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Hwang SM, Oh I, Kwon SR, Lee JS, Seong MW. Comparison of Measurable Residual Disease in Pediatric B-Lymphoblastic Leukemia Using Multiparametric Flow Cytometry and Next-Generation Sequencing. Ann Lab Med 2024; 44:354-358. [PMID: 38237930 PMCID: PMC10961625 DOI: 10.3343/alm.2023.0412] [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: 10/17/2023] [Revised: 11/17/2023] [Accepted: 01/06/2024] [Indexed: 03/26/2024] Open
Abstract
Measurable residual disease (MRD) testing, a standard procedure in B-lymphoblastic leukemia (B-ALL) diagnostics, is assessed using multiparametric flow cytometry (MFC) and next-generation sequencing (NGS) analysis of immunoglobulin gene rearrangements. We evaluated the concordance between eight-color, two-tube MFC-MRD the LymphoTrack NGS-MRD assays using 139 follow-up samples from 54 pediatric patients with B-ALL. We also assessed the effect of hemodilution in MFC-MRD assays. The MRD-concordance rate was 79.9% (N=111), with 25 (18.0%) and 3 (2.2%) samples testing positive only by NGS-MRD (MFC-NGS+MRD) and MFC-MRD (MFC+NGS-MRD), respectively. We found a significant correlation in MRD values from total nucleated cells between the two methods (r=0.736 [0.647-0.806], P<0.001). The median MRD value of MFC-NGS+MRD samples was estimated to be 0.0012% (0.0001%-0.0263%) using the NGS-MRD assays. Notably, 14.3% of MFC-NGS+MRD samples showed NGS-MRD values below the limit of detection in the MFC-MRD assays. The percentages of hematogones detected in MFC-MRD assays significantly differed between the discordant and concordant cases (P<0.001). MFC and NGS-MRD assays showed relatively high concordance and correlation in MRD assessment, whereas the NGS-MRD assay detected MRD more frequently than the MFC-MRD assay in pediatric B-ALL. Evaluating the hematogone percentages can aid in assessing the impact of sample hemodilution.
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Affiliation(s)
- Sang Mee Hwang
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Inseong Oh
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Ryun Kwon
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jee-Soo Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
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2
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Fregona V, Bayet M, Bouttier M, Largeaud L, Hamelle C, Jamrog LA, Prade N, Lagarde S, Hebrard S, Luquet I, Mansat-De Mas V, Nolla M, Pasquet M, Didier C, Khamlichi AA, Broccardo C, Delabesse É, Mancini SJ, Gerby B. Stem cell-like reprogramming is required for leukemia-initiating activity in B-ALL. J Exp Med 2024; 221:e20230279. [PMID: 37930337 PMCID: PMC10626194 DOI: 10.1084/jem.20230279] [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: 02/14/2023] [Revised: 08/31/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
B cell acute lymphoblastic leukemia (B-ALL) is a multistep disease characterized by the hierarchical acquisition of genetic alterations. However, the question of how a primary oncogene reprograms stem cell-like properties in committed B cells and leads to a preneoplastic population remains unclear. Here, we used the PAX5::ELN oncogenic model to demonstrate a causal link between the differentiation blockade, the self-renewal, and the emergence of preleukemic stem cells (pre-LSCs). We show that PAX5::ELN disrupts the differentiation of preleukemic cells by enforcing the IL7r/JAK-STAT pathway. This disruption is associated with the induction of rare and quiescent pre-LSCs that sustain the leukemia-initiating activity, as assessed using the H2B-GFP model. Integration of transcriptomic and chromatin accessibility data reveals that those quiescent pre-LSCs lose B cell identity and reactivate an immature molecular program, reminiscent of human B-ALL chemo-resistant cells. Finally, our transcriptional regulatory network reveals the transcription factor EGR1 as a strong candidate to control quiescence/resistance of PAX5::ELN pre-LSCs as well as of blasts from human B-ALL.
