1
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Kato Y, Sakamoto D, Ohnishi H, Taki T. Detection of decreased granules in neutrophils by automated hematology analyzers XR-1000 and UniCel DxH 800. Lab Med 2024:lmae047. [PMID: 39005201 DOI: 10.1093/labmed/lmae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the utility of neutrophil-related cell population data obtained by automated hematology analyzers in assessing myelodysplastic syndrome cases with decreased granules in neutrophils. METHODS A total of 108 subjects were classified into normal granule (n = 35), hypogranulation (n = 37), or hypergranulation (n = 36) groups. Neutrophil cell area and granule area were measured by ImageJ. All samples were analyzed on the XR-1000 and UniCel DxH 800, and neutrophil-related parameters were compared among the 3 groups. RESULTS Neutrophil cell area and the ratio of the granular area showed significant differences among the 3 groups; they were the highest in the hypergranulation group and lowest in the hypogranulation group. XR-1000 data showed significant differences in NE-SFL and NE-FSC among the 3 groups (P < .0001). NE-SFL and NE-FSC discriminated most accurately hypogranulation group against other groups. UniCel DxH 800 data showed significant differences in MN-V-NE, MN-MALS-N, MN-UMALS-NE, SD-UMALS-NE (P <.01), MN-LMALS-NE, and SD-LMALS-NE (P <.05) among the 3 groups. The combination of SD-V-NE and SD-LMALS-NE discriminated most accurately the hypogranulation group against the other groups. CONCLUSION NE-SFL and NE-FSC and the combination of SD-V-NE and SD-LMALS-NE are useful in detecting cases with decreased granules in neutrophils.
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Affiliation(s)
- Yosuke Kato
- Department of Medical Technology, Kyorin University Faculty of Health Sciences, Mitaka, Japan
| | - Daisuke Sakamoto
- Department of Laboratory Medicine, Kyorin University Faculty of Medicine, Mitaka, Japan
| | - Hiroaki Ohnishi
- Department of Laboratory Medicine, Kyorin University Faculty of Medicine, Mitaka, Japan
| | - Tomohiko Taki
- Department of Medical Technology, Kyorin University Faculty of Health Sciences, Mitaka, Japan
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2
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Plander M, Kányási M, Szendrei T, Skrapits J, Timár B. Flow cytometry in the differential diagnosis of myelodysplastic neoplasm with low blasts and cytopenia of other causes. Pathol Oncol Res 2024; 30:1611811. [PMID: 39040799 PMCID: PMC11260641 DOI: 10.3389/pore.2024.1611811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/26/2024] [Indexed: 07/24/2024]
Abstract
Background Myelodysplastic neoplasms (MDS) are characterized by cytopenia, morphologic dysplasia, and genetic abnormalities. Multiparameter flow cytometry (FCM) is recommended in the diagnostic work-up of suspected MDS, but alone is not sufficient to establish the diagnosis. Our aim was to investigate the diagnostic power of FCM in a heterogeneous population of patients with cytopenia, excluding cases with increased blast count. Methods We analyzed bone marrow samples from 179 patients with cytopenia (58 MDS, 121 non-MDS) using a standardized 8-color FCM method. We evaluated the sensitivity, specificity, and accuracy of several simple diagnostic approaches, including Ogata score, extended Ogata score, the WHO and ELN iMDSFlow recommended "3 aberrations in two cell compartments method," and the combination of the Ogata score and "3 aberrations in two cell compartments method." The patients were followed until the diagnosis was confirmed, with a median follow-up of 2 months (range 0.2-27). Results The combination of Ogata score and "3 aberrations in two cell compartments method" achieved the highest diagnostic accuracy (78%) with sensitivity and specificity 61% and 86%, respectively. When using only the "3 aberrations in two cell compartments method," the accuracy was 77% with a sensitivity of 72% and a specificity of 79%. The most frequently observed etiologies among the false positive cases were substrate deficiencies, inflammation/infection, or toxic effects. MDS can be excluded in all these cases after a thorough clinical evaluation and a relatively short follow-up. Conclusion FCM remains an important but supplementary part in an integrated diagnostic process of MDS with low blasts. The combination of the Ogata score and the "3 aberrations in two cell compartments method" slightly improves accuracy compared to the detection of "3 aberrations in two cell compartments method" alone.
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Affiliation(s)
- Márk Plander
- Department of Hematology, Markusovszky University Teaching Hospital, Szombathely, Hungary
- Central Laboratory, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Mária Kányási
- Central Laboratory, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Tamás Szendrei
- Department of Hematology, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Judit Skrapits
- Central Laboratory, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Botond Timár
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
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3
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van Spronsen MF, Van Gassen S, Duetz C, Westers TM, Saeys Y, van de Loosdrecht AA. Myelodysplastic neoplasms dissected into indolent, leukaemic and unfavourable subtypes by computational clustering of haematopoietic stem and progenitor cells. Leukemia 2024; 38:1365-1377. [PMID: 38459168 PMCID: PMC11147773 DOI: 10.1038/s41375-024-02203-z] [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] [Received: 08/20/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/10/2024]
Abstract
Myelodysplastic neoplasms (MDS) encompass haematological malignancies, which are characterised by dysplasia, ineffective haematopoiesis and the risk of progression towards acute myeloid leukaemia (AML). Myelodysplastic neoplasms are notorious for their heterogeneity: clinical outcomes range from a near-normal life expectancy to leukaemic transformation or premature death due to cytopenia. The Molecular International Prognostic Scoring System made progress in the dissection of MDS by clinical outcomes. To contribute to the risk stratification of MDS by immunophenotypic profiles, this study performed computational clustering of flow cytometry data of CD34+ cells in 67 MDS, 67 AML patients and 49 controls. Our data revealed heterogeneity also within the MDS-derived CD34+ compartment. In MDS, maintenance of lymphoid progenitors and megakaryocytic-erythroid progenitors predicted favourable outcomes, whereas expansion of granulocyte-monocyte progenitors increased the risk of leukaemic transformation. The proliferation of haematopoietic stem cells and common myeloid progenitors with downregulated CD44 expression, suggestive of impaired haematopoietic differentiation, characterised a distinct MDS subtype with a poor overall survival. This exploratory study demonstrates the prognostic value of known and previously unexplored CD34+ populations and suggests the feasibility of dissecting MDS into a more indolent, a leukaemic and another unfavourable subtype.
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Affiliation(s)
- Margot F van Spronsen
- Department of Haematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Sofie Van Gassen
- VIB Inflammation Research Centre, Ghent University, Ghent, Belgium
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Carolien Duetz
- Department of Haematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Theresia M Westers
- Department of Haematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Yvan Saeys
- VIB Inflammation Research Centre, Ghent University, Ghent, Belgium
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Arjan A van de Loosdrecht
- Department of Haematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, Amsterdam, Netherlands.
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4
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Ogata K, Mochimaru Y, Kasai N, Sei K, Kawahara N, Ogata M, Yamamoto Y. Prevalence of massively diluted bone marrow cell samples aspirated from patients with myelodysplastic syndromes (MDS) or suspected of MDS: A retrospective analysis of nationwide samples in Japan. Br J Haematol 2024; 204:1856-1861. [PMID: 38590011 DOI: 10.1111/bjh.19447] [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: 01/13/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/10/2024]
Abstract
Bone marrow (BM) examination is a key element in the diagnosis and prognostic grading of myelodysplastic syndromes (MDSs), and obtaining adequate BM cell samples is critical for accurate test results. Massive haemodilution of aspirated BM samples is a well-known problem; however, its incidence in patients with MDS has not been well studied. We report the first study to examine the incidence of massive haemodilution in nationwide BM samples aspirated from patients diagnosed with or suspected of MDS in Japan. Among 283 cases available for analysis, BM smears from 92 cases (32.5%) were hypospicular (massively haemodiluted) and, particularly, no BM particles were observed in 52 cases (18.4%). Regarding hypospicular cases, we examined how the doctors in charge interpreted the BM smears of their patients. In only 19 of 92 cases (20.7%), doctors realised that the BM smears were haemodiluted. Furthermore, the BM biopsy, which can help diagnose hypospicular cases, was oftentimes not performed when the haemodilution was overlooked by doctors (not performed in 50 of 73 such cases). These real-world data highlight that not only researchers who are working to improve diagnostic tests but also clinicians who perform and use diagnostic tests must realise this common and potentially critical problem.
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Affiliation(s)
- Kiyoyuki Ogata
- Department of Haematology, Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Yuto Mochimaru
- Department of Haematology, Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Nana Kasai
- Department of Haematology, Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Kazuma Sei
- Department of Haematology, Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Naoya Kawahara
- Department of Haematology, Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Mika Ogata
- Department of Haematology, Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Yumi Yamamoto
- Department of Haematology, Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
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5
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Hokland P. Revisiting the most often used item in the haematological tool box-The extent of haemodilution in bone marrow aspirates. Br J Haematol 2024; 204:1593-1594. [PMID: 38602310 DOI: 10.1111/bjh.19474] [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: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/12/2024]
Abstract
In this issue, a nationwide retrospective Japanese study finds that, in a second opinion setting, one-third of bone marrow aspirates from patients suspected of myelodysplastic syndromes are heavily haemodiluted. Moreover, in four-fifths of such cases, the failure to obtain the correct material for diagnosis went undetected by the referring institution. These data are intriguing, but given their special set-up, caution should be exerted in transposing them to other countries. Commentary on: Ogata et al. Prevalence of massively diluted bone marrow cell samples aspirated from patients with myelodysplastic syndromes (MDS) or suspected MDS: A retrospective analysis of nationwide samples in Japan. Br J Haematol 2024;204:1856-1861.
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Affiliation(s)
- Peter Hokland
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Oelschlaegel U, Winter S, Sockel K, Epp K, Schadt J, Röhnert MA, Krüger T, Ruhnke L, Bornhäuser M, Platzbecker U, Kroschinsky F, von Bonin M. MDS-PB13 Score - Blood based detection of aberrancies by flow cytometry in patients with suspected and confirmed Myelodysplastic Neoplasms. Leukemia 2024; 38:446-450. [PMID: 38228682 PMCID: PMC10844065 DOI: 10.1038/s41375-024-02141-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/18/2024]
Affiliation(s)
- Uta Oelschlaegel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
| | - Susann Winter
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Katja Sockel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Katharina Epp
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Jonas Schadt
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Maximilian A Röhnert
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Thomas Krüger
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Leo Ruhnke
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT), Dresden, Germany
| | - Uwe Platzbecker
- Clinic and Policlinic for Hematology, Cellular Therapy Hemostaseology and Infectiology, University Hospital Leipzig, Leipzig, Germany
| | - Frank Kroschinsky
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Malte von Bonin
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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7
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Cargo C, Bernard E, Beinortas T, Bolton KL, Glover P, Warren H, Payne D, Ali R, Khan A, Short M, Van Hoppe S, Smith A, Taylor J, Evans P, Papaemmanuil E, Crouch S. Predicting cytopenias, progression, and survival in patients with clonal cytopenia of undetermined significance: a prospective cohort study. Lancet Haematol 2024; 11:e51-e61. [PMID: 38135373 DOI: 10.1016/s2352-3026(23)00340-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Somatic mutations are frequently reported in individuals with cytopenia but without a confirmed haematological diagnosis (clonal cytopenia of undetermined significance; CCUS). These patients have an increased risk of progression to a myeloid malignancy and worse overall survival than those with no such mutations. To date, studies have been limited by retrospective analysis or small patient numbers. We aimed to establish the natural history of CCUS by prospectively investigating outcome in a large, well defined patient cohort. METHODS This prospective cohort study was conducted at the Haematological Malignancy Diagnostic Service, a diagnostic laboratory in Leeds, UK. Patients aged at least 18 years who were referred for investigation of cytopenia were eligible for inclusion; those with a history of myeloid malignancy were not eligible. Targeted sequencing was conducted alongside routine clinical testing. Baseline mutation analysis was then correlated with the main study outcomes: longitudinal blood counts, disease progression to a myeloid malignancy, and overall survival with a median follow-up of 4·54 years (IQR 4·03-5·04). Data were collected manually from hospital records or extracted from laboratory or clinical outcome databases. FINDINGS Bone marrow samples from 2348 patients were received at the Haematological Malignancy Diagnostic Service between July 1, 2014, and July 31, 2016. Of these, 2083 patients (median age 72 years [IQR 63-80, range 18-99]; 854 [41·0%] female and 1229 [59·0%] male) met the inclusion criteria and had samples of sufficient quality for further analysis. 598 (28·7%) patients received a diagnosis on the basis of their biopsy sample, whereas 1485 (71·3%) samples were classified as non-diagnostic; of these, CCUS was confirmed in 400 (26·9%) patients (256 [64·0%] male and 144 [36·0%] female). TET2, SRSF2, and DNMT3A were the most frequently mutated genes in patients with CCUS, with 320 (80%) of 400 patients harbouring a mutation in at least one of these genes. Age (p<0·0001), sex (p=0·0027), and mutations in ASXL1 (p=0·0009), BCOR (p=0·0056), and TP53 (p=0·0055) correlated with a worse overall survival; however, the number of mutations was the strongest predictor for progression to a myeloid malignancy (two mutations, p=0·0024; three or more mutations, p=0·0004). Extended sequencing of samples from a subgroup of patients with sequential samples and no mutations in the initial myeloid gene panel showed recurrent mutations in both DDX41 and UBA1, suggesting that these genes should be included in clinical test panels. INTERPRETATION Mutation analysis is advised in patients who have undergone bone marrow examination and have an otherwise-unexplained cytopenia. High-risk genetic mutations and increased numbers of mutations are predictive of both survival and progression within 5 years of presentation, warranting clinical surveillance and, when necessary, intervention. FUNDING MDS Foundation.
