P=0.02), and poor-risk cytogenetics (P=0.04). The sensitivity and specificity in the validation cohort (69% and 92%, respectively) were comparable to those in the learning cohort. The likelihood ratio of the flow cytometric score was 10. CONCLUSIONS A flow cytometric score may help to establish the diagnosis of myelodysplastic syndrome, especially when morphology and cytogenetics are indeterminate.
Collapse
Affiliation(s)
- Matteo G Della Porta
- Department of Hematology Oncology, University of Pavia Medical School Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Westers TM, Ireland R, Kern W, Alhan C, Balleisen JS, Bettelheim P, Burbury K, Cullen M, Cutler JA, Della Porta MG, Dräger AM, Feuillard J, Font P, Germing U, Haase D, Johansson U, Kordasti S, Loken MR, Malcovati L, te Marvelde JG, Matarraz S, Milne T, Moshaver B, Mufti GJ, Ogata K, Orfao A, Porwit A, Psarra K, Richards SJ, Subirá D, Tindell V, Vallespi T, Valent P, van der Velden VHJ, de Witte TM, Wells DA, Zettl F, Béné MC, van de Loosdrecht AA. Standardization of flow cytometry in myelodysplastic syndromes: a report from an international consortium and the European LeukemiaNet Working Group. Leukemia 2012; 26:1730-41. [PMID: 22307178 DOI: 10.1038/leu.2012.30] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Flow cytometry (FC) is increasingly recognized as an important tool in the diagnosis and prognosis of myelodysplastic syndromes (MDS). However, validation of current assays and agreement upon the techniques are prerequisites for its widespread acceptance and application in clinical practice. Therefore, a working group was initiated (Amsterdam, 2008) to discuss and propose standards for FC in MDS. In 2009 and 2010, representatives from 23, mainly European, institutes participated in the second and third European LeukemiaNet (ELN) MDS workshops. In the present report, minimal requirements to analyze dysplasia are refined. The proposed core markers should enable a categorization of FC results in cytopenic patients as 'normal', 'suggestive of', or 'diagnostic of' MDS. An FC report should include a description of validated FC abnormalities such as aberrant marker expression on myeloid progenitors and, furthermore, dysgranulopoiesis and/or dysmonocytopoiesis, if at least two abnormalities are evidenced. The working group is dedicated to initiate further studies to establish robust diagnostic and prognostic FC panels in MDS. An ultimate goal is to refine and improve diagnosis and prognostic scoring systems. Finally, the working group stresses that FC should be part of an integrated diagnosis rather than a separate technique.
Collapse
Affiliation(s)
- T M Westers
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Porwit A. Role of flow cytometry in diagnostics of myelodysplastic syndromes--beyond the WHO 2008 classification. Semin Diagn Pathol 2012; 28:273-82. [PMID: 22195405 DOI: 10.1053/j.semdp.2011.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Multiparameter flow cytometry (FCM) is an excellent method to follow the expression patterns of differentiation antigens using monoclonal antibodies to surface and cytoplasmic proteins. Although several authors described various aberrant immunophenotypic features in the bone marrow of patients with myelodysplastic syndromes (MDS), the World Health Organization 2008 classification recommended that, only if 3 or more phenotypic abnormalities are found involving 1 or more of the myeloid lineages can the aberrant FCM findings be considered suggestive of MDS. In the absence of conclusive morphologic and/or cytogenetic features, FCM abnormalities alone were considered not sufficient to establish MDS diagnosis and further follow-up of the patients was recommended. Review of the literature gives accumulating evidence that FCM has become an important part of the integrated diagnostic work-up of patients with suspected MDS. Several studies have also reported FCM findings significant for prognosis and therapy choice in MDS patients. Technical progress in multicolor FCM and new analysis programs, together with ongoing efforts to standardize the methodology, will make it possible to apply FCM in individual risk assessment and choice of best therapy for MDS patients.
Collapse
Affiliation(s)
- Anna Porwit
- Department of Laboratory Hematology, University Health Network, Toronto, Ontario, Canada.
| |
Collapse
|
50
|
Westers TM, van der Velden VHJ, Alhan C, Bekkema R, Bijkerk A, Brooimans RA, Cali C, Dräger AM, de Haas V, Homburg C, de Jong A, Kuiper-Kramer PEA, Leenders M, Lommerse I, te Marvelde JG, van der Molen-Sinke JK, Moshaver B, Mulder AB, Preijers FWMB, Schindhelm RK, van der Sluijs A, van Wering ER, Westra AH, van de Loosdrecht AA. Implementation of flow cytometry in the diagnostic work-up of myelodysplastic syndromes in a multicenter approach: report from the Dutch Working Party on Flow Cytometry in MDS. Leuk Res 2011; 36:422-30. [PMID: 21982641 DOI: 10.1016/j.leukres.2011.09.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/16/2011] [Accepted: 09/18/2011] [Indexed: 11/27/2022]
Abstract
Flow cytometry (FC) is recognized as an important tool in the diagnosis of myelodysplastic syndromes (MDS) especially when standard criteria fail. A working group within the Dutch Society of Cytometry aimed to implement FC in the diagnostic work-up of MDS. Hereto, guidelines for data acquisition, analysis and interpretation were formulated. Based on discussions on analyses of list mode data files and fresh MDS bone marrow samples and recent literature, the guidelines were modified. Over the years (2005-2011), the concordance between the participating centers increased indicating that the proposed guidelines contributed to a more objective, standardized FC analysis, thereby ratifying the implementation of FC in MDS.
Collapse
Affiliation(s)
- Theresia M Westers
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|