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Affiliation(s)
- Vincent Fregona
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer 2023, Toulouse, France
- Équipe Labellisée Institut Carnot Opale, Toulouse, France
| | - Manon Bayet
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer 2023, Toulouse, France
- Équipe Labellisée Institut Carnot Opale, Toulouse, France
| | - Mathieu Bouttier
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer 2023, Toulouse, France
- Équipe Labellisée Institut Carnot Opale, Toulouse, France
| | - Laetitia Largeaud
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer 2023, Toulouse, France
- Équipe Labellisée Institut Carnot Opale, Toulouse, France
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Camille Hamelle
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer 2023, Toulouse, France
- Équipe Labellisée Institut Carnot Opale, Toulouse, France
| | - Laura A. Jamrog
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer 2023, Toulouse, France
- Équipe Labellisée Institut Carnot Opale, Toulouse, France
| | - Naïs Prade
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer 2023, Toulouse, France
- Équipe Labellisée Institut Carnot Opale, Toulouse, France
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Stéphanie Lagarde
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer 2023, Toulouse, France
- Équipe Labellisée Institut Carnot Opale, Toulouse, France
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sylvie Hebrard
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer 2023, Toulouse, France
- Équipe Labellisée Institut Carnot Opale, Toulouse, France
| | - Isabelle Luquet
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer 2023, Toulouse, France
- Équipe Labellisée Institut Carnot Opale, Toulouse, France
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Véronique Mansat-De Mas
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Marie Nolla
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer 2023, Toulouse, France
- Équipe Labellisée Institut Carnot Opale, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Marlène Pasquet
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer 2023, Toulouse, France
- Équipe Labellisée Institut Carnot Opale, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Christine Didier
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer 2023, Toulouse, France
- Équipe Labellisée Institut Carnot Opale, Toulouse, France
| | - Ahmed Amine Khamlichi
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, Centre Nationale de la Recherche Scientifique, Université Toulouse III—Paul Sabatier (UT3), Toulouse, France
| | - Cyril Broccardo
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer 2023, Toulouse, France
- Équipe Labellisée Institut Carnot Opale, Toulouse, France
| | - Éric Delabesse
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer 2023, Toulouse, France
- Équipe Labellisée Institut Carnot Opale, Toulouse, France
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Stéphane J.C. Mancini
- Université de Rennes, Etablissement Français du Sang, Inserm, MOBIDIC—UMR_S 1236, Rennes, France
| | - Bastien Gerby
- Université de Toulouse, Inserm, Centre Nationale de la Recherche Scientifique, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer 2023, Toulouse, France
- Équipe Labellisée Institut Carnot Opale, Toulouse, France
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3
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Boris E, Theron A, Montagnon V, Rouquier N, Almeras M, Moreaux J, Bret C. Immunophenotypic portrait of leukemia-associated-phenotype markers in B acute lymphoblastic leukemia. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2024; 106:45-57. [PMID: 38037221 DOI: 10.1002/cyto.b.22153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Multiparametric flow cytometry (MFC) is an essential diagnostic tool in B acute lymphoblastic leukemia (B ALL) to determine the B-lineage affiliation of the blast population and to define their complete immunophenotypic profile. Most MFC strategies used in routine laboratories include leukemia-associated phenotype (LAP) markers, whose expression profiles can be difficult to interpret. The aim of our study was to reach a better understanding of 7 LAP markers' landscape in B ALL: CD9, CD21, CD66c, CD58, CD81, CD123, and NG2. METHODS Using a 10-color MFC approach, we evaluated the level of expression of 7 LAP markers including CD9, CD21, CD66c, CD58, CD81, CD123, and NG2, at the surface of normal peripheral blood leukocytes (n = 10 healthy donors), of normal precursor B regenerative cells (n = 40 uninvolved bone marrow samples) and of lymphoblasts (n = 100 peripheral blood samples or bone marrow samples from B ALL patients at diagnosis). The expression profile of B lymphoblasts was analyzed according the presence or absence of recurrent cytogenetic aberrations. The prognostic value of the 7 LAP markers was examined using Maxstat R algorithm. RESULTS In order to help the interpretation of the MFC data in routine laboratories, we first determined internal positive and negative populations among normal leukocytes for each of the seven evaluated LAP