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Park M, Lim J, Ahn A, Oh EJ, Song J, Kim KH, Han JY, Choi HW, Park JH, Shin KH, Kim H, Kim M, Hwang SH, Kim HY, Cho D, Kang ES. Current Status of Flow Cytometric Immunophenotyping of Hematolymphoid Neoplasms in Korea. Ann Lab Med 2024; 44:222-234. [PMID: 38145891 PMCID: PMC10813832 DOI: 10.3343/alm.2023.0298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/12/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023] Open
Abstract
Background Flow cytometric immunophenotyping of hematolymphoid neoplasms (FCI-HLN) is essential for diagnosis, classification, and minimal residual disease (MRD) monitoring. FCI-HLN is typically performed using in-house protocols, raising the need for standardization. Therefore, we surveyed the current status of FCI-HLN in Korea to obtain fundamental data for quality improvement and standardization. Methods Eight university hospitals actively conducting FCI-HLN participated in our survey. We analyzed responses to a questionnaire that included inquiries regarding test items, reagent antibodies (RAs), fluorophores, sample amounts (SAs), reagent antibody amounts (RAAs), acquisition cell number (ACN), isotype control (IC) usage, positive/negative criteria, and reporting. Results Most hospitals used acute HLN, chronic HLN, plasma cell neoplasm (PCN), and MRD panels. The numbers of RAs were heterogeneous, with a maximum of 32, 26, 12, 14, and 10 antibodies used for acute HLN, chronic HLN, PCN, ALL-MRD, and multiple myeloma-MRD, respectively. The number of fluorophores ranged from 4 to 10. RAs, SAs, RAAs, and ACN were diverse. Most hospitals used a positive criterion of 20%, whereas one used 10% for acute and chronic HLN panels. Five hospitals used ICs for the negative criterion. Positive/negative assignments, percentages, and general opinions were commonly reported. In MRD reporting, the limit of detection and lower limit of quantification were included. Conclusions This is the first comprehensive study on the current status of FCI-HLN in Korea, confirming the high heterogeneity and complexity of FCI-HLN practices. Standardization of FCI-HLN is urgently needed. The findings provide a reference for establishing standard FCI-HLN guidelines.
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Affiliation(s)
- Mikyoung Park
- Department of Laboratory Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jihyang Lim
- Department of Laboratory Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ari Ahn
- Department of Laboratory Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun-Jee Oh
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jaewoo Song
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyeong-Hee Kim
- Department of Laboratory Medicine, Dong-A University Hospital, College of Medicine, Dong-A University, Busan, Korea
| | - Jin-Yeong Han
- Department of Laboratory Medicine, Dong-A University Hospital, College of Medicine, Dong-A University, Busan, Korea
| | - Hyun-Woo Choi
- Department of Laboratory Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Joo-Heon Park
- Department of Laboratory Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Kyung-Hwa Shin
- Department of Laboratory Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyerim Kim
- Department of Laboratory Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Miyoung Kim
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Hyun Hwang
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Young Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duck Cho
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Suk Kang
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
Acute leukemias of ambiguous lineage are a heterogenous group of diseases that include acute undifferentiated leukemias and mixed-phenotype acute leukemias (MPALs). These leukemias pose a challenge for pathologists and clinicians alike in diagnosis, treatment, and further management. Recent genetic characterization has provided insights into their underlying biology and classification, and has offered potential for targeted therapies. This article addresses diagnosis of MPALs with examples of the most common pitfalls, recent comprehensive molecular studies, and advancement in treatment and follow-up modalities.
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Affiliation(s)
- Nidhi Aggarwal
- Department of Pathology, University of Pittsburgh, School of Medicine, Hill Building, 3477 Euler Way, Pittsburgh, PA 15213, USA.
| | - Olga K Weinberg
- Department of Pathology, University of Texas Southwestern, Texas, BioCenter, 2230 Inwood Road, EB03.220G, Dallas, TX 75235, USA
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Bras AE, Osmani Z, de Haas V, Jongen-Lavrencic M, Te Marvelde JG, Zwaan CM, Mejstrikova E, Fernandez P, Szczepanski T, Orfao A, van Dongen JJM, van der Velden VHJ. Standardised immunophenotypic analysis of myeloperoxidase in acute leukaemia. Br J Haematol 2020; 193:922-927. [PMID: 33161592 PMCID: PMC8247412 DOI: 10.1111/bjh.17210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022]
Abstract
Given its myeloid‐restricted expression, myeloperoxidase (MPO) is typically used for lineage assignment (myeloid vs. lymphoid) during acute leukaemia (AL) diagnostics. In the present study, a robust flow cytometric definition for MPO positivity was established based on the standardised EuroFlow protocols, the standardised Acute Leukaemia Orientation Tube and 1734 multicentre AL cases (with confirmed assay stability). The best diagnostic performance was achieved by defining MPO positivity as ≥20% of the AL cells exceeding a lymphocyte‐based threshold. The methodology employed should be applicable to any form of standardised flow cytometry.
