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Saft L. The role of flow cytometry in the classification of myeloid disorders. PATHOLOGIE (HEIDELBERG, GERMANY) 2023; 44:164-175. [PMID: 37991530 PMCID: PMC10739577 DOI: 10.1007/s00292-023-01272-8] [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] [Accepted: 10/24/2023] [Indexed: 11/23/2023]
Abstract
The World Health Organization classification (WHO-HAEM5) and the International Consensus Classification (ICC 2022) of myeloid neoplasms are based on the integration of clinical, morphologic, immunophenotypic, and genomic data. Flow cytometric immunophenotyping (FCIP) allows the identification, enumeration, and characterization of hematopoietic cells, and is therefore a powerful tool in the diagnosis, classification, and monitoring of hematological neoplasms. The vast majority of flow cytometry (FCM) studies in chronic myeloid neoplasms focus on its role in myelodysplastic neoplasms (MDS). FCM can also be helpful for the assessment of myeloproliferative neoplasms (MPN) and MDS/MPN, including the early detection of evolving myeloid or lymphoid blast crisis and the characterization of monocytic subsets. The classification of acute myeloid leukemia (AML) is primarily based on cytogenetic and molecular findings; however, FCIP is needed for subclassification of AML, not otherwise specified (NOS; ICC)/AML defined by differentiation (WHO-HAEM5). The main role of FCM in AML remains in making a rapid diagnosis and as a tool for measurable residual disease monitoring. Machine learning and artificial intelligence approaches can be used to analyze and classify FCM data. This article, based on an invited lecture at the 106th Annual Meeting of the German Society of Pathology in 2023, reviews the role of FCM in the classification of myeloid neoplasms, including recent publications on the application of artificial intelligence.
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Affiliation(s)
- Leonie Saft
- Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital and Institute, 171 76, Stockholm, Sweden.
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2
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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.
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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
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van der Velden VHJ, Preijers F, Johansson U, Westers TM, Dunlop A, Porwit A, Béné MC, Valent P, Te Marvelde J, Wagner-Ballon O, Oelschlaegel U, Saft L, Kordasti S, Ireland R, Cremers E, Alhan C, Duetz C, Hobo W, Chapuis N, Fontenay M, Bettelheim P, Eidenshink-Brodersen L, Font P, Loken MR, Matarraz S, Ogata K, Orfao A, Psarra K, Subirá D, Wells DA, Della Porta MG, Burbury K, Bellos F, Weiß E, Kern W, van de Loosdrecht A. Flow cytometric analysis of myelodysplasia: Pre-analytical and technical issues-Recommendations from the European LeukemiaNet. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2023; 104:15-26. [PMID: 34894176 PMCID: PMC10078694 DOI: 10.1002/cyto.b.22046] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Flow cytometry (FCM) aids the diagnosis and prognostic stratification of patients with suspected or confirmed myelodysplastic syndrome (MDS). Over the past few years, significant progress has been made in the FCM field concerning technical issues (including software and hardware) and pre-analytical procedures. METHODS Recommendations are made based on the data and expert discussions generated from 13 yearly meetings of the European LeukemiaNet international MDS Flow working group. RESULTS We report here on the experiences and recommendations concerning (1) the optimal methods of sample processing and handling, (2) antibody panels and fluorochromes, and (3) current hardware technologies. CONCLUSIONS These recommendations will support and facilitate the appropriate application of FCM assays in the diagnostic workup of MDS patients. Further standardization and harmonization will be required to integrate FCM in MDS diagnostic evaluations in daily practice.