markers. Second, their profile of expression was evaluated in normal B cell differentiation in comparison with B lymphoblasts to establish a synopsis of their expression in normal hematogones. We then evaluated the frequency of expression of these LAP markers at the surface of B lymphoblasts at diagnosis of B ALL. CD9 was expressed in 60% of the cases, CD21 in only 3% of the cases, CD58 in 96% of the cases, CD66c in 45% of the cases, CD81 in 97% of the cases, CD123 in 72% of the cases, and NG2 in only 2% of the cases. We confirmed the interest of the CD81/CD58 MFI expression ratio as a way to discriminate hematogones from lymphoblasts. We observed a significant lower expression of CD9 and of CD81 at the surface of B lymphoblasts with a t(9;22)(BCR-ABL) in comparison with B lymphoblasts without any recurrent cytogenetic alteration (p = 0.0317 and p = 0.0011, respectively) and with B lymphoblasts harboring other cytogenetic recurrent abnormalities (p = 0.0032 and p < 0.0001, respectively). B lymphoblasts with t(1;19) at diagnosis significantly overexpressed CD81 when compared with B lymphoblasts with other recurrent cytogenetic abnormalities or without any recurrent alteration (p = 0.0001). An overexpression of CD58 was also observed in the cases harboring this abnormal cytogenetic event, when compared with B lymphoblasts with other recurrent cytogenetic abnormalities (p = 0.030), or without any recurrent alteration (p = 0.0002). In addition, a high expression of CD123, of CD58 and of CD81 was associated with a favorable prognosis in our cohort of pediatric and young adult B ALL patients. We finally built a risk score based on the expression of these 3 LAP markers, this scoring approach being able to split these patients into a high-risk group (17%) and a better outcome group (83%, p < 0.0001). CONCLUSION The complexity of the phenotypic signature of lymphoblasts at diagnosis of B ALL is illustrated by the variability in the expression of LAP antigens. Knowledge of the expression levels of these markers in normal leukocytes and during normal B differentiation is crucial for an optimal interpretation of diagnostic cytometry results and serves as a basis for the biological follow-up of B ALL.
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Affiliation(s)
- Emilia Boris
- Department of Biological Hematology, St Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Alexandre Theron
- Department of Pediatric Onco-Hematology, Arnaud de Villeneuve Hospital, Montpellier University Hospital, Montpellier, France
- Faculty of Medicine, University of Montpellier, Montpellier, France
| | - Valentin Montagnon
- Department of Biological Hematology, St Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Nicolas Rouquier
- Department of Biological Hematology, St Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | | | - Jérôme Moreaux
- Department of Biological Hematology, St Eloi Hospital, Montpellier University Hospital, Montpellier, France
- Faculty of Medicine, University of Montpellier, Montpellier, France
- CNRS UMR 9002, Institute of Human Genetics, Montpellier, France
- Institut Universitaire de France, Paris, France
| | - Caroline Bret
- Department of Biological Hematology, St Eloi Hospital, Montpellier University Hospital, Montpellier, France
- Faculty of Medicine, University of Montpellier, Montpellier, France
- CNRS UMR 9002, Institute of Human Genetics, Montpellier, France
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4
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Das N, Gajendra S, Gupta R. Analytical Appraisal of Hematogones in B-ALL MRD Assessment Using Multidimensional Dot-Plots by Multiparametric Flow Cytometry: A Critical Review and Update. Indian J Hematol Blood Transfus 2024; 40:12-24. [PMID: 38312180 PMCID: PMC10830989 DOI: 10.1007/s12288-023-01696-5] [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: 01/05/2023] [Accepted: 08/25/2023] [Indexed: 02/06/2024] Open
Abstract
The spectrum of benign B-cell precursors, known as hematogones (HGs), shows a significant morphological and immunophenotypic overlap with their malignant counterpart i.e. B-lymphoid blasts (BLBs). This results in a diagnostic dilemma in assessment of cases wherein there is a physiological preponderance of HGs and also poses a significant challenge in measurable residual disease assessment in B-cell acute lymphoblastic leukaemia. Consequently, expression patterns of various immunophenotypic markers are considered the most important tool in identification and delineation of HGs from BLBs. However, certain aspects of B-cell compartment evaluation by flow cytometric immunophenotyping and its relevance in clinical scenarios is yet to be defined precisely. This review summarizes current flowcytometric data on HGs and its discrimination from BLBs based on thorough review of literature and evaluation of in-house data. Furthermore, it focuses on the utility of an additional analytical tool i.e., radar plot for a comprehensive representation of various subsets of the B-cell compartment and their differentiation from BLBs. Supplementary Information The online version contains supplementary material available at 10.1007/s12288-023-01696-5.