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Affiliation(s)
- Catherine Cargo
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK.
| | - Elsa Bernard
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tumas Beinortas
- St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kelly L Bolton
- Washington University School of Medicine, St Louis, MO, USA
| | - Paul Glover
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Helen Warren
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Daniel Payne
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Rukhsaar Ali
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Alesia Khan
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Mike Short
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Suzan Van Hoppe
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Alex Smith
- Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - Jan Taylor
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Paul Evans
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Elli Papaemmanuil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Simon Crouch
- Epidemiology and Cancer Statistics Group, University of York, York, UK
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8
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Chen X, Johansson U, Cherian S. Flow Cytometric Assessment of Myelodysplastic Syndromes/Neoplasms. Clin Lab Med 2023; 43:521-547. [PMID: 37865501 DOI: 10.1016/j.cll.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Myelodysplastic syndromes/neoplasms (MDS) are a heterogeneous class of hematopoietic stem cell neoplasms characterized by ineffective hematopoiesis leading to peripheral cytopenias. This group of diseases is typically diagnosed using a combination of clinical, morphologic, and genetic criteria. Many studies have described the value of multiparametric flow cytometry (MFC) in the diagnosis, classification, and prognostication of MDS. This review summarizes the approach to MDS diagnosis and immunophenotypic characterization using MFC and describes the current state while highlighting future opportunities and potential pitfalls.
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Affiliation(s)
- Xueyan Chen
- Translational Science and Therapeutics Division, Fred Hutch Cancer Center, Seattle, WA, USA; Department of Laboratory Medicine and Pathology, University of Washington, 825 Eastlake Avenue East, Seattle, WA 98109, USA
| | - Ulrika Johansson
- SI-HMDS, Haematology, UHBW NHS Foundation Trust, Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Sindhu Cherian
- Department of Laboratory Medicine and Pathology, University of Washington, 825 Eastlake Avenue East, Seattle, WA 98109, USA.
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9
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Guarnera L, Fabiani E, Attrotto C, Hajrullaj H, Cristiano A, Latagliata R, Fenu S, Buccisano F, Irno-Consalvo M, Conti C, Voso MT, Maurillo L. Reliability of flow-cytometry in diagnosis and prognostic stratification of myelodysplastic syndromes: correlations with morphology and mutational profile. Ann Hematol 2023; 102:3015-3023. [PMID: 37535147 PMCID: PMC10567902 DOI: 10.1007/s00277-023-05384-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Abstract
Diagnosis and prognostic stratification of myelodysplastic syndromes (MDS) have been complemented by new techniques, including flow cytometry and NGS. To analyze the relationship between molecular and cytofluorimetric data, we enrolled in this retrospective study, 145 patients, including 106 diagnosed with MDS and 39 controls. At disease onset, immunophenotypic (IF), cytogenetic tests, and cytomorphological (CM) examination on bone marrow were carried out in all patients, while NGS was performed in 58 cases. Ogata score presented a specificity of 100% and a sensitivity of 59%. The detection of at least two phenotypic aberrancies in Ogata negative patients increased the sensitivity to 83% and specificity to 87%. Correlations were identified between IF aberrancies and mutations, including positive Ogata>2 and mutations in SRSF2 (p=0.035), CD15 and U2AF1 (0.032), CD56 and DNMT3A (p=0.042), and CD38 and TP53 (p=0.026). In multivariate analysis, U2AF1 mutations, associated with del(20q) and/or abnormalities of chromosome 7 (group 4 as defined by the EuroMDS score), significantly correlated with an inferior overall survival (p=0.019). These parameters and Ogata score>2 also showed a significant correlation with inferior event-free survival (p=0.023 and p=0.041, respectively). Both CM and FC features correlated with prognosis and mutational patterns. In an integrated MDS work-up, these tools may guide indications for mutational screening for optimal risk stratification.
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Affiliation(s)
- Luca Guarnera
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Emiliano Fabiani
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Cristina Attrotto
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Hajro Hajrullaj
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Antonio Cristiano
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | | | - Susanna Fenu
- Haematology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Francesco Buccisano
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Maria Irno-Consalvo
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Consuelo Conti
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.
- Neuro-Oncohematology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy.
| | - Luca Maurillo
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
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10
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Clichet V, Lebon D, Chapuis N, Zhu J, Bardet V, Marolleau JP, Garçon L, Caulier A, Boyer T. Artificial intelligence to empower diagnosis of myelodysplastic syndromes by multiparametric flow cytometry. Haematologica 2023; 108:2435-2443. [PMID: 36924240 PMCID: PMC10483367 DOI: 10.3324/haematol.2022.282370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
The diagnosis of myelodysplastic syndromes (MDS) might be challenging and relies on the convergence of cytological, cytogenetic, and molecular factors. Multiparametric flow cytometry (MFC) helps diagnose MDS, especially when other features do not contribute to the decision-making process, but its usefulness remains underestimated, mostly due to a lack of standardization of cytometers. We present here an innovative model integrating artificial intelligence (AI) with MFC to improve the diagnosis and the classification of MDS. We develop a machine learning model through an elasticnet algorithm directed on a cohort of 191 patients, only based on flow cytometry parameters selected by the Boruta algorithm, to build a simple but reliable prediction score with five parameters. Our AI-assisted MDS prediction score greatly improves the sensitivity of the Ogata score while keeping an excellent specificity validated on an external cohort of 89 patients with an Area Under the Curve of 0.935. This model allows the diagnosis of both high- and low-risk MDS with 91.8% sensitivity and 92.5% specificity. Interestingly, it highlights a progressive evolution of the score from clonal hematopoiesis of indeterminate potential (CHIP) to highrisk MDS, suggesting a linear evolution between these different stages. By significantly decreasing the overall misclassification of 52% for patients with MDS and of 31.3% for those without MDS (P=0.02), our AI-assisted prediction score outperforms the Ogata score and positions itself as a reliable tool to help diagnose MDS.
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Affiliation(s)
- Valentin Clichet
- Service d’Hématologie Biologique, CHU Amiens-Picardie, Amiens, France
| | - Delphine Lebon
- Service d’Hématologie Clinique et de Thérapie Cellulaire, CHU Amiens-Picardie, Amiens, France
- HEMATIM, EA 4666, Université Picardie Jules Verne, Amiens, France
| | - Nicolas Chapuis
- Assistance Publique-Hôpitaux de Paris, Centre-Université Paris Cité, Service d’Hématologie Biologique, Hôpital Cochin, Paris, France
| | - Jaja Zhu
- Service d’Hématologie-Immunologie-Transfusion, CHU Ambroise Paré, INSERM UMR 1184, AP-HP, Université Paris Saclay, 92100 Boulogne Billancourt, France
| | - Valérie Bardet
- Service d’Hématologie-Immunologie-Transfusion, CHU Ambroise Paré, INSERM UMR 1184, AP-HP, Université Paris Saclay, 92100 Boulogne Billancourt, France
| | - Jean-Pierre Marolleau
- Service d’Hématologie Clinique et de Thérapie Cellulaire, CHU Amiens-Picardie, Amiens, France
- HEMATIM, EA 4666, Université Picardie Jules Verne, Amiens, France
| | - Loïc Garçon
- Service d’Hématologie Biologique, CHU Amiens-Picardie, Amiens, France
- HEMATIM, EA 4666, Université Picardie Jules Verne, Amiens, France
| | - Alexis Caulier
- Service d’Hématologie Clinique et de Thérapie Cellulaire, CHU Amiens-Picardie, Amiens, France
- HEMATIM, EA 4666, Université Picardie Jules Verne, Amiens, France
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Division of Hematology/Oncology, Boston Children’s Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Thomas Boyer
- Service d’Hématologie Biologique, CHU Amiens-Picardie, Amiens, France
- HEMATIM, EA 4666, Université Picardie Jules Verne, Amiens, France
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El Hussein S, Loghavi S. Clinical Flow Cytometry Analysis in the Setting of Chronic Myeloid Neoplasms and Clonal Hematopoiesis. Clin Lab Med 2023; 43:411-426. [PMID: 37481320 DOI: 10.1016/j.cll.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
The utility of flow cytometry analysis in the evaluation of chronic myeloid neoplasms, such as myelodysplastic neoplasms and chronic myeloproliferative neoplasms, continues to be emphasized and explored. Recently flow cytometry analysis has been also proven to be able to distinguish persistent clonal hematopoiesis from measurable residual disease in patients with acute myeloid leukemia (AML), a finding with potential critical treatment impact in the management of patients with AML.
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Affiliation(s)
- Siba El Hussein
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA.
| | - Sanam Loghavi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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12
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Duetz C, Westers TM, Van de Loosdrecht AA. Challenging the status flow: how artificial intelligence is advancing diagnosis of myelodysplastic neoplasms. Haematologica 2023; 108:2271-2272. [PMID: 37078265 PMCID: PMC10483337 DOI: 10.3324/haematol.2023.282998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 04/21/2023] Open
Abstract
Not available.
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Affiliation(s)
- Carolien Duetz
- Department of Hematology, Amsterdam UMC Amsterdam, location VUmc, The Netherlands; Cancer Center Amsterdam
| | - Theresia M Westers
- Department of Hematology, Amsterdam UMC Amsterdam, location VUmc, The Netherlands; Cancer Center Amsterdam
| | - Arjan A Van de Loosdrecht
- Department of Hematology, Amsterdam UMC Amsterdam, location VUmc, The Netherlands; Cancer Center Amsterdam.
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Cutler JA, Pugsley HR, Bennington R, Fritschle W, Hartmann L, Zaidi N, Menssen AJ, Singleton TP, Xu D, Loken MR, Wells DA, Brodersen LE, Zehentner BK. Integrated analysis of genotype and phenotype reveals clonal evolution and cytogenetically driven disruption of myeloid cell maturation in myelodysplastic syndromes. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2023; 104:183-194. [PMID: 34773362 DOI: 10.1002/cyto.b.22036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/07/2021] [Accepted: 10/14/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) are a heterogenous collection of clonal bone marrow diseases characterized by cytopenias, abnormal karyotypes, molecular abnormalities, and dysplasia by flow cytometry and/or morphology. The progression of MDS to severe cytopenias and/or overt leukemia is associated with the accumulation of additional cytogenetic abnormalities, suggesting clonal evolution. The impact of these accumulated abnormalities on myeloid maturation and the severity of the disease is poorly understood. METHODS Bone marrow specimens from 16 patients with cytogenetic abnormalities were flow cytometrically sorted into three myeloid populations: progenitors, immature myeloid cells, and mature myeloid cells. Fluorescence in situ hybridization analysis was performed on each to determine the distribution of chromosomal abnormalities during myeloid maturation. RESULTS Our findings revealed three distinct distributions of cytogenetic abnormalities across myeloid maturation, each of which corresponded to specific cytogenetic abnormalities. Group 1 had continuous distribution across all maturational stages and contained patients with a single cytogenetic aberration associated with good-to-intermediate prognosis; Group 2 had accumulation of abnormalities in immature cells and contained patients with high-risk monosomy 7; and Group 3 had abnormalities defining the founding clone equally distributed across maturational stages while subclonal abnormalities were enriched in progenitor cells and contained patients with multiple, non-monosomy 7, abnormalities with evidence of clonal evolution. CONCLUSIONS Our findings demonstrate that low-risk abnormalities (e.g., del(20q) and trisomy 8) occurring in the founding clone display a markedly different disease etiology, with respect to myeloid maturation, than monosomy 7 or abnormalities acquired in subclones, which result in a disruption of myeloid cell maturation in MDS.
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Affiliation(s)
- Jevon A Cutler
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | - Dongbin Xu
- Hematologics Inc., Seattle, Washington, USA
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14
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Oelschlaegel U, Oelschlaeger L, von Bonin M, Kramer M, Sockel K, Mohr B, Wagenfuehr L, Kroschinsky F, Bornhaeuser M, Platzbecker U. Comparison of five diagnostic flow cytometry scores in patients with myelodysplastic syndromes: Diagnostic power and prognostic impact. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2023; 104:141-150. [PMID: 34390327 DOI: 10.1002/cyto.b.22030] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Flow cytometry (FCM) is a co-criterion in myelodysplastic syndromes (MDS) diagnostics according to the WHO classification. The presented study compared diagnostic power and prognostic impact of different FCM-based scores. METHODS A total of 807 bone marrow (BM) samples of patients with cytopenia (543 MDS, 153 non-clonal cytopenias, 111 non-MDS myeloid malignancies) and 78 healthy controls have been investigated using a standardized 8-color-FCM procedure. FCSS, Ogata-score, iFS, RED-score, and ELN-NEC were analyzed for sensitivity and specificity in comparison to standard diagnostic tools. Median follow up for patients was 26 month (range: 0.2-89). RESULTS The iFS showed the highest accuracy (80%) with the best balance between sensitivity (79%) and specificity (86%). This was also valid in MDS with very low IPSS-R and even in MDS without ring sideroblasts, with normal blast count and karyotype, where iFS could confirm diagnosis in 62% and 65% of patients. Besides the high diagnostic power, the established iFS category "consistent with MDS" was associated with inferior overall survival (OS) independent from WHO classification (median: 51 month vs. not reached, p < 0.0001). Remarkably, this iFS category redefined a subgroup of patients with worse OS within IPSS-R low-risk category (73 month vs. not reached, p = 0.0433). Finally, multivariable analysis showed that iFS added independent prognostic information regarding OS besides IPSS-R. CONCLUSIONS The iFS separates non-clonal cytopenias and MDS with the highest accuracy, provided information in addition to standard diagnostic procedures, and refined established prognostic tools for outcome prediction.