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Affiliation(s)
- Vincent H J van der Velden
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank Preijers
- Department of Laboratory Medicine - Laboratory for Hematology, Radboudumc, Nijmegen, The Netherlands
| | - Ulrika Johansson
- Laboratory Medicine, SI-HMDS, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Theresia M Westers
- Department of Hematology, Amsterdam UMC, location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Alan Dunlop
- Department of Haemato-Oncology, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Anna Porwit
- Department of Clinical Sciences, Division of Oncology And Pathology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Marie C Béné
- Hematology Biology, Nantes University Hospital and CRCINA, Nantes, France
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Jeroen Te Marvelde
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Orianne Wagner-Ballon
- Department of Hematology and Immunology; and Université Paris-Est Créteil, Assistance Publique-Hôpitaux de Paris, University Hospital Henri Mondor, Inserm U955, Créteil, France
| | - Uta Oelschlaegel
- Department of Internal Medicine, University Hospital Carl-Gustav-Carus, Dresden, TU, Germany
| | - Leonie Saft
- Department of Clinical Pathology and Oncology, Karolinska University Hospital and Institute, Solna, Stockholm, Sweden
| | - Sharham Kordasti
- Comprehensive Cancer Centre, King's College London and Hematology Department, Guy's Hospital, London, UK
| | - Robin Ireland
- Comprehensive Cancer Centre, King's College London and Hematology Department, Guy's Hospital, London, UK
| | - Eline Cremers
- Department of Internal Medicine, Division of Hematology, Maastricht University Medical Center, AZ, Maastricht, The Netherlands
| | - Canan Alhan
- Department of Hematology, Amsterdam UMC, location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Carolien Duetz
- Department of Hematology, Amsterdam UMC, location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Willemijn Hobo
- Department of Laboratory Medicine - Laboratory for Hematology, Radboudumc, Nijmegen, The Netherlands
| | - Nicolas Chapuis
- Assistance Publique-Hôpitaux de Paris. Centre-Université de Paris, Cochin Hospital, Laboratory of Hematology and Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
| | - Michaela Fontenay
- Assistance Publique-Hôpitaux de Paris. Centre-Université de Paris, Cochin Hospital, Laboratory of Hematology and Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
| | - Peter Bettelheim
- Department of Internal Medicine, Ordensklinikum Linz Barmherzige Schwestern - Elisabethinen, Linz, Austria
| | | | - Patricia Font
- Department of Hematology, Hospital General Universitario Gregorio Marañon-IiSGM, Madrid, Spain
| | | | - Sergio Matarraz
- Cancer Research Center (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service, University of Salamanca, Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto Carlos III, Salamanca, Spain
| | - 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, University of Salamanca, Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto Carlos III, Salamanca, Spain
| | - Katherina Psarra
- Immunology Histocompatibility Department, Evangelismos Hospital, Athens, Greece
| | - Dolores Subirá
- Flow Cytometry Unit. Department of Hematology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - Matteo G Della Porta
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy & Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Kate Burbury
- Department of Haematology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | | | | | | | - Arjan van de Loosdrecht
- Department of Hematology, Amsterdam UMC, location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Advantages and Challenges of Differential Immune Cell Count Determination in Blood and Milk for Monitoring the Health and Well-Being of Dairy Cows. Vet Sci 2022; 9:vetsci9060255. [PMID: 35737307 PMCID: PMC9229168 DOI: 10.3390/vetsci9060255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/07/2022] [Accepted: 05/24/2022] [Indexed: 02/05/2023] Open
Abstract
A key challenge of the 21st century will be to provide the growing world population with a sustainable and secure supply of food. Consequently, the dairy farming’s primary task is to lower milk losses and other inefficiencies associated with diseased cows. Moreover, a shift from curative to preventive health management would be desirable for mastitis and a wide variety of other infectious and non-infectious cattle diseases, some of which are known to have profound negative effects on the performance and well-being of cows. Differential cell counting (DCC), a procedure that aims to determine the proportions of different somatic cell types in raw milk samples, has not only the potential to optimize mastitis diagnostics, but it could furthermore serve as a diagnostic tool for monitoring the general and overall health status of dairy cows. Based on a broad search of the literature, the practical utility of various types of DCC is summarized and discussed in this review. Since it might be of advantage to interpret DCC with the aid of data from studies in humans, differences between the immune systems of humans and dairy cattle, with a special focus on surface marker expression profiles and γδ (gamma delta) T-cell characteristics, are also described.