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Affiliation(s)
- Nupur Das
- Laboratory Oncology, Dr. BRAIRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Smeeta Gajendra
- Laboratory Oncology, Dr. BRAIRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Ritu Gupta
- Laboratory Oncology, Dr. BRAIRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
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5
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Chan A, Gao Q, Roshal M. 19-color, 21-Antigen Single Tube for Efficient Evaluation of B- and T-cell Neoplasms. Curr Protoc 2023; 3:e884. [PMID: 37725693 PMCID: PMC10516508 DOI: 10.1002/cpz1.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Non-Hodgkin lymphoma (NHL) is a heterogeneous disease, encompassing a wide variety of individually distinct neoplastic entities of mature B-, T-, and NK-cells. While they constitute a broad category, they are the most common hematologic malignancies in the world. The distinction between different neoplastic entities requires a multi-modal approach, such as flow cytometric immunophenotyping, which can exclude a neoplastic proliferation and help narrow the differential diagnosis. This article describes a flow cytometric test developed at Memorial Sloan Kettering Cancer Center to assess B-, T-, and NK-cells in a single tube, 21-antibody, 19-color assay. The assay can identify most B- and T-cell NHLs with high specificity and sensitivity and significantly narrow the differential when a specific diagnosis cannot be made. The basic protocol provides a detailed operational procedure for sample processing, staining, and cytometric acquisition. The support protocol provides typical steps and caveats for data analysis in lymphoproliferative disorders and in discriminating a variety of specific disease entities from each other and normal lymphoid populations. © 2023 Wiley Periodicals LLC. Basic Protocol: Processing, staining, and cytometric analysis of samples for B- and T-cell assessment Support Protocol: Analysis and interpretation of the B- and T-cell lymphocyte assay.
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Affiliation(s)
- Alexander Chan
- Hematopathology service, Memorial Sloan Kettering Cancer Center, Department of Pathology and Laboratory Medicine, New York, New York
| | - Qi Gao
- Hematopathology service, Memorial Sloan Kettering Cancer Center, Department of Pathology and Laboratory Medicine, New York, New York
| | - Mikhail Roshal
- Hematopathology service, Memorial Sloan Kettering Cancer Center, Department of Pathology and Laboratory Medicine, New York, New York
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6
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Singh AP, Courville EL. Advances in Monitoring and Prognostication for Lymphoma by Flow Cytometry. Clin Lab Med 2023; 43:351-361. [PMID: 37481316 DOI: 10.1016/j.cll.2023.04.010] [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: 07/24/2023]
Abstract
Flow cytometry (FC) is a well-established method important in the diagnosis and subclassification of lymphoma. In this article, the role of FC in lymphoma prognostication will be explored, and the clinical role for FC minimal/measurable residual disease testing as a monitoring tool for mature lymphoma will be introduced. Potential pitfalls of monitoring for residual/recurrent disease following immunotherapy will be presented.
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Affiliation(s)
- Amrit P Singh
- Department of Pathology, University of Virginia Health, PO Box 800214, Charlottesville, VA 22908, USA
| | - Elizabeth L Courville
- Department of Pathology, University of Virginia Health, PO Box 800214, Charlottesville, VA 22908, USA.