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Affiliation(s)
- Uta Oelschlaegel
- Department of Internal Medicine, University Hospital Carl-Gustav-Carus, TU, Dresden, Germany
| | - Lorenz Oelschlaeger
- Department of Internal Medicine, University Hospital Carl-Gustav-Carus, TU, Dresden, Germany
| | - Malte von Bonin
- Department of Internal Medicine, University Hospital Carl-Gustav-Carus, TU Dresden, and German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ) Heidelberg, Dresden, Germany
| | - Michael Kramer
- Department of Internal Medicine, University Hospital Carl-Gustav-Carus, TU, Dresden, Germany
| | - Katja Sockel
- Department of Internal Medicine, University Hospital Carl-Gustav-Carus, TU, Dresden, Germany
| | - Brigitte Mohr
- Department of Internal Medicine, University Hospital Carl-Gustav-Carus, TU, Dresden, Germany
| | - Lisa Wagenfuehr
- Department of Internal Medicine, University Hospital Carl-Gustav-Carus, TU, Dresden, Germany
| | - Frank Kroschinsky
- Department of Internal Medicine, University Hospital Carl-Gustav-Carus, TU, Dresden, Germany
| | - Martin Bornhaeuser
- Department of Internal Medicine, University Hospital Carl-Gustav-Carus, TU Dresden, German Cancer Research Center (DKFZ), and National Center for Tumor Diseases (NCT) Heidelberg, Dresden, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
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15
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Johansson U, McIver-Brown N, Cullen M, Duetz C, Dunlop A, Oelschlägel U, Psarra K, Subirá D, Westers TM. The flow cytometry myeloid progenitor count: A reproducible parameter for diagnosis and prognosis of myelodysplastic syndromes. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2023; 104:115-127. [PMID: 34931733 DOI: 10.1002/cyto.b.22048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/04/2021] [Accepted: 12/09/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The bone marrow blast count is central to the diagnosis and monitoring of myelodysplastic syndromes (MDS). It is an independent risk factor for worse prognosis whether based on the morphology blast count or the flow cytometry (FC) myeloid progenitor (MyP) count. It is a principal population in FC MDS analysis also because once defined; it provides significant contributions to the overall FC MDS score. METHODS We elected to investigate inter-analyst agreement for the most fundamental parameter of the FC MDS diagnostic score: the MyP count. A common gating strategy was agreed and used by seven cytometrists for blind analysis of 34 routine bone marrows sent for MDS work-up. Additionally, we compared the results with a computational approach. RESULTS Concordance was excellent: Intraclass correlation was 0.993 whether measuring %MyP of total cells or CD45+ cells, and no significant difference was observed between files from different centers or for samples with abnormal MyP phenotypes. Computational and manual results were similar. Applying the common strategy to individual laboratories' control cohorts produced similar MyP reference ranges across centers. CONCLUSION The FC MyP count offers a reliable diagnostic and prognostic measurement in MDS. The use of manual and computational approaches side by side may allow for optimizing both strategies. Considering its known prognostic power, the MyP count could be considered a useful and reliable addition to existing prognostic scoring systems.
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Affiliation(s)
- Ulrika Johansson
- Haematological Malignancy Diagnostic Service, University Hospitals and Weston NHS Foundation Trust, Bristol, UK
| | - Neil McIver-Brown
- Molecular Pathology Department, Royal Bournemouth Hospital, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Matthew Cullen
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Carolien Duetz
- Department of Haematology, Amsterdam University Medical Centres, VU University Medical Center, Amsterdam, The Netherlands
| | - Alan Dunlop
- Haematological Malignancy Diagnostic Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Uta Oelschlägel
- Department of Haematology, Medical Clinic and Policlinic I, University Hospital of TU Dresden, Dresden, Germany
| | - Katherina Psarra
- Department of Immunology and Histocompatibility, Evangelismos Hospital, Athens, Greece
| | - Dolores Subirá
- Department of Haematology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Theresia M Westers
- Department of Hematology, Amsterdam University Medical Centers, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
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16
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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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17
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Kern W, Westers TM, Bellos F, Bene MC, Bettelheim P, Brodersen LE, Burbury K, Chu SC, Cullen M, Porta MD, Dunlop AS, Johansson U, Matarraz S, Oelschlaegel U, Ogata K, Porwit A, Preijers F, Psarra K, Saft L, Subirá D, Weiß E, van der Velden VHJ, van de Loosdrecht A. Multicenter prospective evaluation of diagnostic potential of flow cytometric aberrancies in myelodysplastic syndromes by the ELN iMDS flow working group. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2023; 104:51-65. [PMID: 36416672 DOI: 10.1002/cyto.b.22105] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) represent a diagnostic challenge. This prospective multicenter study was conducted to evaluate pre-defined flow cytometric markers in the diagnostic work-up of MDS and chronic myelomonocytic leukemia (CMML). METHODS Thousand six hundred and eighty-two patients with suspected MDS/CMML were analyzed by both cytomorphology according to WHO 2016 criteria and flow cytometry according to ELN recommendations. Flow cytometric readout was categorized 'non-MDS' (i.e. no signs of MDS/CMML and limited signs of MDS/CMML) and 'in agreement with MDS' (i.e., in agreement with MDS/CMML). RESULTS Flow cytometric readout categorized 60% of patients in agreement with MDS, 28% showed limited signs of MDS and 12% had no signs of MDS. In 81% of cases flow cytometric readouts and cytomorphologic diagnosis correlated. For high-risk MDS, the level of concordance was 92%. A total of 17 immunophenotypic aberrancies were found independently related to MDS/CMML in ≥1 of the subgroups of low-risk MDS, high-risk MDS, CMML. A cut-off of ≥3 of these aberrancies resulted in 80% agreement with cytomorphology (20% cases concordantly negative, 60% positive). Moreover, >3% myeloid progenitor cells were significantly associated with MDS (286/293 such cases, 98%). CONCLUSION Data from this prospective multicenter study led to recognition of 17 immunophenotypic markers allowing to identify cases 'in agreement with MDS'. Moreover, data emphasizes the clinical utility of immunophenotyping in MDS diagnostics, given the high concordance between cytomorphology and the flow cytometric readout. Results from the current study challenge the application of the cytomorphologically defined cut-off of 5% blasts for flow cytometry and rather suggest a 3% cut-off for the latter.
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Affiliation(s)
| | - Theresia M Westers
- Department of Hematology, Amsterdam University Medical Centers, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | | | - Peter Bettelheim
- Department of Hematology, Elisabethinen Hospital, Linz, Upper Austria, Austria
| | | | - Kate Burbury
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sung-Chao Chu
- Department of Hematology and Oncology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Matthew Cullen
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Matteo Della Porta
- Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | | | - Ulrika Johansson
- Laboratory Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sergio Matarraz
- Cytometry Service (NUCLEUS), Department of Medicine and IBSAL, Cancer Research Center (IBMCC, University of Salamanca-CSIC), Salamanca, Spain and Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Salamanca, Spain
| | - Uta Oelschlaegel
- Department of Internal Medicine, University Hospital of Technical University Dresden, Dresden, Germany
| | - Kiyoyuki Ogata
- Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Anna Porwit
- Division of Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Frank Preijers
- Department of Laboratory Medicine, Laboratory of Hematology, Radboudumc, Nijmegen, The Netherlands
| | - Katherina Psarra
- Immunology Histocompatibility Department, Evangelismos Hospital, Athens, Greece
| | - Leonie Saft
- Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital and Institute, Stockholm, Sweden
| | - Dolores Subirá
- Department of Medical Immunology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - Vincent H J van der Velden
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arjan van de Loosdrecht
- Department of Hematology, Amsterdam University Medical Centers, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
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18
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Ogata K, Sei K, Kawahara N, Ogata M, Yamamoto Y. Clinical, immunophenotypic, and cytogenetic characteristics of high-grade myelodysplastic syndromes with CD41-positive progenitor cells. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2023; 104:98-107. [PMID: 34964228 DOI: 10.1002/cyto.b.22052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/29/2021] [Accepted: 12/15/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patients with myelodysplastic syndromes (MDS) with progenitors expressing CD41 (CD41+ MDS) showed a poor prognosis in a previous study but their detailed characteristics remain unclear. METHODS One hundred thirty-seven subjects at our institution were diagnosed with excess blasts (EB)-1, EB-2, and acute myeloid leukemia with a low blast count (20%-30%). The immunophenotypes of progenitor cells in their bone marrow (BM) were determined by CD45-gating flow cytometry. A false-positive reaction to CD41 was eliminated by examining the flow cytometry data of lymphocytes and monocytes in addition to progenitors and by examining CD42b in histological sections. The characteristics were compared between CD41+ and CD41- MDS patients. RESULTS Forty-three patients (31%) were CD41+. Additionally, 91% of the CD41+ MDS patients were very high-risk defined by the Revised International Prognostic Score System, which was higher than in patients with CD41- MDS (p = 0.015). Approximately 60% of the CD41+ MDS patients had a monosomal karyotype and very poor cytogenetics, which was higher than in CD41- MDS patients (p < 0.001). Normal cytogenetics was less common in CD41+ patients (p = 0.0016). Blasts with bleb formation were more abundant in CD41+ MDS patients (p = 0.026). All CD41+ MDS patients were positive for CD13 and were mostly positive for CD33. The frequency of aberrant expression of other antigens on progenitors was similar between CD41+ and CD41- MDS patients. CONCLUSIONS We determined clinical, immunophenotypic, and cytogenetic characteristics of CD41+ MDS patients. Further studies are needed to improve the survival of these patients.
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Affiliation(s)
- Kiyoyuki Ogata
- Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Kazuma Sei
- Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Naoya Kawahara
- Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Mika Ogata
- Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Yumi Yamamoto
- Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
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19
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The Impact of Clonal Hierarchy and Heterogeneity on Phenotypic Manifestations of Myelodysplastic Neoplasms. Cancers (Basel) 2022; 14:cancers14225690. [PMID: 36428782 PMCID: PMC9688198 DOI: 10.3390/cancers14225690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/30/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Until recently, conventional prognostication of myelodysplastic neoplasms (MDS) was performed using the revised International Prognostic Scoring System (IPSS-R), with additional adverse prognoses conferred by select mutations. Nonetheless, the clonal diversity and dynamics of coexisting mutations have been shown to alter the prognosis and treatment response in patients with MDS. Often in the process of clonal evolution, various initial hits are preferentially followed by a specific spectrum of secondary alterations, shaping the phenotypic and biologic features of MDS. Our ability to recapitulate the clonal ontology of MDS is a necessary step toward personalized therapy and the conceptualization of a better classification system, which ideally would take into consideration all genomic aberrations and their inferred clonal architecture in individual cases. In this review, we summarize our current understanding of the molecular landscape of MDS and the role of mutational combinations, clonal burden, and clonal hierarchy in defining the clinical fate of the disease.
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20
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Jevremovic D, Nanaa A, Geyer SM, Timm M, Azouz H, Hengel C, Reberg A, He R, Viswanatha D, Salama ME, Shi M, Olteanu H, Horna P, Otteson G, Greipp PT, Xie Z, Alkhateeb HB, Hogan W, Litzow M, Patnaik MM, Shah M, Al-Kali A, Nguyen PL. Abnormal CD13/HLA-DR Expression Pattern on Myeloblasts Predicts Development of Myeloid Neoplasia in Patients With Clonal Cytopenia of Undetermined Significance. Am J Clin Pathol 2022; 158:530-536. [PMID: 35938646 PMCID: PMC9535519 DOI: 10.1093/ajcp/aqac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/09/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Patients with clonal cytopenia of undetermined significance (CCUS) are at increased risk of developing myeloid neoplasia (MN). We evaluated whether a simple flow cytometry immunophenotyping (FCIP) assay could differentiate the risk of development of MN in patients with CCUS. METHODS Bone marrow aspirates were assessed by FCIP panel in a cohort of 80 patients identified as having CCUS based on next-generation sequencing or cytogenetics from March 2015 to May 2020, with available samples. Flow cytometric assay included CD13/HLA-DR expression pattern on CD34-positive myeloblasts; CD13/CD16 pattern on maturing granulocytic precursors; and aberrant expression of CD2, CD7, or CD56 on CD34-positive myeloblasts. Relevant demographic, comorbidity, and clinical and laboratory data, including the type and extent of genetic abnormalities, were extracted from the electronic health record. RESULTS In total, 17 (21%) patients with CCUS developed MN over the follow-up period (median survival follow-up, 28 months [95% confidence interval, 19-31]). Flow cytometry immunophenotyping abnormalities, including the aberrant pattern of CD13/HLA-DR expression, as detected at the time of the diagnosis of CCUS, were significantly associated with risk of developing MN (hazard ratio, 2.97; P = .006). Additional FCIP parameters associated with the development of MN included abnormal expression of CD7 on myeloblasts and the presence vs absence of any FCIP abnormality. CONCLUSIONS A simple FCIP approach that includes assessment of CD13/HLA-DR pattern on CD34-positive myeloblasts can be useful in identifying patients with CCUS at higher risk of developing MN.
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Affiliation(s)
| | - Ahmad Nanaa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Susan M Geyer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Michael Timm
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Haya Azouz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Cynthia Hengel
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | | | - Rong He
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Min Shi
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Horatiu Olteanu
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Gregory Otteson
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Patricia T Greipp
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA.,Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Zhuoer Xie
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - William Hogan
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Phuong L Nguyen
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
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21
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Myelodysplastic Syndrome: Diagnosis and Screening. Diagnostics (Basel) 2022; 12:diagnostics12071581. [PMID: 35885487 PMCID: PMC9319204 DOI: 10.3390/diagnostics12071581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are heterogeneous groups of clonal myeloid disorders characterized by unexplained persistent peripheral blood (PB) cytopenia(s) of one or more of the hematopoietic lineages, or bone marrow (BM) morphologic dysplasia in hematopoietic cells, recurrent genetic abnormalities, and an increased risk of progression to acute myeloid leukemia (AML). In the past several years, diagnostic, prognostic, and therapeutic approaches have substantially improved with the development of Next Generation Sequencing (NGS) diagnostic testing and new medications. However, there is no single diagnostic parameter specific for MDS, and correlations with clinical information, and laboratory test findings are needed to reach the diagnosis.