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Li JL, Lin YC, Wang YF, Monaghan SA, Ko BS, Lee CC. A Chunking-for-Pooling Strategy for Cytometric Representation Learning for Automatic Hematologic Malignancy Classification. IEEE J Biomed Health Inform 2022; 26:4773-4784. [PMID: 35588419 DOI: 10.1109/jbhi.2022.3175514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Differentiating types of hematologic malignancies is vital to determine therapeutic strategies for the newly diagnosed patients. Flow cytometry (FC) can be used as diagnostic indicator by measuring the multi-parameter fluorescent markers on thousands of antibody-bound cells, but the manual interpretation of large scale flow cytometry data has long been a time-consuming and complicated task for hematologists and laboratory professionals. Past studies have led to the development of representation learning algorithms to perform sample-level automatic classification. In this work, we propose a chunking-for-pooling strategy to include large-scale FC data into a supervised deep representation learning procedure for automatic hematologic malignancy classification. The use of discriminatively-trained representation learning strategy and the fixed-size chunking and pooling design are key components of this framework. It improves the discriminative power of the FC sample-level embedding and simultaneously addresses the robustness issue due to an inevitable use of down-sampling in conventional distribution based approaches for deriving FC representation. We evaluated our framework on two datasets. Our framework outperformed other baseline methods and achieved 92.3% unweighted average recall (UAR) for four-class recognition on the UPMC dataset and 85.0% UAR for five-class recognition on the hema.to dataset. We further compared the robustness of our proposed framework with that of the traditional downsampling approach. Analysis of the effects of the chunk size and the error cases revealed further insights about different hematologic malignancy characteristics in the FC data.
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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.
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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
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Hedley BD, Cheng G, Keeney M, Kern W, Padurean A, Luider J, Chin‐Yee I, Lowes LE, Rohrbach J, Ortega R, Smit A, Lo K, Magari R, Tejidor L. A multicenter study evaluation of the ClearLLab 10C panels. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2021; 100:225-234. [PMID: 32667744 PMCID: PMC8048967 DOI: 10.1002/cyto.b.21935] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/20/2020] [Accepted: 06/16/2020] [Indexed: 11/26/2022]
Abstract
Multiparameter flow cytometry plays an important role in the diagnosis, staging, and monitoring of patients with a suspected hematological malignancy. The ClearLLab 10C Panels consist of four reagent panels (B-Lineage Tube, T-Lineage Tube, and 2 Myeloid Lineage Tubes), each consisting of 10 color/10 antibody conjugates utilizing Beckman Coulters proprietary dry format optimized for investigating patients with suspected leukemia or lymphoma. A multicenter study was conducted to evaluate the performance of the ClearLLab 10C Panels for qualitative assessment of normal versus abnormal phenotype in peripheral blood, bone marrow, and lymph node samples with suspected hematological malignancies. ClearLLab 10C was compared to laboratory developed tests (LDTs) and final clinical diagnosis. Four clinical sites were used to enroll patient's spent specimens (n = 453); three laboratories in North America and one in Europe. Of the 453 specimens, 198 had no malignancy and 255 contained an abnormal population. The diagnostic accuracy of the ClearLLab 10C Panels was achieved with sensitivity of 96% and specificity of 95% with respect to patient final clinical diagnosis. The agreement of phenotyping between ClearLLab10C Panels and LDTs was 98%. Any differences noted between ClearLLab 10C and LDT were due to either the presence of populations below the level of detection, the lack of clinical information provided to the evaluators, or marker(s) not present in these panels. Overall, the ClearLLab 10C demonstrated excellent agreement to LDTs and diagnosis. These four reagent panels can be adopted by individual laboratories to assess the presence or absence of malignancy.