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7
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Zhou T, Karrs J, Ho T, Doverte A, Kochenderfer JN, Shah NN, Yuan CM, Wang HW. Circulating CD22+/CD19-/CD24- progenitors and CD22+/CD19+/CD24- mature B cells: Diagnostic pitfalls for minimal residual disease detection in B-lymphoblastic leukemia. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2023; 104:294-303. [PMID: 36433814 PMCID: PMC10735170 DOI: 10.1002/cyto.b.22104] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 08/20/2023]
Abstract
BACKGROUND Multiparametric flow cytometry (MFC) has become a powerful tool in minimal residual disease (MRD) detection in B-lymphoblastic leukemia/lymphoma (B-ALL). In the setting of targeted immunotherapy, B-ALL MRD detection often relies on alterative gating strategies, such as the utilization of CD22 and CD24. It is important to depict the full diversity of normal cell populations included in the alternative B-cell gating methods to avoid false-positive results. We describe two CD22-positive non-neoplastic cell populations in the peripheral blood (PB), including one progenitor population of uncertain lineage and one mature B-cell population, which are immunophenotypic mimics of B-ALL. METHODS Using MFC, we investigated the prevalence and phenotypic profiles of both CD22-positive populations in 278 blood samples from 52 patients with B-ALL; these were obtained pre- and post-treatment with CD19 and/or CD22 CAR-T therapies. We further assessed whether these two populations in the blood were exclusively associated with B-ALL or recent anticancer therapies, by performing the same analysis on patients diagnosed with other hematological malignancies but in long-term MRD remission. RESULTS The progenitor population and mature B-cell population were detected at low levels in PB of 61.5% and 44.2% of B-ALL patients, respectively. Both cell types showed distinctive and highly consistent antigen expression patterns that are reliably distinguishable from B-ALL. Furthermore, their presence is not restricted solely to B-ALL or recent therapy. CONCLUSIONS Our findings aid in building a complete immunophenotypic profile of normal cell populations in PB, thereby preventing misdiagnosis of B-ALL MRD and inappropriate management.
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Affiliation(s)
- Ting Zhou
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jeremiah Karrs
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Truc Ho
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alyssa Doverte
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - James N. Kochenderfer
- Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nirali N. Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Constance M. Yuan
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Hao-Wei Wang
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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8
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Momen N, Tario J, Fu K, Qian YW. Multiparameter flow cytometry and ClonoSEQ correlation to evaluate precursor B-lymphoblastic leukemia measurable residual disease. J Hematop 2023; 16:85-94. [PMID: 38175444 DOI: 10.1007/s12308-023-00544-9] [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: 02/10/2023] [Accepted: 04/03/2023] [Indexed: 01/05/2024] Open
Abstract
Measurable residual disease (MRD) detection for precursor B-lymphoblastic leukemia (B-ALL) has become the standard of care. However, the testing methodology has not been standardized. We aim to correlate COG multiparameter flow cytometry (MFC) and ClonoSEQ techniques to assess the test characteristics, to study abnormal immunophenotype for B-ALL MRD, and to observe B-ALL clonal evolution and the impact of blinatumomab therapy on MFC testing. MFC and molecular reports were retrieved from electronic medical records and data was reviewed. Included in this study were 74 bone marrow samples collected from 31 B-ALL patients at our institution between January 2021 and March 2022. COG MFC and ClonoSEQ results were concordant in 59/74 samples (80%) with positive concordant results in 12 samples (16%) and negative concordant results in 47 samples (64%). Discordant results were seen in 15/74 samples (20%), with 14 samples (19%) showing ClonoSEQ + /MFC- results and only 1 sample (1%) showing MFC + /ClonoSEQ- result. ClonoSEQ + /MFC- cases had MRD values ranging from 1 to 1400 cells/million nucleated cells with 86% of cases showing MRD values of < 100 cells/million nucleated cells. Newly identified dominant sequences were detected using ClonoSEQ in 2/31 patients (6%) during follow-up. All 14 bone marrow samples from 8 patients, who had gone through blinatumomab immunotherapy, were MRD negative by MFC, but 3 cases were MRD positive by ClonoSEQ. Our results show strong correlation between COG MFC and ClonoSEQ (r = 0.96), and both methods are complementary. Clonal evolution may occur, and blinatumomab immunotherapy may impact MFC B-ALL MRD evaluation.
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Affiliation(s)
- Nouran Momen
- Department of Pathology, Roswell Park Cancer Institute, Basic Science Building, Room 529, Elm St & Carlton St, Buffalo, NY, 14203, USA
- Clinical & Chemical Pathology Department, Cairo University, Cairo, Egypt
| | - Joseph Tario
- Department of Pathology, Roswell Park Cancer Institute, Basic Science Building, Room 529, Elm St & Carlton St, Buffalo, NY, 14203, USA
| | - Kai Fu
- Department of Pathology, Roswell Park Cancer Institute, Basic Science Building, Room 529, Elm St & Carlton St, Buffalo, NY, 14203, USA
| | - You-Wen Qian
- Department of Pathology, Roswell Park Cancer Institute, Basic Science Building, Room 529, Elm St & Carlton St, Buffalo, NY, 14203, USA.