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22
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Oliveira AF, Tansini A, Toledo T, Balceiro R, Lee MLM, Villela N, Ikeuty P, Metze K, Lopes LF, Lorand-Metze I. Immunophenotypic changes in juvenile myelomonocytic leukaemia after treatment with hypomethylating agent: Do they help to evaluate dept of response? Br J Haematol 2022; 197:339-348. [PMID: 35187646 DOI: 10.1111/bjh.18089] [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: 11/03/2021] [Revised: 01/27/2022] [Accepted: 01/30/2022] [Indexed: 11/29/2022]
Abstract
5-Azacitidine has been used before stem cell transplantation in juvenile myelomonocytic leukaemia (JMML) patients. Recently, we have described immunophenotypic features in JMML at diagnosis. Here, our aim was to examine the changes in the immunophenotypic features during azacitidine treatment, correlating it with clinical response. Patients treated with 5-azacitidine were evaluated at diagnosis and after three and six cycles of medication. Among 32 patients entering the study, 28 patients were examined after three cycles and 25 patients after six. Patients showed a reduction in CD34/CD117+ cells: median 3.35% at diagnosis, 2.8% after three cycles and 1.63% after six. B-cell progenitors were decreased at diagnosis and decreased after treatment. Monocytes decreased: 11.91% to 6.4% and 4.18% respectively. Complete response was associated with increase in classical monocytes. T lymphocytes, reduced at diagnosis, increased in patients responding to 5-azacitidine. Immunophenotypic aberrancies including expression of CD7 in myeloid progenitors remained after treatment. This feature was associated with a worse response to treatment, as well as presence of NF1. Immunophenotyping was feasible in all patients. Clinical response was associated with a decrease of myeloid progenitors and monocytes and a rise in T lymphocytes although phenotypic aberrancies persisted. The largest effect was observed after three cycles.
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Affiliation(s)
- Anita Frisanco Oliveira
- Barretos Children´s Cancer Hospital, Barretos, Brazil.,Brazilian Co-operative Group of Pediatric Myelodysplastic Syndrome (GCB-SMD-PED), Myeloproliferative Diseases Committee, Barretos, Brazil
| | - Aline Tansini
- Barretos Children´s Cancer Hospital, Barretos, Brazil.,Brazilian Co-operative Group of Pediatric Myelodysplastic Syndrome (GCB-SMD-PED), Morfology and Flow Cytometry Committee, Barretos, Brazil
| | - Thais Toledo
- Barretos Children´s Cancer Hospital, Barretos, Brazil.,Brazilian Co-operative Group of Pediatric Myelodysplastic Syndrome (GCB-SMD-PED), Morfology and Flow Cytometry Committee, Barretos, Brazil
| | | | - Maria Lucia Martino Lee
- Brazilian Co-operative Group of Pediatric Myelodysplastic Syndrome (GCB-SMD-PED), Myeloproliferative Diseases Committee, Barretos, Brazil
| | - Neysimelia Villela
- Barretos Children´s Cancer Hospital, Hematopoietic Stem Cell Transplantation, Barretos, Brazil.,Brazilian Co-operative Group of Pediatric Myelodysplastic Syndrome (GCB-SMD-PED), HSCT Committee, Barretos, Brazil
| | - Patricia Ikeuty
- Brazilian Co-operative Group of Pediatric Myelodysplastic Syndrome (GCB-SMD-PED), HSCT Committee, Barretos, Brazil
| | - Konradin Metze
- Department of Pathology, Faculty Medical Sciences, State University of Campinas, Campinas, Brazil
| | - Luiz Fernando Lopes
- Barretos Children´s Cancer Hospital, Barretos, Brazil.,Brazilian Co-operative Group of Pediatric Myelodysplastic Syndrome (GCB-SMD-PED), Barretos, Brazil
| | - Irene Lorand-Metze
- Brazilian Co-operative Group of Pediatric Myelodysplastic Syndrome (GCB-SMD-PED), Morfology and Flow Cytometry Committee, Barretos, Brazil.,Department of Internal Medicine, Faculty Medical Sciences, State University of Campinas, Campinas, Brazil
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23
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Mestrum SG, Cremers EM, de Wit NC, Drent RJ, Ramaekers FC, Hopman AH, Leers MP. Integration of the Ki-67 proliferation index into the Ogata score improves its diagnostic sensitivity for low-grade myelodysplastic syndromes. Leuk Res 2022; 113:106789. [DOI: 10.1016/j.leukres.2022.106789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/30/2021] [Accepted: 01/10/2022] [Indexed: 11/27/2022]
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24
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Pembroke JS, Joseph JE, Smith SABC, Parker AJC, Jiang W, Sewell WA. Comparison of flow cytometry with other modalities in the diagnosis of myelodysplastic syndrome. Int J Lab Hematol 2021; 44:313-319. [PMID: 34841680 DOI: 10.1111/ijlh.13771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/14/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The myelodysplastic syndromes (MDSs) are heterogeneous myeloid malignancies, conventionally diagnosed by cytomorphology and cytogenetics, with an emerging role for flow cytometry. This study compared the performance of a 4-parameter flow cytometry scoring system, the Ogata Score, with other modalities in the diagnosis of MDS. METHODS Bone marrow aspirate and trephine biopsies from 238 patients performed to assess for possible MDS were analysed, and the flow cytometry score was retrospectively applied. The sensitivity and specificity of the flow cytometry score, the aspirate microscopy, the trephine microscopy with immunohistochemistry, and cytogenetic and molecular results were determined relative to the final diagnosis. RESULTS The medical records of the 238 patients were reviewed to determine the final clinical diagnosis made at the time of the bone marrow examination. This final diagnosis of MDS, possible MDS or not MDS, was based on clinical features and laboratory tests, including all parameters of the bone marrow investigation, except for the flow cytometry score, which was only determined for this study. The flow cytometry score was 67.4% sensitive and 93.8% specific. Aspirate microscopy had higher sensitivity (83.7%) and similar specificity (92.0%), whereas trephine microscopy had similar sensitivity (66.3%) and specificity (89.4%) to flow cytometry. Although the flow cytometry score had a lower sensitivity than aspirate microscopy, in 18 patients (7.6% of the total) the flow cytometry score was positive for MDS, whereas aspirate microscopy was negative or inconclusive. CONCLUSION The flow cytometry score and trephine microscopy exhibited reasonable sensitivity and high specificity, and complement aspirate microscopy in the assessment of MDS.
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Affiliation(s)
- John S Pembroke
- St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia.,St Vincent's Pathology (SydPath), St Vincent's Hospital, Sydney, Australia
| | - Joanne E Joseph
- St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia.,St Vincent's Pathology (SydPath), St Vincent's Hospital, Sydney, Australia.,Haematology Department, St Vincent's Hospital, Sydney, Australia
| | - Sandy A B C Smith
- St Vincent's Pathology (SydPath), St Vincent's Hospital, Sydney, Australia
| | - Andrew J C Parker
- St Vincent's Pathology (SydPath), St Vincent's Hospital, Sydney, Australia
| | - Wei Jiang
- St Vincent's Pathology (SydPath), St Vincent's Hospital, Sydney, Australia.,Haematology Department, St Vincent's Hospital, Sydney, Australia
| | - William A Sewell
- St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia.,St Vincent's Pathology (SydPath), St Vincent's Hospital, Sydney, Australia.,Garvan Institute of Medical Research, Sydney, Australia
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25
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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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26
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Duetz C, Van Gassen S, Westers TM, van Spronsen MF, Bachas C, Saeys Y, van de Loosdrecht AA. Computational flow cytometry as a diagnostic tool in suspected-myelodysplastic syndromes. Cytometry A 2021; 99:814-824. [PMID: 33942494 PMCID: PMC8453916 DOI: 10.1002/cyto.a.24360] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/06/2021] [Accepted: 04/26/2021] [Indexed: 12/03/2022]
Abstract
The diagnostic work‐up of patients suspected for myelodysplastic syndromes is challenging and mainly relies on bone marrow morphology and cytogenetics. In this study, we developed and prospectively validated a fully computational tool for flow cytometry diagnostics in suspected‐MDS. The computational diagnostic workflow consists of methods for pre‐processing flow cytometry data, followed by a cell population detection method (FlowSOM) and a machine learning classifier (Random Forest). Based on a six tubes FC panel, the workflow obtained a 90% sensitivity and 93% specificity in an independent validation cohort. For practical advantages (e.g., reduced processing time and costs), a second computational diagnostic workflow was trained, solely based on the best performing single tube of the training cohort. This workflow obtained 97% sensitivity and 95% specificity in the prospective validation cohort. Both workflows outperformed the conventional, expert analyzed flow cytometry scores for diagnosis with respect to accuracy, objectivity and time investment (less than 2 min per patient).
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Affiliation(s)
- Carolien Duetz
- Department of Hematology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Sofie Van Gassen
- VIB Inflammation Research Center, Ghent University, Ghent, Belgium.,Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Theresia M Westers
- Department of Hematology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Margot F van Spronsen
- Department of Hematology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Costa Bachas
- Department of Hematology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Yvan Saeys
- VIB Inflammation Research Center, Ghent University, Ghent, Belgium.,Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Arjan A van de Loosdrecht
- Department of Hematology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, Netherlands
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27
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Majcherek M, Kiernicka-Parulska J, Mierzwa A, Barańska M, Matuszak M, Lewandowski K, Komarnicki M, Czyż A. The diagnostic and prognostic significance of flow cytometric bone marrow assessment in myelodysplastic syndromes according to the European LeukemiaNet recommendations in single-centre real-life experience. Scand J Immunol 2021; 94:e13028. [PMID: 33577137 DOI: 10.1111/sji.13028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 01/31/2021] [Accepted: 02/09/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This analysis attempts to determine the diagnostic and prognostic value of bone marrow (BM) evaluation by multiparameter flow cytometry in patients with myelodysplastic syndrome (MDS). MATERIALS AND METHODS The study group consisted of patients who underwent diagnostic process in the years 2008-2017 due to cytopenia and finally were diagnosed with MDS (n = 71). The comparative group included patients with cytopenia diagnosed in the same period, whose definitive diagnosis was other than MDS (n = 39). Flow cytometric evaluation of BM was performed following the recommendations of the European LeukemiaNet (ELN) in all patients. RESULTS The median number of immunophenotypic abnormalities found on granulocytes in the MDS group was significantly higher compared to the comparative group [2 (range 0-5) vs 0 (range 0-2); P < .0001]. Similarly, the median Ogata score was significantly higher in the MDS group [2 (range 0-4) vs 1 (range 0-3); P < .0001]. Since the disturbances of the CD11b/HLA-DR and CD11b/CD13 on granulocytes were significantly more common in MDS patients, the Ogata score was extended by these abnormalities, what resulted in its higher diagnostic sensitivity (82%) while preserving high specificity (87%). The positive correlation was found between risk score determined by the Revised International Prognostic Scoring System and the number of the BM immunophenotypic abnormalities (P = .017). CONCLUSIONS Our results indicate that the diagnostic usefulness of the Ogata score may be increased by including the abnormal expression of CD11b/HLA-DR and CD11b/CD13 on granulocytes. Moreover, our findings suggest the prognostic significance of the number of BM cytometric abnormalities in MDS.
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Affiliation(s)
- Maciej Majcherek
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland.,Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Jolanta Kiernicka-Parulska
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Mierzwa
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Marta Barańska
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Magdalena Matuszak
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Lewandowski
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Mieczysław Komarnicki
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Czyż
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland.,Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
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28
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Genetics of progression from MDS to secondary leukemia. Blood 2021; 136:50-60. [PMID: 32430504 DOI: 10.1182/blood.2019000942] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/27/2019] [Indexed: 12/14/2022] Open
Abstract
Our understanding of the genetics of acute myeloid leukemia (AML) development from myelodysplastic syndrome (MDS) has advanced significantly as a result of next-generation sequencing technology. Although differences in cell biology and maturation exist between MDS and AML secondary to MDS, these 2 diseases are genetically related. MDS and secondary AML cells harbor mutations in many of the same genes and functional categories, including chromatin modification, DNA methylation, RNA splicing, cohesin complex, transcription factors, cell signaling, and DNA damage, confirming that they are a disease continuum. Differences in the frequency of mutated genes in MDS and secondary AML indicate that the order of mutation acquisition is not random during progression. In almost every case, disease progression is associated with clonal evolution, typically defined by the expansion or emergence of a subclone with a unique set of mutations. Monitoring tumor burden and clonal evolution using sequencing provides advantages over using the blast count, which underestimates tumor burden, and could allow for early detection of disease progression prior to clinical deterioration. In this review, we outline advances in the study of MDS to secondary AML progression, with a focus on the genetics of progression, and discuss the advantages of incorporating molecular genetic data in the diagnosis, classification, and monitoring of MDS to secondary AML progression. Because sequencing is becoming routine in the clinic, ongoing research is needed to define the optimal assay to use in different clinical situations and how the data can be used to improve outcomes for patients with MDS and secondary AML.