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Affiliation(s)
- Benjamin D. Hedley
- Department of Pathology and Laboratory MedicineLondon Health Sciences CenterLondonOntarioCanada
| | - Guoyan Cheng
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Michael Keeney
- Department of Pathology and Laboratory MedicineLondon Health Sciences CenterLondonOntarioCanada
| | - Wolfgang Kern
- MLL Munich Leukemia LaboratoryDepartment of ImmunophenotypingMunichGermany
| | - Adrian Padurean
- Neogenomics Laboratory, Inc.Department of Flow CytometryFort MyersFloridaUSA
| | - Joanne Luider
- Calgary Laboratory ServicesFlow Cytometry CalgaryAlbertaCanada
| | - Ian Chin‐Yee
- Department of Pathology and Laboratory MedicineLondon Health Sciences CenterLondonOntarioCanada
| | - Lori E. Lowes
- Department of Pathology and Laboratory MedicineLondon Health Sciences CenterLondonOntarioCanada
| | - Justin Rohrbach
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Robert Ortega
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Astrid Smit
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Ka‐Wai Lo
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Robert Magari
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Liliana Tejidor
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
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Gupta M, Jafari K, Rajab A, Wei C, Mazur J, Tierens A, Hyjek E, Musani R, Porwit A. Radar plots facilitate differential diagnosis of acute promyelocytic leukemia and NPM1+ acute myeloid leukemia by flow cytometry. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 100:409-420. [PMID: 33301193 PMCID: PMC8359362 DOI: 10.1002/cyto.b.21979] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/09/2020] [Accepted: 11/24/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Acute promyelocytic leukemia (APL) is one of the most life-threatening hematological emergencies and requires a prompt correct diagnosis by cytomorphology and flow cytometry (FCM) with later confirmation by cytogenetics/molecular genetics. However, nucleophosmin 1 muted acute myeloid leukemia (NPM1+ AML) can mimic APL, especially the hypogranular variant of APL. Our study aimed to develop a novel, Radar plot-based FCM strategy to distinguish APLs and NPM1+ AMLs quickly and accurately. METHOD Diagnostic samples from 52 APL and 32 NPM1+ AMLs patients were analyzed by a 3-tube panel of 10-color FCM. Radar plots combining all markers were constructed for each tube. Percentages of positive leukemic cells and mean fluorescence intensity were calculated for all the markers. RESULTS APL showed significantly higher expression of CD64, CD2, and CD13, whereas more leukemic cells were positive for CD11b, CD11c, CD15, CD36, and HLA-DR in NPM1+ AMLs. Radar plots featured CD2 expression, a lack of a monocytic component, lack of expression of HLA-DR and CD15, and a lack of a prominent CD11c+ population as recurring characteristics of APL. The presence of blasts with low SSC, presence of at least some monocytes, some expression of HLA-DR and/or CD15, and a prominent CD11c population were recurrent characteristics of NPM1+ AMLs. Radar plot analysis could confidently separate all hypergranular APL cases from any NPM1+ AML and in 90% of cases between variant APL and blastic NPM1+ AML. CONCLUSION Radar plots can potentially add to differential diagnostics as they exhibit characteristic patterns distinguishing APL and different types of NPM1+ AMLs.