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Chen X, Gao Q, Roshal M, Cherian S. Flow cytometric assessment for minimal/measurable residual disease in B lymphoblastic leukemia/lymphoma in the era of immunotherapy. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2023; 104:205-223. [PMID: 36683279 DOI: 10.1002/cyto.b.22113] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/30/2022] [Accepted: 12/28/2022] [Indexed: 01/24/2023]
Abstract
Minimal/measurable residual disease (MRD) is the most important independent prognostic factor for patients with B-lymphoblastic leukemia (B-LL). MRD post therapy has been incorporated into risk stratification and clinical management, resulting in substantially improved outcomes in pediatric and adult patients. Currently, MRD in B-ALL is most commonly assessed by multiparametric flow cytometry and molecular (polymerase chain reaction or high-throughput sequencing based) methods. The detection of MRD by flow cytometry in B-ALL often begins with B cell antigen-based gating strategies. Over the past several years, targeted immunotherapy directed against B cell markers has been introduced in patients with relapsed or refractory B-ALL and has demonstrated encouraging results. However, targeted therapies have significant impact on the immunophenotype of leukemic blasts, in particular, downregulation or loss of targeted antigens on blasts and normal B cell precursors, posing challenges for MRD detection using standard gating strategies. Novel flow cytometric approaches, using alternative strategies for population identification, sometimes including alternative gating reagents, have been developed and implemented to monitor MRD in the setting of post targeted therapy.
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Affiliation(s)
- Xueyan Chen
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Qi Gao
- Hematopathology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mikhail Roshal
- Hematopathology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sindhu Cherian
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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Zhang T, Gao M, Chen X, Gao C, Feng S, Chen D, Wang J, Zhao X, Chen J. Demands and technical developments of clinical flow cytometry with emphasis in quantitative, spectral, and imaging capabilities. NANOTECHNOLOGY AND PRECISION ENGINEERING 2022. [DOI: 10.1063/10.0015301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As the gold-standard method for single-cell analysis, flow cytometry enables high-throughput and multiple-parameter characterization of individual biological cells. This review highlights the demands for clinical flow cytometry in laboratory hematology (e.g., diagnoses of minimal residual disease and various types of leukemia), summarizes state-of-the-art clinical flow cytometers (e.g., FACSLyricTM by Becton Dickinson, DxFLEX by Beckman Coulter), then considers innovative technical improvements in flow cytometry (including quantitative, spectral, and imaging approaches) to address the limitations of clinical flow cytometry in hematology diagnosis. Finally, driven by these clinical demands, future developments in clinical flow cytometry are suggested.