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Affiliation(s)
- Anne E Bras
- Laboratory Medical Immunology (LMI), Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Zgjim Osmani
- Laboratory Medical Immunology (LMI), Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Valerie de Haas
- Dutch Childhood Oncology Group, Utrecht, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Mojca Jongen-Lavrencic
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jeroen G Te Marvelde
- Laboratory Medical Immunology (LMI), Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - C Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology/Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ester Mejstrikova
- CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Paula Fernandez
- Institute for Laboratory Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Tomasz Szczepanski
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia (SUM), Katowice, Poland
| | - Alberto Orfao
- Cancer Research Center (IBMCC-CSIC), Department of Medicine and Cytometry Service, University of Salamanca (USAL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Centro de Investigaciόn Biomédicaen Red de Cáncer, Instituto Carlos III, Madrid, Spain
| | | | - Vincent H J van der Velden
- Laboratory Medical Immunology (LMI), Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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International cooperative study identifies treatment strategy in childhood ambiguous lineage leukemia. Blood 2018; 132:264-276. [PMID: 29720486 DOI: 10.1182/blood-2017-12-821363] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/09/2018] [Indexed: 01/15/2023] Open
Abstract
Despite attempts to improve the definitions of ambiguous lineage leukemia (ALAL) during the last 2 decades, general therapy recommendations are missing. Herein, we report a large cohort of children with ALAL and propose a treatment strategy. A retrospective multinational study (International Berlin-Frankfurt-Münster Study of Leukemias of Ambiguous Lineage [iBFM-AMBI2012]) of 233 cases of pediatric ALAL patients is presented. Survival statistics were used to compare the prognosis of subsets and types of treatment. Five-year event-free survival (EFS) of patients with acute lymphoblastic leukemia (ALL)-type primary therapy (80% ± 4%) was superior to that of children who received acute myeloid leukemia (AML)-type or combined-type treatment (36% ± 7.2% and 50% ± 12%, respectively). When ALL- or AML-specific gene fusions were excluded, 5-year EFS of CD19+ leukemia was 83% ± 5.3% on ALL-type primary treatment compared with 0% ± 0% and 28% ± 14% on AML-type and combined-type primary treatment, respectively. Superiority of ALL-type treatment was documented in single-population mixed phenotype ALAL (using World Health Organization and/or European Group for Immunophenotyping of Leukemia definitions) and bilineal ALAL. Treatment with ALL-type protocols is recommended for the majority of pediatric patients with ALAL, including cases with CD19+ ALAL. AML-type treatment is preferred in a minority of ALAL cases with CD19- and no other lymphoid features. No overall benefit of transplantation was documented, and it could be introduced in some patients with a poor response to treatment. As no clear indicator was found for a change in treatment type, this is to be considered only in cases with ≥5% blasts after remission induction. The results provide a basis for a prospective trial.
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Ahuja A, Tyagi S, Seth T, Pati HP, Gahlot G, Tripathi P, Somasundaram V, Saxena R. Comparison of Immunohistochemistry, Cytochemistry, and Flow Cytometry in AML for Myeloperoxidase Detection. Indian J Hematol Blood Transfus 2017; 34:233-239. [PMID: 29622864 DOI: 10.1007/s12288-017-0849-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/08/2017] [Indexed: 11/27/2022] Open
Abstract
Acute Myeloid Leukemia (AML) as per World Health Organization (WHO 2008) classification is on the basis of the antigenic characterization, enzymes restriction in the neoplastic myeloid cells and the specific translocations/mutations. AML can be assessed and differentiated by flowcytometry (FCM)/immunohistochemistry (IHC)/cytochemistry techniques. Myeloperoxidase (MPO) is an unequivocal marker to differentiate AML from the acute lymphoblastic leukemia. Despite FCM popularity, it has its limitations, in form of 'dry-tap', cost, and inability of being performed by retrospective analysis. IHC, though an old technique has overcome these disadvantages of FCM. Cytochemistry, on the other hand has its own advantages in being cost-effective; technically easy to do while its disadvantages are its inability to be carried out in the old samples, 'dry-tap' conditions in aleukemic leukemia. There has been non-uniformity in the literature among these techniques especially concerning their sensitivity for MPO. A prospective study was done at All India Institute of Medical Sciences New Delhi from 01 July 2014 to 30 Nov 2015 to include 120 diagnosed acute myeloid leukemia cases. Myeloperoxidase stain was done by cytochemistry, immunohistochemistry and flow cytometry and results were compared. There were 28 cases which showed discrepancies. Out of these 28 cases immunohistochemistry showed positivity in majority (22 cases) followed by flow cytometry (14 cases). Therefore it is important to employ more than one technique and IHC must be included for detection of MPO in all suspected cases of AML especially when negative with FCM .