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Chanias I, Wilk CM, Benz R, Daskalakis M, Stüssi G, Schmidt A, Bacher U, Bonadies N. Survey on Recommended Health Care for Adult Patients with Myelodysplastic Syndromes Identifies Areas for Improvement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249562. [PMID: 33371225 PMCID: PMC7766925 DOI: 10.3390/ijerph17249562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 12/29/2022]
Abstract
The impact on health care of patients with myelodysplastic syndromes (MDS) is continuously rising. To investigate the perception of hemato-oncologists concerning the recommended MDS patient care in Switzerland, we conducted a web-based survey on diagnosis, risk-stratification and treatment. 43/309 physicians (13.9%) replied to 135 questions that were based on current guidelines between 3/2017 and 2/2018. Only questions with feedback-rates >50% were further analysed and ratios >90% defined “high agreement”, 70–90% “agreement”, 30–70% “insufficient agreement” and <30% “disagreement”. For diagnosis, we found insufficient agreement on using flow-cytometry, classifying MDS precursor conditions, performing treatment response assessment after hypomethylating agents (HMA) and evaluating patients with suspected germ-line predisposition. For risk-stratification, we identified agreement on using IPSS-R but insufficient agreement for IPSS and patient-based assessments. For treatment, we observed disagreement on performing primary infectious prophylaxis in neutropenia but agreement on using only darbepoetin alfa in anaemic, lower-risk MDS patients. For thrombopoietin receptor agonists, insufficient agreement was found for the indication, preferred agent and triggering platelet count. Insufficient agreement was also found for immunosuppressive treatment in hypoplastic MDS and HMA dose adjustments. In conclusion, we identified areas for improvement in MDS patient care, in need of further clinical trials, information, and guiding documents.
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Affiliation(s)
- Ioannis Chanias
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (I.C.); (M.D.); (U.B.)
| | - C. Matthias Wilk
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, 3010 Bern, Switzerland;
| | - Rudolf Benz
- Department of Hematology and Oncology, Cantonal Hospital Muensterlingen, 8596 Muensterlingen, Switzerland;
| | - Michael Daskalakis
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (I.C.); (M.D.); (U.B.)
| | - Georg Stüssi
- Clinic of Hematology, Oncology Institute of Southern Switzerland, 6500 Bellinzona, Switzerland;
| | - Adrian Schmidt
- Clinic for Medical Oncology and Hematology, City Hospital Waid and Triemli, 8063 Zurich, Switzerland;
| | - Ulrike Bacher
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (I.C.); (M.D.); (U.B.)
| | - Nicolas Bonadies
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (I.C.); (M.D.); (U.B.)
- Department for BioMedical Research (DBMR), University of Bern, 3010 Bern, Switzerland
- Correspondence: ; Tel.: +41-(0)31-632-45-71
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30
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Rosenberg CA, Bill M, Rodrigues MA, Hauerslev M, Kerndrup GB, Hokland P, Ludvigsen M. Exploring dyserythropoiesis in patients with myelodysplastic syndrome by imaging flow cytometry and machine-learning assisted morphometrics. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 100:554-567. [PMID: 33285035 DOI: 10.1002/cyto.b.21975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/19/2020] [Accepted: 11/19/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The hallmark of myelodysplastic syndrome (MDS) remains dysplasia in the bone marrow (BM). However, diagnosing MDS may be challenging and subject to inter-observer variability. Thus, there is an unmet need for novel objective, standardized and reproducible methods for evaluating dysplasia. Imaging flow cytometry (IFC) offers combined analyses of phenotypic and image-based morphometric parameters, for example, cell size and nuclearity. Hence, we hypothesized IFC to be a useful tool in MDS diagnostics. METHODS Using a different-from-normal approach, we investigated dyserythropoiesis by quantifying morphometric features in a median of 5953 erythroblasts (range: 489-68,503) from 14 MDS patients, 11 healthy donors, 6 non-MDS controls with increased erythropoiesis, and 6 patients with cytopenia. RESULTS First, we morphometrically confirmed normal erythroid maturation, as immunophenotypically defined erythroid precursors could be sequenced by significantly decreasing cell-, nuclear- and cytoplasm area. In MDS samples, we demonstrated cell size enlargement and increased fractions of macronormoblasts in late-stage erythroblasts (both p < .0001). Interestingly, cytopenic controls with high-risk mutational patterns displayed highly aberrant cell size morphometrics. Furthermore, assisted by machine learning algorithms, we reliably identified and enumerated true binucleated erythroblasts at a significantly higher frequency in two out of three erythroblast maturation stages in MDS patients compared to normal BM (both p = .0001). CONCLUSION We demonstrate proof-of-concept results of the applicability of automated IFC-based techniques to study and quantify morphometric changes in dyserythropoietic BM cells. We propose that IFC holds great promise as a powerful and objective tool in the complex setting of MDS diagnostics with the potential for minimizing inter-observer variability.
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Affiliation(s)
| | - Marie Bill
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mathias Hauerslev
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Gitte B Kerndrup
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Hokland
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maja Ludvigsen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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A simple score derived from bone marrow immunophenotyping is important for prognostic evaluation in myelodysplastic syndromes. Sci Rep 2020; 10:20281. [PMID: 33219285 PMCID: PMC7679401 DOI: 10.1038/s41598-020-77158-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/04/2020] [Indexed: 11/08/2022] Open
Abstract
Immunophenotyping of bone marrow (BM) precursors has been used as an ancillary diagnostic tool in myelodysplastic syndromes (MDS), but there is no general agreement about which variables are the most relevant for prognosis. We developed a parsimonious prognostic model based on BM cell populations well-defined by phenotype. We analyzed 95 consecutive patients with primary MDS diagnosed at our Institution between 2005 and 2012 where BM immunophenotyping had been performed at diagnosis. Median follow-up: 42 months (4-199). Median age: 67 years (33-79). According to IPSS-R, 71 cases were low or intermediate risk. Flow variables significant in the univariate Cox analysis: "%monocytes/TNCs", "% CD16+ monocytes/TNCs", "total alterations in monocytes", "% myeloid CD34+ cells", "number of abnormal expressions in myeloblasts" and "% of B-cell progenitors". In the multivariate model remained independent: "% myeloid CD34+ cells", B-cell progenitors" and "% CD16+ monocytes/TNCs". These variables were categorized by the extreme quartile risk ratio strategy in order to build the score: % myeloid CD34+ cells" (≥ 2.0% = 1 point), B-cell progenitors" (< 0.05% 1 point) and "CD16+ monocytes/TNCs" (≥ 1.0% 1 point). This score could separate patients with a different survival. There was a weak correlation between the score and IPSS-R. Both had independent prognostic values and so, the flow score adds value for the prognostic evaluation in MDS.
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Dhingra G, Dass J, Arya V, Gupta N, Saraf A, Langer S, Aggarwal S, Kotwal J, Bhargava M. Evaluation of multiparametric flow cytometry in diagnosis & prognosis of myelodysplastic syndrome in India. Indian J Med Res 2020; 152:254-262. [PMID: 33107485 PMCID: PMC7881827 DOI: 10.4103/ijmr.ijmr_924_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background & objectives: Diagnosis of myelodysplastic syndromes (MDS) is subjective in low-grade cases with <5 per cent blasts or <15 per cent ring sideroblasts. Flow cytometry (FCM) has been used to diagnose MDS; but, it still has only an adjunctive role. This study was conducted to evaluate the role of FCM to diagnose MDS and correlate the number of aberrancies with revised international prognostic scoring system (R-IPSS). Methods: This study included 44 consecutive clinically suspected cases of MDS with refractory cytopenia(s) and 10 controls. Patients were divided into two groups: (i) proven MDS cases (n=26), and (ii) suspected MDS (n=18). Ogata quantitative approach, pattern analysis and aberrant antigen expression were studied. Results: Ogata score ≥2 correctly diagnosed 80.7 per cent (21/26) while aberrant antigen and pattern analysis with flow score of ≥3 could diagnose 92.3 per cent (24/26) patients with proven MDS. Combination of both with flow score ≥3 could diagnose 100 per cent patients. Eight patients in suspected MDS group with persistent cytopenia on follow up were labelled as probable MDS. Ogata score ≥2 was present in 5 of 8 and pattern analysis score ≥3 was present in six probable MDS patients. Combination of both with flow score ≥3 was present in seven of eight patients. Spearman's correlation between Ogata score and R-IPSS, pattern analysis and R-IPSS and combination of both scores and R-IPSS showed significant positive correlation in proven MDS as well as when proven and probable MDS patients were combined. Interpretation & conclusions: Our results showed that combined Ogata approach and pattern analysis, demonstration of ≥3 aberrancies in >1 cell compartment could diagnose most MDS patients. Patients with high flow scores had high R-IPSS scores. Patient with flow score ≥3 and borderline cytomorphology should be observed closely for the development of MDS.
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Affiliation(s)
- Gaurav Dhingra
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Jasmita Dass
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Vandana Arya
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Nitin Gupta
- Department of Clinical Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Amrita Saraf
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Sabina Langer
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Shyam Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - Jyoti Kotwal
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
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33
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Davydova YO, Parovichnikova EN, Galtseva IV, Kokhno AV, Dvirnyk VN, Kovrigina AM, Obukhova TN, Kapranov NM, Nikiforova KA, Glinkina SA, Troitskaya VV, Mikhailova EA, Fidarova ZT, Moiseeva TN, Lukina EA, Tsvetaeva NV, Nikulina OF, Kuzmina LA, Savchenko VG. Diagnostic significance of flow cytometry scales in diagnostics of myelodysplastic syndromes. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 100:312-321. [PMID: 33052634 DOI: 10.1002/cyto.b.21965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/07/2020] [Accepted: 10/02/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) can present a challenge for clinicians. Multicolor flow cytometry (MFC) can aid in establishing a diagnosis. The aim of this study was to determine the optimal MFC approach for MDS. METHODS The study included 102 MDS (39 low-grade MDS), 83 cytopenic patients without myeloid neoplastic disorders (control group), and 35 healthy donors. Bone marrow was analyzed using a six-color MFC. Analysis was conducted according to the "Ogata score," "Wells score," and the integrated flow cytometry (iFC) score. RESULTS The respective sensitivity and specificity values were 77.5% and 90.4% for the Ogata score, 79.4% and 81.9% for the Wells score, and 87.3% and 87.6% for the iFC score. Specificity was not 100% due to deviations of MFC parameters in the control group. Patients with paroxysmal nocturnal hemoglobinuria (PNH) had higher levels of CD34+ CD7+ myeloid cells than donors. Aplastic anemia and PNH were characterized by a high proportion of CD56+ cells among CD34+ precursors and neutrophils. The proportion of MDS-related features increased with the progression of MDS. The highest number of CD34+ blasts was found in MDS with excess blasts. MDS with isolated del(5q) was characterized by a high proportion of CD34+ CD7+ cells and low granularity of neutrophils. In 39 low-grade MDS, the sensitivities were 53.8%, 61.5%, and 71.8% for Ogata score, Wells score, and iFC, respectively. CONCLUSION The results support iFC as a useful diagnostic tool in MDS.
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Affiliation(s)
- Yulia O Davydova
- Laboratory of Immunophenotyping, National Research Center for Hematology, Moscow, Russia
| | - Elena N Parovichnikova
- Chemotherapy Department for Hemoblastoses, Hemopoiesis Depression and BMT, National Research Center for Hematology, Moscow, Russia
| | - Irina V Galtseva
- Laboratory of Immunophenotyping, National Research Center for Hematology, Moscow, Russia
| | - Alina V Kokhno
- Intensive High-Dose Chemotherapy Department for Hemoblastoses and Hematopoiesis Depressions, National Research Center for Hematology, Moscow, Russia
| | - Valentina N Dvirnyk
- Centralized Diagnostic Laboratory, National Research Center for Hematology, Moscow, Russia
| | - Alla M Kovrigina
- Department of Pathology, National Research Center for Hematology, Moscow, Russia
| | - Tatyana N Obukhova
- Karyology Laboratory, National Research Center for Hematology, Moscow, Russia
| | - Nikolay M Kapranov
- Laboratory of Immunophenotyping, National Research Center for Hematology, Moscow, Russia
| | - Ksenia A Nikiforova
- Laboratory of Immunophenotyping, National Research Center for Hematology, Moscow, Russia
| | - Svetlana A Glinkina
- Department of Pathology, National Research Center for Hematology, Moscow, Russia
| | - Vera V Troitskaya
- Intensive High-Dose Chemotherapy Department for Hemoblastoses and Hematopoiesis Depressions, National Research Center for Hematology, Moscow, Russia
| | - Elena A Mikhailova
- Intensive High-Dose Chemotherapy Department for Hemoblastoses and Hematopoiesis Depressions, National Research Center for Hematology, Moscow, Russia
| | - Zalina T Fidarova
- Intensive High-Dose Chemotherapy Department for Hemoblastoses and Hematopoiesis Depressions, National Research Center for Hematology, Moscow, Russia
| | - Tatyana N Moiseeva
- Department of Hematology Advisory, National Research Center for Hematology, Moscow, Russia
| | - Elena A Lukina
- Department of Orphan Diseases, National Research Center for Hematology, Moscow, Russia
| | - Nina V Tsvetaeva
- Department of Orphan Diseases, National Research Center for Hematology, Moscow, Russia
| | - Olga F Nikulina
- Department of Orphan Diseases, National Research Center for Hematology, Moscow, Russia
| | - Larisa A Kuzmina
- Department of Intensive High-Dose Chemotherapy and BMT, National Research Center for Hematology, Moscow, Russia
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Frisanco Oliveira A, Tansini A, Toledo TR, Balceiro R, Onofre Vidal D, de Martino Lee ML, Lorand-Metze I, Lopes LF. Immunophenotypic characteristics of juvenile myelomonocytic leukaemia and their relation with the molecular subgroups of the disease. Br J Haematol 2020; 192:129-136. [PMID: 32966606 DOI: 10.1111/bjh.17098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
The diagnosis of juvenile myelomonocytic leukaemia (JMML) is based on clinical, laboratory and molecular features but immunophenotyping [multiparametric flow cytometry (MFC)] has not been used routinely. In the present study, we describe the flow cytometric features at diagnosis with special attention to the distribution of monocytic subsets and the relation between MFC and molecular subgroups. MFC was performed with an eight-colour platform based on Euroflow. We studied 33 JMML cases. CD34+ /CD117+ /CD13+ cells >2% was found in 25 cases, and 51·5% presented an aberrant expression of CD7. A decrease of CD34+ /CD19+ /CD10+ cells was seen in eight cases and in four they were absent. The granulocytic population had a decreased side scatter in 29 cases. Bone marrow monocytic precursors were increased in 28 patients, with a decrease in classical monocytes (median 80·7%) and increase in CD16+ (intermediate and non-classical). A more pronounced increase in myeloid CD34+ cells was seen in patients with Neurofibromatosis type 1 (NF1) and tyrosine-protein phosphatase non-receptor type 11 (PTPN11), with aberrant CD7 expression in four of six and 10/12 patients respectively. Thus, JMML shows an immunophenotypic profile similar to myelodysplastic syndromes, and a different monocyte subset distribution when compared with chronic MML. MFC proved to be an important diagnostic tool that can help in differential diagnosis with other clonal diseases with monocytosis.