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Affiliation(s)
- Monali Gupta
- Immunophenotyping Laboratory, Viapath Analytics LLP, Department of Hematology, Kings College Hospital, London, UK.,Department of Pathobiology and Laboratory Medicine, Division of Hematopathology, University Health Network, Toronto, Ontario, Canada
| | - Katayoon Jafari
- Department of Pathobiology and Laboratory Medicine, Division of Hematopathology, University Health Network, Toronto, Ontario, Canada.,Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Amr Rajab
- Department of Pathobiology and Laboratory Medicine, Division of Hematopathology, University Health Network, Toronto, Ontario, Canada.,Medical-Scientific Department, Lifelabs Medical Laboratory Services, Toronto, Ontario, Canada
| | - Cuihong Wei
- Department of Pathobiology and Laboratory Medicine, Division of Hematopathology, University Health Network, Toronto, Ontario, Canada.,Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Joanna Mazur
- Department of Humanization of Medicine and Sexology, Collegium Medicum, University of Zielona Gora, Zielona Gora, Poland.,Department of Child and Adolescent Health, Institute of Mother and Child, Warsaw, Poland
| | - Anne Tierens
- Department of Pathobiology and Laboratory Medicine, Division of Hematopathology, University Health Network, Toronto, Ontario, Canada
| | - Elizabeth Hyjek
- Department of Pathobiology and Laboratory Medicine, Division of Hematopathology, University Health Network, Toronto, Ontario, Canada.,Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Rumina Musani
- Department of Pathobiology and Laboratory Medicine, Division of Hematopathology, University Health Network, Toronto, Ontario, Canada
| | - Anna Porwit
- Department of Pathobiology and Laboratory Medicine, Division of Hematopathology, University Health Network, Toronto, Ontario, Canada.,Faculty of Medicine, Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 or extractvalue(1224,concat(0x5c,0x7170707871,(select (elt(1224=1224,1))),0x7162627671))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 rlike (select (case when (2397=1595) then 0x31302e313030322f6379746f2e622e3231373833 else 0x28 end))-- mlwg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 procedure analyse(extractvalue(1697,concat(0x5c,0x7170707871,(select (case when (1697=1697) then 1 else 0 end)),0x7162627671)),1)-- dotb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 rlike (select (case when (2220=2220) then 0x31302e313030322f6379746f2e622e3231373833 else 0x28 end))-- yagd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 procedure analyse(extractvalue(1697,concat(0x5c,0x7170707871,(select (case when (1697=1697) then 1 else 0 end)),0x7162627671)),1)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 rlike (select (case when (8458=4072) then 0x31302e313030322f6379746f2e622e3231373833 else 0x28 end))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 order by 1-- adlw] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and 1217=5418-- qlta] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and extractvalue(1180,concat(0x5c,0x7170707871,(select (elt(1180=1180,1))),0x7162627671))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and (select (case when (2892=2892) then null else ctxsys.drithsx.sn(1,2892) end) from dual) is null] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and extractvalue(1180,concat(0x5c,0x7170707871,(select (elt(1180=1180,1))),0x7162627671))-- evzo] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and (select (case when (2892=2892) then null else ctxsys.drithsx.sn(1,2892) end) from dual) is null-- lgvs] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and 8193=(select (case when (8193=1440) then 8193 else (select 1440 union select 7618) end))-- wyue] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 order by 1-- ciuf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and (select (case when (8983=5378) then null else cast((chr(100)||chr(108)||chr(65)||chr(65)) as numeric) end)) is null] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 rlike (select (case when (2220=2220) then 0x31302e313030322f6379746f2e622e3231373833 else 0x28 end))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 order by 1#] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and (select (case when (8951=8951) then null else cast((chr(80)||chr(107)||chr(78)||chr(65)) as numeric) end)) is null] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 or extractvalue(1224,concat(0x5c,0x7170707871,(select (elt(1224=1224,1))),0x7162627671))-- eljp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and 5328=5155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and (select (case when (8951=8951) then null else cast((chr(80)||chr(107)||chr(78)||chr(65)) as numeric) end)) is null-- fcav] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 or (select 3518 from(select count(*),concat(0x7170707871,(select (elt(3518=3518,1))),0x7162627671,floor(rand(0)*2))x from information_schema.plugins group by x)a)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and (select (case when (1060=9577) then null else ctxsys.drithsx.sn(1,1060) end) from dual) is null-- tpsl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and (select 4939 from(select count(*),concat(0x7170707871,(select (elt(4939=4939,1))),0x7162627671,floor(rand(0)*2))x from information_schema.plugins group by x)a)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019; 96:183-194. [DOI: 10.1002/cyto.b.21783] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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