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Affiliation(s)
- Ankur Ahuja
- 1Department of Lab Sciences and Molecular Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - Seema Tyagi
- 2Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
| | - Tulika Seth
- 2Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
| | - Hara Prasad Pati
- 2Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
| | - Gps Gahlot
- 1Department of Lab Sciences and Molecular Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - Preeti Tripathi
- 2Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Renu Saxena
- 2Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
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Pomerantz A, Rodríguez-Rodríguez S, Demichelis-Gómez R, Barrera-Lumbreras G, Barrales-Benítez OV, Díaz-Huízar MJ, Goldberg-Murow M, López-Karpovitch X, Aguayo Á. Importance of CD117 in the Assignation of a Myeloid Lineage in Acute Leukemias. Arch Med Res 2017. [PMID: 28625325 DOI: 10.1016/j.arcmed.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The correct classification of acute leukemias (AL) is an essential part in the evaluation of any patient with this disease. Historically, CD117 has been an important asset in the diagnosis of patients with mixed-phenotype acute leukemia (MPAL). In an attempt to simplify the diagnosis of MPAL with fewer and more lineage specific markers, the World Health Organization (WHO) proposed in 2008 a new criteria for the diagnosis of this type of AL, which excluded CD117 from the myeloid markers that are utilized to diagnose MPAL. In order to assess whether CD117 is necessary in the diagnosis of MPAL, we evaluated the sensitivity and specificity of CD117 for acute myeloid leukemia (AML) in 331 patients with AL. The calculated sensitivity of CD117 for AML was 85.88% (103/120), while the specificity was 83.9% (177/211). Besides myeloperoxidase (MPO), which was used as the gold standard in differentiating AML from other type of ALs, the most specific markers for AML in our study were CD14 and CD64 (99.5 and 95.6%). Although the specificity of CD117 in this study is not as high as CD14 and CD64, markers concomitantly used in this this study and in the WHO classification, based on the results of other researches (i.e. the specificity of CD117 for AML was 100% in one study) and due to the fact that its specificity for AML in this study is relatively high, we recommend the use CD117 in assigning a myeloid lineage in MPAL.
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Affiliation(s)
- Alan Pomerantz
- Departamento de Hematología y Oncología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Ciudad de México, México; Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Huixquilucan, Estado de México, México
| | - Sergio Rodríguez-Rodríguez
- Departamento de Hematología y Oncología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Ciudad de México, México; Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Huixquilucan, Estado de México, México
| | - Roberta Demichelis-Gómez
- Departamento de Hematología y Oncología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Ciudad de México, México
| | - Georgina Barrera-Lumbreras
- Departamento de Hematología y Oncología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Ciudad de México, México
| | - Olga V Barrales-Benítez
- Departamento de Hematología y Oncología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Ciudad de México, México
| | - María José Díaz-Huízar
- Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Huixquilucan, Estado de México, México
| | - Monica Goldberg-Murow
- Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Huixquilucan, Estado de México, México
| | - Xavier López-Karpovitch
- Departamento de Hematología y Oncología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Ciudad de México, México.
| | - Álvaro Aguayo
- Departamento de Hematología y Oncología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Ciudad de México, México
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7
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Shang L, Chen X, Li Y, Guo G, He D, Cai X, Zheng B, Mi Y, Wang J, Ru K, Wang H. [Expression of cMPO in 502 cases of acute myeloid leukemia (AML) and its diagnosis significance in AML subtypes]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:906-11. [PMID: 26632461 PMCID: PMC7342422 DOI: 10.3760/cma.j.issn.0253-2727.2015.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
目的 探讨髓过氧化物酶(cMPO)在急性髓系白血病(AML)患者中的表达及其在诊断分型中的意义。 方法 采用CD45/SSC双参数散点图设门方法对502例AML患者进行八色流式细胞术免疫表型分析,观察患者白血病细胞cMPO表达的阳性率和阳性强度。 结果 502例AML患者cMPO总体阳性率为58.0%,其中阳性占21.5%,弱阳性占34.1%,部分阳性占2.4%;阴性占42.0%。各亚型中,AML伴t(15;17)(q22;q12)/PML-RARα的cMPO阳性率最高,为100%,阳性强度多数接近正常粒细胞水平;其次为AML伴t(8;21)(q22;q22)/RUNX1-RUNX1T1,阳性率为91.4%,阳性强度多为弱阳性;AML微分化型和急性巨核细胞白血病患者cMPO表达皆为阴性;余各亚型阳性率在22.7%~76.2%。 结论 各亚型AML cMPO的阳性率及阳性强度存在显著差异。
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Affiliation(s)
- Lei Shang
- Institute of Hematology and Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Xuejing Chen
- Institute of Hematology and Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Yuanyuan Li
- Institute of Hematology and Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Guiqing Guo
- Institute of Hematology and Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Dashui He
- Institute of Hematology and Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Xiaojin Cai
- Institute of Hematology and Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Bin Zheng
- Institute of Hematology and Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Yingchang Mi
- Institute of Hematology and Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Jianxiang Wang
- Institute of Hematology and Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Kun Ru
- Institute of Hematology and Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Huijun Wang
- Institute of Hematology and Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
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