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Affiliation(s)
- Anita Frisanco Oliveira
- Barretos Children's Cancer Hospital, Barretos, São Paulo, Brazil.,Brazilian Co-operative Study Group for Paediatric Myelodysplastic Syndrome (GCB-SMD-PED) - Morphology and Flow Cytometry Committee, Barretos, São Paulo, Brazil
| | - Aline Tansini
- Barretos Children's Cancer Hospital, Barretos, São Paulo, Brazil.,GCB-SMD-PED - Flow cytometry Committee, Barretos, São Paulo, Brazil
| | - Thais Regina Toledo
- Barretos Children's Cancer Hospital, Barretos, São Paulo, Brazil.,GCB-SMD-PED - Flow cytometry Committee, Barretos, São Paulo, Brazil
| | - Rafael Balceiro
- Barretos Children's Cancer Hospital, Barretos, São Paulo, Brazil.,Brazilian Co-operative Study Group for Paediatric Myelodysplastic Syndrome (GCB-SMD-PED) - Morphology and Flow Cytometry Committee, Barretos, São Paulo, Brazil
| | - Daniel Onofre Vidal
- GCB-SMD-PED - Molecular Biology and Genetic Committee, Barretos, São Paulo, Brazil
| | - Maria Lucia de Martino Lee
- Barretos Children's Cancer Hospital, Barretos, São Paulo, Brazil.,GCB-SMD-PED - Morphology and Myeloproliferative Diseases Committee, Barretos, São Paulo, Brazil
| | - Irene Lorand-Metze
- Brazilian Co-operative Study Group for Paediatric Myelodysplastic Syndrome (GCB-SMD-PED) - Morphology and Flow Cytometry Committee, Barretos, São Paulo, Brazil.,GCB-SMD-PED - Chairman, Barretos, São Paulo, Brazil
| | - Luiz Fernando Lopes
- Barretos Children's Cancer Hospital, Barretos, São Paulo, Brazil.,GCB-SMD-PED - Chairman, Barretos, São Paulo, Brazil
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35
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Bento LC, Bacal NS, Rocha FA, Severino P, Marti LC. Bone Marrow Monocytes and Derived Dendritic Cells from Myelodysplastic Patients Have Functional Abnormalities Associated with Defective Response to Bacterial Infection. THE JOURNAL OF IMMUNOLOGY 2020; 204:2098-2109. [PMID: 32179638 DOI: 10.4049/jimmunol.1900328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 02/06/2020] [Indexed: 01/14/2023]
Abstract
Myelodysplastic syndromes (MDS) are a heterogeneous group of hematopoietic stem cell diseases characterized by dysplasia of one or more hematologic lineages and a high risk of developing into acute myeloid leukemia. MDS patients have recurrent bacterial infections and abnormal expression of CD56 by monocytes. We investigated MDS patients' bone marrow CD56+/CD56- monocytes and their in vitro-derived dendritic cell populations in comparison with cells obtained from disease-free subjects. We found that monocytes from MDS patients, irrespective of CD56 expression, have reduced phagocytosis activity and low expression of genes involved in triggering immune responses, regulation of immune and inflammatory response signaling pathways, and in the response to LPS. Dendritic cells derived in vitro from MDS monocytes failed to develop dendritic projections and had reduced expression of HLA-DR and CD86, suggesting that Ag processing and T cell activation capabilities are impaired. In conclusion, we identified, in both CD56+ and CD56- monocytes from MDS patients, several abnormalities that may be related to the increased susceptibility to infections observed in these patients.
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Affiliation(s)
- Laiz C Bento
- Clinical Pathology Laboratory, Hospital Israelita Albert Einstein, São Paulo 05652 000, Brazil; and
| | - Nydia S Bacal
- Clinical Pathology Laboratory, Hospital Israelita Albert Einstein, São Paulo 05652 000, Brazil; and
| | - Fernanda A Rocha
- Experimental Research Laboratory, Hospital Israelita Albert Einstein, São Paulo 05652 000, Brazil
| | - Patricia Severino
- Experimental Research Laboratory, Hospital Israelita Albert Einstein, São Paulo 05652 000, Brazil
| | - Luciana C Marti
- Experimental Research Laboratory, Hospital Israelita Albert Einstein, São Paulo 05652 000, Brazil
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36
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Araújo HVD, Correia RP, Bento LC, Vaz ADC, Sousa FAD, Alexandre AM, Schimidell D, Pedro EDC, Ioshida MR, Barroso RDS, Bacal NS. Myelodysplastic syndrome: validation of flow cytometry multilineage score system. EINSTEIN-SAO PAULO 2020; 18:eAO4966. [PMID: 31994605 PMCID: PMC6986454 DOI: 10.31744/einstein_journal/2020ao4966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 09/06/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To validate multilineage score system correlating results of flow cytometry, cytogenetics, cytomorphology and histology from samples of patients with suspected myelodysplastic syndrome or cytopenia of unknown origin. METHODS A retrospective study analyzing laboratory data of 49 patients with suspected myelodysplastic syndrome or cytopenia of unknown origin, carried out between May and September 2017. The inclusion criteria were availability of flow cytometry results, and at least one more method, such as morphology, histology or cytogenetics. Thirty-eight patients were classified as diagnosis of myelodysplastic syndromes, whereas 11 were classified as normal. Patients were evaluated based on score systems, Ogata score and flow cytometry multilineage score. RESULTS Comparing the scores obtained in the Ogata score and the multilineage score, it was observed that in four cases the Ogata score was zero or 1 point, while the multilineage score was higher than 3 points. In addition, in 12 cases with Ogata score of 2, the multilineage score was greater than 3. CONCLUSION The flow cytometry multilineage score system demonstrated to be more effective in dysplasia analysis, by assessing the erythroid, monocytic, granulocytic and precursor cell lineages, apart from the parameters evaluated by the Ogata score.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Nydia Strachman Bacal
- Centro de Hematologia de São Paulo, São Paulo, SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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37
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Barreau S, Green AS, Dussiau C, Alary A, Raimbault A, Mathis S, Willems L, Bouscary D, Kosmider O, Bardet V, Fontenay M, Chapuis N. Phenotypic landscape of granulocytes and monocytes by multiparametric flow cytometry: A prospective study of a 1‐tube panel strategy for diagnosis and prognosis of patients with MDS. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019; 98:226-237. [DOI: 10.1002/cyto.b.21843] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/02/2019] [Accepted: 08/19/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Sylvain Barreau
- Assistance Publique‐Hôpitaux de Paris, Hôpitaux Universitaires Paris CentreService d'Hématologie Biologique Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104INSERM U1016 Paris France
| | - Alexa S. Green
- Assistance Publique‐Hôpitaux de Paris, Hôpitaux Universitaires Paris CentreService d'Hématologie Biologique Paris France
| | - Charles Dussiau
- Assistance Publique‐Hôpitaux de Paris, Hôpitaux Universitaires Paris CentreService d'Hématologie Biologique Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104INSERM U1016 Paris France
| | - Anne‐Sophie Alary
- Assistance Publique‐Hôpitaux de Paris, Hôpitaux Universitaires Paris CentreService d'Hématologie Biologique Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104INSERM U1016 Paris France
| | - Anna Raimbault
- Assistance Publique‐Hôpitaux de Paris, Hôpitaux Universitaires Paris CentreService d'Hématologie Biologique Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104INSERM U1016 Paris France
| | - Stephanie Mathis
- Assistance Publique‐Hôpitaux de Paris, Hôpitaux Universitaires Paris CentreService d'Hématologie Biologique Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104INSERM U1016 Paris France
| | - Lise Willems
- Assistance Publique‐Hôpitaux de ParisHôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique Paris France
| | - Didier Bouscary
- Université de Paris, Institut Cochin, CNRS UMR8104INSERM U1016 Paris France
- Assistance Publique‐Hôpitaux de ParisHôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique Paris France
| | - Olivier Kosmider
- Assistance Publique‐Hôpitaux de Paris, Hôpitaux Universitaires Paris CentreService d'Hématologie Biologique Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104INSERM U1016 Paris France
| | - Valerie Bardet
- Assistance Publique‐Hôpitaux de ParisHôpitaux Universitaires Paris Ile de France Ouest, Service d'Hématologie‐Immunologie‐Transfusion Boulogne France
- INSERM U1173Université Versailles Saint Quentin en Yvelines France
| | - Michaela Fontenay
- Assistance Publique‐Hôpitaux de Paris, Hôpitaux Universitaires Paris CentreService d'Hématologie Biologique Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104INSERM U1016 Paris France
| | - Nicolas Chapuis
- Assistance Publique‐Hôpitaux de Paris, Hôpitaux Universitaires Paris CentreService d'Hématologie Biologique Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104INSERM U1016 Paris France
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Mannelli F, Gesullo F, Rotunno G, Pacilli A, Bencini S, Annunziato F, Zanotti R, Scaffidi L, Giona F, Santopietro M, Grifoni F, Pieri L, Guglielmelli P, Vannucchi AM. Myelodysplasia as assessed by multiparameter flow cytometry refines prognostic stratification provided by genotypic risk in systemic mastocytosis. Am J Hematol 2019; 94:845-852. [PMID: 31056768 DOI: 10.1002/ajh.25506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/22/2022]
Abstract
Systemic mastocytosis (SM) is characterized by extreme heterogeneity of manifestations and prognosis. Several disease-related biomarkers, including clinical, hematological and molecular variables, have been correlated with prognosis. Although relevant, the mutation profile closely reflects the WHO classification that has per se prognostic value. High-risk mutations (HRM) are largely confined to advanced forms, and thus fail in providing information regarding progression and outcome in the not-advanced variants. In this work, we studied hematopoietic cells by multi-parameter flow cytometry (MFC) in order to highlight dysplastic traits that might provide insights into outcome. A score previously validated for myelodysplastic syndromes, with high reproducibility in standard diagnostics, was used. The application of an MFC score to a cohort of 71 SM cases, concurrently genotyped for configuring a HRM category, resulted in the identification of two separate patients' categories (MFC+ and MFC-) characterized by significantly different clinical and laboratory features at presentation. The extent of dysplasia by MFC tended to parallel WHO-category and genotype-related stratification. MFC+ patients had shorter survival compared to MFC- ones, for whom the incidence of progression and/or death was virtually null. Of note, MFC score remained prognostically informative in unadvanced subsets. Furthermore, the integration of MFC and HRM was an independent predictor for outcome, also overcoming WHO-categories in multivariate analysis for EFS. Our results support the use of MFC analysis in the evaluation of patients with SM, alone and in combination with HRM, for refinement of prognosis assessment.
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Affiliation(s)
- Francesco Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Francesca Gesullo
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Giada Rotunno
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Annalisa Pacilli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Sara Bencini
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e ClinicaDenothe Excellence Center Firenze Italy
| | - Francesco Annunziato
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e ClinicaDenothe Excellence Center Firenze Italy
| | - Roberta Zanotti
- Multidisplinary Outpatients Clinic for Mastocytosis (GISM)Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
- Department of Medicine, Haematology UnitAzienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Luigi Scaffidi
- Multidisplinary Outpatients Clinic for Mastocytosis (GISM)Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
- Department of Medicine, Haematology UnitAzienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Fiorina Giona
- EmatologiaDipartimento di Medicina Traslazionale e di Precisione, Università Sapienza Roma Italy
| | - Michelina Santopietro
- EmatologiaDipartimento di Medicina Traslazionale e di Precisione, Università Sapienza Roma Italy
| | - Federica Grifoni
- UOC EmatologiaFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Milano Italy
| | - Lisa Pieri
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Paola Guglielmelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Alessandro M. Vannucchi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
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39
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Takeuchi A, Imataki O, Kubo H, Kondo A, Seo K, Uemura M, Yamaoka G, Murao K, Takeuchi A. Diagnostic Value of Flow Cytometry Standardized Using the European LeukemiaNet for Myelodysplastic Syndrome. Acta Haematol 2019; 143:140-145. [PMID: 31330512 DOI: 10.1159/000501147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/24/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) and idiopathic cytopenia of undetermined significance (ICUS) are heterogeneous hematological disorders characterized by hematopoietic dysplasia and/or chromosomal aberrancy. OBJECTIVES This study aimed to evaluate the diagnostic value of flow cytometry standardized using the European LeukemiaNet (ELN) for MDS and ICUS by analyzing samples obtained from patients with cytopenia based on morphological examination, cytogenetic analysis, and flow cytometry. METHODS We retrospectively analyzed bone marrow samples aspirated from 253 consecutive patients (median age: 66 years [range: 1-92]) to identify the cause of cytopenia. RESULTS Sixty patients presented with MDS, and 16 with ICUS. MDS subtypes were distributed as follows: MDS with single-lineage dysplasia (n = 10); MDS with multi-lineage dysplasia (n = 10); MDS with ringed sideroblasts (n = 4); MDS with excess blasts-1 (n = 9); MDS with excess blasts-2 (n = 13), MDS unclassified (n = 5); 5q-syndrome (n = 6); and MDS/myeloproliferative neoplasms (n = 3). Four representative ELN indexes were used. Two or more ELN MDS indexes were in the abnormal range in 35 MDS cases (58.3%) and 4 ICUS cases (25.0%). CONCLUSIONS Morphological examination remains the standard for MDS diagnosis. Considering the low incidence of genetically proven ICUS (20.2-27.5%), the low sensitivity of ELN MDS indexes for ICUS is considered a valuable alternative.