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Affiliation(s)
- Ting Zhang
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, People’s Republic of China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, People’s Republic of China
| | - Mengge Gao
- Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, People’s Republic of China
| | - Xiao Chen
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, People’s Republic of China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, People’s Republic of China
| | - Chiyuan Gao
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, People’s Republic of China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, People’s Republic of China
| | - Shilun Feng
- State Key Laboratory of Transducer Technology, Shanghai Institute of Microsystem and Information Technology, Chinese Academy of Sciences, Shanghai 200050, People’s Republic of China
| | - Deyong Chen
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, People’s Republic of China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, People’s Republic of China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, People’s Republic of China
| | - Junbo Wang
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, People’s Republic of China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, People’s Republic of China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, People’s Republic of China
| | - Xiaosu Zhao
- Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, People’s Republic of China
| | - Jian Chen
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, People’s Republic of China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, People’s Republic of China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, People’s Republic of China
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11
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Soh KT, Conway A, Liu X, Wallace PK. Development of a 27-color panel for the detection of measurable residual disease in patients diagnosed with acute myeloid leukemia. Cytometry A 2022; 101:970-983. [PMID: 35716345 DOI: 10.1002/cyto.a.24667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 04/26/2022] [Accepted: 06/15/2022] [Indexed: 01/27/2023]
Abstract
Acute myeloid leukemia (AML) measurable residual disease (MRD) evaluated by multiparametric flow cytometry (MFC) is a surrogate for progression-free and overall survival in clinical trials and patient management. Due to the limited number of detection channels available in conventional flow cytometers, panels used for assessing AML MRD are typically split into multiple tubes. This cripples the simultaneous and correlated assessment of all myeloblast measurements. In response, we prototyped a single-tube 27-color MFC assay for the evaluation of AML MRD, incorporating all recommended markers. Marrow aspirates from 22 patients were processed for analysis using full spectrum flow cytometry (FSFC). The signal resolution of each marker was compared between samples stained with single antibody vs. the fully stained panel. The analytical accuracy for quantifying hematopoietic cells between our established 8-color assay and the new 27-color method were compared. Variations within an operator and between separate operators were assessed to evaluate the assays reproducibility. The limited of blank (LOB), limit of detection (LOD), and lower limit of quantification (LLOQ) of the 27-color method were empirically determined using limiting dilution experiments. The stability of antibody cocktails over a period of 120 h was also studied using cryopreserved marrow cells. The stain indices for all antibodies were lower in the fully stained panel compared to cells stained with one antibody but clear separations between negative and positive signals were achieved for all antibodies. Our results demonstrated a high concordance between the established 8-color method and the new 27-color assay for enumerating myeloblasts and MRD interpretation within and between operators. The data further showed that the single-tube 27-color assay easily achieved the minimum required detection sensitivity of 0.1%. When antibodies were combined, however, expression intensity of some antigens deteriorated significantly when stored. Our single-tube 27-color panel is a suitable, high sensitivity flow cytometric approach that can be used for AML MRD testing, which improves the correlation of aberrant antigens and detection of asynchronous differentiation patterns. Based on the stability study, we recommend the full panel be made prior to staining.
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Affiliation(s)
- Kah Teong Soh
- Department of Flow and Image Cytometry, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Alexis Conway
- Department of Flow and Image Cytometry, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Xiaojun Liu
- Department of Flow and Image Cytometry, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Paul K Wallace
- Department of Flow and Image Cytometry, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Kurzer JH, Weinberg OK. To B- or not to B-: A review of lineage switched acute leukemia. Int J Lab Hematol 2022; 44 Suppl 1:64-70. [PMID: 35770493 DOI: 10.1111/ijlh.13923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Abstract
Acute leukemia is a heterogeneous disorder of hematologic malignancies composed primarily of hematopoietic precursors that have acquired unregulated self-renewal and proliferation. Hematology classification systems typically divide these neoplasms into lymphoid (B- or T-) and myeloid-lineage subtypes, with therapy dependent upon this distinction. Infrequently, certain acute leukemias may undergo a complete lineage switch at relapse, subsequently complicating the diagnosis and treatment of these recurrent diseases. Transformation from B-lineage to myeloid lineage is the most common switch observed, and is frequently associated with a balanced 11q23 translocation, involving KMT2A. The mechanisms involved in the lineage-switch are unclear, but modern therapies targeting the B-cell-specific marker, CD19, have proven to promote this conversion as one means of treatment escape. Broadly speaking, therapy-mediated selection of alternate lineage-committed subclones derived from the same initial pluripotent progenitors, clonal evolution and reprogramming of lineage-committed blasts, and de novo clonally unrelated leukemias may account for the clinical impression of lineage switched acute leukemia during treatment. This review will explore the phenomenon and potential mechanisms of lineage transformation during the treatment of acute leukemia.