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Affiliation(s)
- Akihiro Takeuchi
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
- Department of Clinical Laboratory, Kagawa University Hospital, Kagawa, Japan
| | - Osamu Imataki
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan,
| | - Hiroyuki Kubo
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Akihiro Kondo
- Department of Clinical Laboratory, Kagawa University Hospital, Kagawa, Japan
| | - Kayoko Seo
- Department of Clinical Laboratory, Kagawa University Hospital, Kagawa, Japan
| | - Makiko Uemura
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Genji Yamaoka
- Department of Clinical Laboratory, Kagawa University Hospital, Kagawa, Japan
| | - Koji Murao
- Department of Clinical Laboratory Medicine, Kagawa University, Kagawa, Japan
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40
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Mogwasi R, Kariuki DK, Getenga MZ, Nischwitz V. Comparison of aqueous and enzymatic extraction combination with sequential filtration for the profiling of selected trace elements in medicinal plants from Kenya. J Trace Elem Med Biol 2019; 54:1-7. [PMID: 31109598 DOI: 10.1016/j.jtemb.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
Abstract
This work presents results for the profiling of eight essential elements (Co, Cu, Ni, V, Mo, Mn, Zn and Cr) in aqueous and enzymatic extracts of eight anti-diabetic medicinal plants, used by Traditional Medicine Practitioners from Nyamira County, Kenya determined by ICP-MS. The plants used in the study were Solanum indicum, Plectranthus barbatus, Ultrica dioica, Bidens pilosa, Solanum mauense, Clerodendrum myricoides, Carissa edulis and Aloe vera. A sequential filtration procedure was applied to fractionate the elemental contents of the obtained aqueous extracts into molecular size fractions. The results indicate that the low molecular size species (<3 kDa) were predominant for Mo, Zn, Ni, Co, Mn and Cu, while the moderately large species (10 kDa-0.45 μm) of V were predominant in most of the medicinal plant extracts. In addition enzymatic extraction was compared to aqueous extraction to study the effect of the gastric and intestinal conditions on the release of selected elements from the plants. The amount of the elements extracted by the gastric phase enzymes was higher than the amount extracted by the intestinal phase enzymes. In general, the determined elemental amounts of enzymatic extractions were higher than those of corresponding water extractions for 70% of the elements studied.
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Affiliation(s)
- R Mogwasi
- Department of Chemistry, Kisii University, P.O. Box 408-40200, Kisii, Kenya; Department of Chemistry, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya.
| | - D K Kariuki
- Department of Chemistry, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya
| | - M Z Getenga
- Department of Chemistry, Chuka University, P.O. Box 109-60400, Chuka, Kenya
| | - V Nischwitz
- Central Institute for Engineering, Electronics and Analytics, Analytics (ZEA-3), Forschungszentrum Juelich, 52425, Juelich, Germany
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41
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Camburn AE, Petrasich M, Ruskova A, Chan G. Myeloblasts in normal bone marrows expressing leukaemia-associated immunophenotypes. Pathology 2019; 51:502-506. [PMID: 31262563 DOI: 10.1016/j.pathol.2019.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 03/17/2019] [Accepted: 03/21/2019] [Indexed: 01/07/2023]
Abstract
Measurable residual disease (MRD) status of patients undergoing treatment for acute myeloid leukaemia (AML) is important for prognosis and guides treatment. Multicolour flow cytometry (MCF) is a sensitive MRD method. The current approach relies on identification of blasts expressing leukaemia-associated immunophenotypes (LAIP) or by blasts expressing aberrant differentiation/maturation profiles compared to that seen in normal haematopoietic precursor cells at follow-up, i.e., different from normal (DFN). However, expression of LAIP on normal myeloblasts affects the specificity of the result, and the understanding of what is normal is important. Limited published data are currently available. We report findings from 14 normal adult bone marrows. MCF was performed on the residual normal marrow specimens from 14 adults. Expression of CD15, CD11b, CD7, CD4, and CD56 on CD34+ myeloblasts was assessed. Analysis of samples was performed using 4-colour flow cytometry which was the methodology used when this work was done, and is still being used in many clinical flow laboratories worldwide. LAIP is defined by lineage infidelity or asynchronous expression of differentiation markers. The cases of normal myeloblasts with LAIP involving the markers used and above the cut-off levels for MRD detection (0.01%) varies between 43% and 100%, limiting the specificity of the results for MRD. Even if the threshold is raised to 0.1%, there will still be false positive cases using aberrant CD15 or CD7. Our work provided useful information for AML MRD determination in our laboratory. A collaborative database of LAIP on normal myeloblasts using standardised analysis should be useful to determine the optimal diagnostic cut-off for AML MRD using LAIP.
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Affiliation(s)
| | | | - Anna Ruskova
- LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - George Chan
- LabPlus, Auckland City Hospital, Auckland, New Zealand
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42
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Chen Z, Ok CY, Wang W, Goswami M, Tang G, Routbort M, Jorgensen JL, Medeiros LJ, Wang SA. Low‐Grade Myelodysplastic Syndromes with Preserved CD34+ B‐Cell Precursors (CD34+ Hematogones). CYTOMETRY PART B-CLINICAL CYTOMETRY 2019; 98:36-42. [DOI: 10.1002/cyto.b.21830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/19/2019] [Accepted: 05/30/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Zhining Chen
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
- Department of PathologyAffiliated Tumor Hospital of Guangxi Medical University Nanning Guangxi China
| | - Chi Young Ok
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Wei Wang
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Maitrayee Goswami
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Guilin Tang
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Mark Routbort
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Jeffrey L. Jorgensen
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - L. Jeffrey Medeiros
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Sa A. Wang
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
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Sanz-De Pedro M, Wang W, Kanagal-Shamanna R, Khoury JD. Myelodysplastic Syndromes: Laboratory Workup in the Context of New Concepts and Classification Criteria. Curr Hematol Malig Rep 2019; 13:467-476. [PMID: 30338456 DOI: 10.1007/s11899-018-0483-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review provides a comprehensive update of myelodysplastic syndromes (MDS) and their diagnostic criteria, with emphasis on novel concepts and state-of-the-art laboratory workup, including multiparameter/multicolor flow cytometry, chromosome analysis, and mutation profiling. RECENT FINDINGS Recent advances in genetics and molecular technologies have provided unprecedented insights into the pathogenic mechanisms and genomic landscape of MDS and its precursor lesions. This has resulted in revised diagnostic criteria in the World Health Organization (WHO) classification and proposed new terminology for early lesions such as clonal hematopoiesis of indeterminate potential (CHIP). Against this landscape, a thorough understanding of the advantages and limitations of laboratory tests employed in the evaluation of patients with cytopenia has gained unprecedented importance. Healthcare providers involved in the care of patients with hematologic diseases should be aware of the intricacies of laboratory workup of such patients, particularly in view of the novel concepts and classification criteria of MDS.
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Affiliation(s)
- Maria Sanz-De Pedro
- Department of Laboratory Medicine, La Paz University Hospital, Madrid, Spain
| | - Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, MS-072, Houston, TX, 77030, USA
| | - Rashmi Kanagal-Shamanna
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, MS-072, Houston, TX, 77030, USA
| | - Joseph D Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, MS-072, Houston, TX, 77030, USA.
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Grille Montauban S, Hernandez‐Perez CR, Velloso EDRP, Novoa V, Lorand‐Metze I, Gonzalez J, Solari L, Cismondi V, Serrano JC, Burgnini A, Rabelo‐Carrasco LJ, Bacal N, Trias N, Guevara R, Rico Vido J, Crisp R, Enrico A, Boada M, Pereira Cunha FG, Fanessi V, Venegas MB, Issouribehere D, Novoa A, Lens D. Flow cytometry “Ogata score” for the diagnosis of myelodysplastic syndromes in a real‐life setting. A Latin American experience. Int J Lab Hematol 2019; 41:536-541. [DOI: 10.1111/ijlh.13047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/15/2019] [Accepted: 04/18/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Sofía Grille Montauban
- Facultad de Medicina, Cátedra de Hematología, Hospital de Clínicas Universidad de la República Montevideo Uruguay
- Facultad de Medicina, Laboratorio de Citometría y Biología Molecular, Hospital de Clínicas Universidad de la República Montevideo Uruguay
| | | | - Elvira D. R. P. Velloso
- Hospital das Clínicas da FMUSP Sao Paulo Brazil
- Hospital Israelita Albert Einstein Sao Paulo Brazil
| | - Viviana Novoa
- Laboratorio de Inmunología, Unidad de Inmunología e Histocompatibilidad Hospital Gral. de Agudos Dr. Carlos G. Durand Buenos Aires Argentina
| | | | - Jaqueline Gonzalez
- Servicio de Hematología Hospital General de Agudos. Dr. Carlos G. Durand Buenos Aires Argentina
| | - Liliana Solari
- Laboratorio de Citometría, Departamento de Diagnóstico Hospital Nacional Posadas El Palomar Argentina
| | - Valeria Cismondi
- S.A.M.I.C, Laboratorio de Citometría Hospital El Cruce "Nestor Carlos Kirchner" Florencio Varela Buenos Aires Argentina
| | | | - Andreína Burgnini
- Facultad de Medicina, Laboratorio de Citometría y Biología Molecular, Hospital de Clínicas Universidad de la República Montevideo Uruguay
| | | | - Nydia Bacal
- Hospital das Clínicas da FMUSP Sao Paulo Brazil
- Centro de Hematologia de São Paulo São Paulo Brazil
| | - Natalia Trias
- Facultad de Medicina, Laboratorio de Citometría y Biología Molecular, Hospital de Clínicas Universidad de la República Montevideo Uruguay
| | - Romina Guevara
- Laboratorio de Inmunología, Unidad de Inmunología e Histocompatibilidad Hospital Gral. de Agudos Dr. Carlos G. Durand Buenos Aires Argentina
- Centro de Diagnóstico Molecular Laboratorio Citometría de Flujo Buenos Aires Argentina
| | - Joyce Rico Vido
- Hematology ‐ Hemotherapy Center University of Campinas Campinas Brazil
| | - Renee Crisp
- Servicio de Hematología Hospital Nacional Posadas El Palomar Argentina
| | - Alicia Enrico
- Area de Hematología Hospital Italiano de La Plata La Plata Argentina
| | - Matilde Boada
- Facultad de Medicina, Cátedra de Hematología, Hospital de Clínicas Universidad de la República Montevideo Uruguay
- Facultad de Medicina, Laboratorio de Citometría y Biología Molecular, Hospital de Clínicas Universidad de la República Montevideo Uruguay
| | | | - Viviana Fanessi
- S.A.M.I.C, Laboratorio de Citometría Hospital El Cruce "Nestor Carlos Kirchner" Florencio Varela Buenos Aires Argentina
| | - María Belén Venegas
- Laboratorio de Citometría, Departamento de Diagnóstico Hospital Nacional Posadas El Palomar Argentina
| | - Diego Issouribehere
- S.A.M.I.C, Laboratorio de Citometría Hospital El Cruce "Nestor Carlos Kirchner" Florencio Varela Buenos Aires Argentina
| | - Andrea Novoa
- Centro de Diagnóstico Molecular Laboratorio Citometría de Flujo Buenos Aires Argentina
| | - Daniela Lens
- Facultad de Medicina, Laboratorio de Citometría y Biología Molecular, Hospital de Clínicas Universidad de la República Montevideo Uruguay
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45
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Xiao W, Goldberg AD, Famulare CA, Devlin SM, Nguyen NT, Sim S, Kabel CC, Patel MA, McGovern EM, Patel A, Schulman J, Dunbar AJ, Epstein-Peterson ZD, Menghrajani KN, Getta BM, Cai SF, Geyer MB, Glass JL, Taylor J, Viny AD, Levine RL, Zhang Y, Giralt SA, Klimek V, Tallman MS, Roshal M. Loss of plasmacytoid dendritic cell differentiation is highly predictive for post-induction measurable residual disease and inferior outcomes in acute myeloid leukemia. Haematologica 2018; 104:1378-1387. [PMID: 30523054 PMCID: PMC6601104 DOI: 10.3324/haematol.2018.203018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/04/2018] [Indexed: 12/21/2022] Open
Abstract
Measurable residual disease is associated with inferior outcomes in patients with acute myeloid leukemia (AML). Measurable residual disease monitoring enhances risk stratification and may guide therapeutic intervention. The European LeukemiaNet working party recently came to a consensus recommendation incorporating leukemia associated immunophenotype-based different from normal approach by multi-color flow cytometry for measurable residual disease evaluation. However, the analytical approach is highly expertise-dependent and difficult to standardize. Here we demonstrate that loss of plasmacytoid dendritic cell differentiation after 7+3 induction in AML is highly specific for measurable residual disease positivity (specificity 97.4%) in a uniformly treated patient cohort. Moreover, loss of plasmacytoid dendritic cell differentiation as determined by a blast-to-plasmacytoid dendritic cell ratio >10 was strongly associated with inferior overall and relapse-free survival (RFS) [Hazard ratio 2.79, 95% confidence interval (95%CI): 0.98-7.97; P=0.077) and 3.83 (95%CI: 1.51-9.74; P=0.007), respectively), which is similar in magnitude to measurable residual disease positivity. Importantly, measurable residual disease positive patients who reconstituted plasmacytoid dendritic cell differentiation (blast/ plasmacytoid dendritic cell ratio <10) showed a higher rate of measurable residual disease clearance at later pre-transplant time points compared to patients with loss of plasmacytoid dendritic cell differentiation (blast/ plasmacytoid dendritic cell ratio <10) (6 of 12, 50% vs. 2 of 18, 11%; P=0.03). Furthermore pre-transplant plasmacytoid dendritic cell recovery was associated with superior outcome in measurable residual disease positive patients. Our study provides a novel, simple, broadly applicable, and quantitative multi-color flow cytometry approach to risk stratification in AML.
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Affiliation(s)
- Wenbin Xiao
- Department of Pathology, Hematopathology Diagnostic Service
| | | | | | | | - Nghia T Nguyen
- Department of Pathology, Hematopathology Diagnostic Service
| | - Sinnifer Sim
- Department of Pathology, Hematopathology Diagnostic Service
| | | | | | | | | | | | | | | | | | | | | | - Mark B Geyer
- Department of Medicine, Leukemia Service.,Center for Cell Engineering
| | | | | | | | - Ross L Levine
- Department of Medicine, Leukemia Service.,Center for Hematologic Malignancies.,Human Oncology and Pathogenesis Program
| | | | - Sergio A Giralt
- Department of Medicine, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Mikhail Roshal
- Department of Pathology, Hematopathology Diagnostic Service
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46
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Boutault R, Peterlin P, Boubaya M, Sockel K, Chevallier P, Garnier A, Guillaume T, Le Bourgeois A, Debord C, Godon C, Le Bris Y, Theisen O, Kroschinsky F, Moreau P, Béné MC, Platzbecker U, Eveillard M. A novel complete blood count-based score to screen for myelodysplastic syndrome in cytopenic patients. Br J Haematol 2018; 183:736-746. [PMID: 30406952 DOI: 10.1111/bjh.15626] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/24/2018] [Indexed: 12/21/2022]
Abstract
The diagnosis of myelodysplastic syndromes (MDS) is often challenging, time- and resource-consuming. A thorough analysis of complete blood count (CBC) parameters could, however, help to screen for MDS among other causes of cytopenia. To test this hypothesis, 109 newly-diagnosed MDS patients and 399 cytopenic patients older than 50 years with confirmed absence of MDS were enrolled in a prospective study. Multiparametric analysis highlighted three CBC parameters that were significantly different between the two cohorts: mean corpuscular volume, absolute neutrophil count and median neutrophil complexity and width of dispersion of the events measured (Ne-WX), which were used to define an MDS-CBC score. This score enables the prediction of MDS with 86% sensitivity and 88% specificity. The MDS-CBC score excluded MDS in 89% of cytopenic controls. Moreover, high score values at MDS diagnosis significantly correlated with decreased event-free (P = 0·02) and overall survival (P = 0·01). The power of this score was confirmed in an independent validation cohort (MDS n = 34, cytopenic controls n = 28). The MDS-CBC score is an easy and fast tool to exclude or suspect MDS in unselected patients with cytopenia of unknown reasons at the time of analysis, by prompting blood smear examination. It may thus improve allocation of further MDS-specific work-up in patients with cytopenia at the time of CBC assessment.
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Affiliation(s)
| | | | - Marouane Boubaya
- Clinical Research, Avicenne University Hospital, Bobigny, Germany
| | - Katja Sockel
- Universitätsklinikum "Carl Gustav Carus" der Technischen Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK) and National Center for Tumor Diseases (NCT) Dresden, Dresden, Germany
| | | | | | | | | | | | | | | | | | - Frank Kroschinsky
- Universitätsklinikum "Carl Gustav Carus" der Technischen Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK) and National Center for Tumor Diseases (NCT) Dresden, Dresden, Germany
| | | | | | - Uwe Platzbecker
- Universitätsklinikum "Carl Gustav Carus" der Technischen Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK) and National Center for Tumor Diseases (NCT) Dresden, Dresden, Germany.,Medical Clinic and Policlinic 1 University Hospital Leizpig, Leipzig, Germany
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47
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Matzen SMH, Raaschou‐Jensen KK, Kallenbach K. Implementation of the Ogata flow cytometric scoring system in routine diagnostics of myelodysplastic syndrome. Health Sci Rep 2018; 1:e90. [PMID: 30623045 PMCID: PMC6242364 DOI: 10.1002/hsr2.90] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/12/2018] [Accepted: 08/09/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIMS Compiling evidence has emerged for the relevance of flow cytometric assessment as a valuable part of the diagnostic work-up of myelodysplastic syndrome (MDS). This study aimed at evaluating the implementation of a simple flow cytometric scoring system (FCSS), the Ogata score, in a routine diagnostic laboratory. METHODS A total of 35 patient samples with a clinical suspicion of MDS were retrospectively assessed using the FCSS. The accuracy of the FCSS was evaluated on the basis of the final diagnoses of the patients. RESULTS The final diagnoses included 17 MDS, 4 other myeloid cancers, and 14 reactive changes. Thirty-two of 35 (91%) were correctly scored by the FCSS. All 3 incorrect scores were from samples classified as "other myeloid cancers." Of the initial pathological evaluation of the bone marrows, 20% were inconclusive or incorrect. All inconclusive samples were correctly scored using the FCSS. CONCLUSION The FCSS evaluated here has high accuracy and low complexity. Cases with inconclusive pathological evaluation will especially potentially benefit from adding the Ogata score to the diagnostic work-up. The system will be feasible to implement in most flow cytometry laboratories without the need for supplemental antibody panels. It should be emphasized that the FCSS, in our hands, provided poor discrimination between MDS and other myeloid clonal diseases.
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Affiliation(s)
| | - Klas Kræsten Raaschou‐Jensen
- Department of HaematologyZealand University HospitalRoskildeDenmark
- Department of HaematologyOdense University HospitalOdenseDenmark
| | - Klaus Kallenbach
- Department of Clinical PathologyZealand University HospitalRoskildeDenmark
- Department of Pathology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
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48
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Muyldermans A, Florin L, Devos H, Cauwelier B, Emmerechts J. Diagnostic utility of the lymphoid screening tube supplemented with CD34 for Ogata score calculation in patients with peripheral cytopenia. ACTA ACUST UNITED AC 2018; 24:166-172. [PMID: 30334700 DOI: 10.1080/10245332.2018.1535536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The diagnosis of myelodysplastic syndrome (MDS) is not always straightforward in the absence of objective markers such as ringed sideroblasts, an excess of blasts or clonal cytogenetic abnormalities. Moreover, the lack of specificity of morphological dysplasia makes the differentiation between MDS and other causes of peripheral cytopenia difficult. The WHO 2016 classification of MDS recognizes multiparameter flow cytometry (MFC) as an adjuvant tool for MDS diagnosis. An easily applicable MFC protocol based on CD34 and CD45 is proposed by Ogata et al. Furthermore, in the diagnostic workup of patients with peripheral cytopenia, the integration of MFC by means of a Lymphoid Screening Tube (LST) is recommended by the EuroFlow™ consortium. The aim of this study was to investigate whether the LST, supplemented with CD34, can be used to calculate the Ogata score, thereby obviating the need to run different flow cytometric tubes. METHODS Bone marrow samples from 108 patients with peripheral cytopenia were analyzed (MDS n = 32; non-MDS n = 76). The LST used in the present study was based on the tube designed by the EuroFlow™ consortium, but with addition of CD34 and without TCRγδ. RESULTS Rather low sensitivities of 55% in low-grade MDS patients and 80% in high-grade MDS patients were observed. However, a high specificity of 92% was found in the non-MDS group. CONCLUSION Besides screening for clonal lymphocytes, plasma cells and blasts, an LST supplemented with CD34 allows the calculation of the Ogata score as an adjuvant tool in the diagnostic workup of cytopenic patients suspected of MDS.
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Affiliation(s)
- Astrid Muyldermans
- a Department of Laboratory Hematology , AZ Sint-Jan Hospital , Bruges , Belgium
| | - Lisa Florin
- a Department of Laboratory Hematology , AZ Sint-Jan Hospital , Bruges , Belgium
| | - Helena Devos
- a Department of Laboratory Hematology , AZ Sint-Jan Hospital , Bruges , Belgium
| | - Barbara Cauwelier
- a Department of Laboratory Hematology , AZ Sint-Jan Hospital , Bruges , Belgium
| | - Jan Emmerechts
- a Department of Laboratory Hematology , AZ Sint-Jan Hospital , Bruges , Belgium
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49
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Liu C, An WB, Zhang JL, Zhang RR, Sun CC, Chang LX, Liu TF, Zou Y, Wang HJ, Zhu XF. [Value of multiparameter flow cytometry in the diagnosis and prognostic evaluation of childhood myelodysplastic syndrome]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:819-824. [PMID: 30369356 PMCID: PMC7389052 DOI: 10.7499/j.issn.1008-8830.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the value of multiparameter flow cytometry (MFC) and flow cytometric scoring system (FCSS) in the diagnosis and prognostic evaluation of childhood myelodysplastic syndrome (MDS). METHODS A retrospective analysis was performed for the clinical data of 42 children who were diagnosed with MDS. MFC was performed to investigate the phenotype and proportion of each lineage of bone marrow cells. The correlations of FCSS score with MDS type, International Prognostic Scoring System (IPSS) score, and revised IPSS (IPSS-R) score were analyzed. RESULTS Of all the 42 children, 20 (48%) had an increase in abnormal marrow blasts, 19 (45%) had a lymphoid/myeloid ratio of >1, 14 (33%) had abnormal cross-lineage expression of lymphoid antigens in myeloid cells, 8 (19%) had abnormal CD13/CD16 differentiation antigens, 5 (12%) had abnormal expression of CD56, 3 (7%) had reduced or increased side scatter of granulocytes, 3 (7%) had reduced expression of CD36 in nucleated red blood cells, 2 (5%) had reduced expression of CD71 in nucleated red blood cells, 1 (2%) had absent expression of CD33 in myeloid cells, 1 (2%) had reduced or absent expression of CD11b in granulocytes, and 1 (2%) had absent expression of CD56 and CD14 in monocytes. There were significant differences in the median overall survival time and event-free survival time among the low-, medium-, and high-risk FCSS groups (P<0.05). Among the low-, medium-, and high-risk FCSS groups, the low-risk FCSS group had the highest 2-year overall survival rate, while there was no significant difference between the medium- and high-risk FCSS groups (P>0.05). The three groups had a 2-year event-free survival rate of 95%, 60%, and 46% respectively (P<0.05). FCSS score was positively correlated with MDS type, IPSS score, and IPSS-R score (P<0.05). CONCLUSIONS MFC and FCSS help with the diagnosis and prognostic evaluation of childhood MDS.
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Affiliation(s)
- Chao Liu
- Department of Pediatric Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
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50
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Liu C, An WB, Zhang JL, Zhang RR, Sun CC, Chang LX, Liu TF, Zou Y, Wang HJ, Zhu XF. [Value of multiparameter flow cytometry in the diagnosis and prognostic evaluation of childhood myelodysplastic syndrome]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:819-824. [PMID: 30369356 PMCID: PMC7389052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/23/2018] [Indexed: 03/30/2024]
Abstract
OBJECTIVE To investigate the value of multiparameter flow cytometry (MFC) and flow cytometric scoring system (FCSS) in the diagnosis and prognostic evaluation of childhood myelodysplastic syndrome (MDS). METHODS A retrospective analysis was performed for the clinical data of 42 children who were diagnosed with MDS. MFC was performed to investigate the phenotype and proportion of each lineage of bone marrow cells. The correlations of FCSS score with MDS type, International Prognostic Scoring System (IPSS) score, and revised IPSS (IPSS-R) score were analyzed. RESULTS Of all the 42 children, 20 (48%) had an increase in abnormal marrow blasts, 19 (45%) had a lymphoid/myeloid ratio of >1, 14 (33%) had abnormal cross-lineage expression of lymphoid antigens in myeloid cells, 8 (19%) had abnormal CD13/CD16 differentiation antigens, 5 (12%) had abnormal expression of CD56, 3 (7%) had reduced or increased side scatter of granulocytes, 3 (7%) had reduced expression of CD36 in nucleated red blood cells, 2 (5%) had reduced expression of CD71 in nucleated red blood cells, 1 (2%) had absent expression of CD33 in myeloid cells, 1 (2%) had reduced or absent expression of CD11b in granulocytes, and 1 (2%) had absent expression of CD56 and CD14 in monocytes. There were significant differences in the median overall survival time and event-free survival time among the low-, medium-, and high-risk FCSS groups (P<0.05). Among the low-, medium-, and high-risk FCSS groups, the low-risk FCSS group had the highest 2-year overall survival rate, while there was no significant difference between the medium- and high-risk FCSS groups (P>0.05). The three groups had a 2-year event-free survival rate of 95%, 60%, and 46% respectively (P<0.05). FCSS score was positively correlated with MDS type, IPSS score, and IPSS-R score (P<0.05). CONCLUSIONS MFC and FCSS help with the diagnosis and prognostic evaluation of childhood MDS.
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Affiliation(s)
- Chao Liu
- Department of Pediatric Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
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