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Affiliation(s)
- Jason H Kurzer
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Olga K Weinberg
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
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Borowitz MJ, Wood BL, Keeney M, Hedley BD. Measurable Residual Disease Detection in B-Acute Lymphoblastic Leukemia: The Children's Oncology Group (COG) Method. Curr Protoc 2022; 2:e383. [PMID: 35263042 DOI: 10.1002/cpz1.383] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Measurable (minimal) residual disease (MRD) in B-acute lymphoblastic leukemia (B-ALL), as assessed by flow cytometry, is an established prognostic factor used to adjust treatment in most pediatric therapeutic protocols. MRD in B-ALL has been standardized by the Children's Oncology Group in North America and more recently in a multicenter Foundation for the National Institutes of Health-funded study. This article outlines the reagents, instrument setup, and analysis protocols required for the reproducible detection of residual leukemic cells in patients following induction therapy for B-ALL. © 2022 Wiley Periodicals LLC. Basic Protocol 1: Staining and flow cytometry for B-acute lymphoblastic leukemia (B-ALL) measurable residual disease detection Support Protocol: Specimen collection, handling, storage, and shipping Basic Protocol 2: Analysis and interpretation of data for B-ALL measurable residual disease detection Basic Protocol 3: Analysis of samples lacking sufficient CD19+ events.
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Affiliation(s)
- Michael J Borowitz
- Pathology and Oncology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Brent L Wood
- Pathology and Laboratory Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
| | - Michael Keeney
- Department of Pathology and Laboratory Medicine, London Health Sciences Center, London, Ontario
| | - Benjamin D Hedley
- Department of Pathology and Laboratory Medicine, London Health Sciences Center, London, Ontario
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Abstract
Flow cytometry is a widely used diagnostic tool in many laboratories, which generates information that is essential for the diagnosis and classification of different hematolymphoid neoplasms (Reichard KK, KS, Flow cytometry in the assessment of hematologic disorders. In: Orazi A, Foucar K, Knowles DM et al (eds) Neoplastic hematopathology. Lippincott, Williams and Wilkins, Baltimore, MD, pp 119-145, 2013). Flow cytometry allows us to identify individual cells within heterogeneous populations. It is also useful for the quantification of cells, such as CD4 counts in HIV patients and CD34 stem cells on bone marrow and peripheral blood specimens. Lastly, it can also be used to describe the pattern of antigen expression on cells known as immunophenotyped (Craig FE, Foon KA, Blood 111(8):3941-3967, 2008).
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Affiliation(s)
- Luis F Carrillo
- Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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A Novel Method for the Evaluation of Bone Marrow Samples from Patients with Pediatric B-Cell Acute Lymphoblastic Leukemia-Multidimensional Flow Cytometry. Cancers (Basel) 2021; 13:cancers13205044. [PMID: 34680191 PMCID: PMC8533788 DOI: 10.3390/cancers13205044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary By supporting the selection of the most suitable treatment protocol, the advancement of diagnostic methods contributes to achieving the best possible outcome for pediatric cases of acute lymphoblastic leukemia (ALL). In this study, we focused on a novel possibility in the flow cytometric (FC) analysis, as this method is the initial, crucial step in the diagnostic algorithm of ALL and can determine further diagnostic and therapeutic strategies. After the retrospective, multidimensional dot-plot-based FC analysis of 72 bone marrow samples of children with ALL, we found that the integrated appearance of immunophenotype resulted in a simple, quick, and accurate method. Furthermore, associations between immunophenotype and cytogenetic alterations were detected, which enabled the identification of cases with potential adverse outcome by completing the conventional FC analysis with multidimensional dot-plots. Standardized multi-center studies would be required to validate our results. Abstract Multicolor flow cytometry (FC) evaluation has a key role in the diagnosis and prognostic stratification of ALL. Our aim was to create new analyzing protocols using multidimensional dot-plots. Seventy-two pediatric patients with ALL were included in this single-center study. Data of a normal BM sample and three BM samples of patients with BCP-ALL were merged, then all B cell populations of the four samples were presented in a single radar dot-plot, and those parameters and locations were selected in which the normal and pathological cell populations differed from each other the most. The integrated profile of immunophenotype resulted in a simple, rapid, and accurate method. There were no significant differences between the percentages of lymphoblasts in the detection of minimal residual disease (MRD) by multidimensional or conventional FC method (p = 0.903 at Day 15 and p = 0.155 at Day 33). Furthermore, we found associations between the position and the number of clusters of blast cells in the radar plots and cytogenetic properties (p = 0.002 and p < 0.0001 by the position and p = 0.02 by the number of subclones). FC analysis based on multidimensional dot-plots is not only a rapid, easy-to-use method, but can also provide additional information to screen cases which require detailed genetic examination.
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