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Flow cytometry in myelodysplastic syndrome: analysis of diagnostic utility using maturation pattern-based and quantitative approaches. Ann Hematol 2012; 91:1351-62. [PMID: 22526362 DOI: 10.1007/s00277-012-1461-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
Abstract
Flow cytometry (FCM) is being increasingly evaluated for the diagnosis of myelodysplastic syndrome (MDS). We employed multiple FCM approaches to assess MDS. Five-color FCM, morphology blind, was done on bone marrow aspirates of 57 suspected MDS and 31 normal controls. Maturation pattern, quantitative FCM for low-grade MDS that awards FCM score, and expression of selected antigens on erythroid cells and CD34(+) blasts were evaluated. FCM results were correlated with clinical and laboratory workup. Patients (n = 57) included proven MDS (n = 14), suspected MDS (n = 13), and non-MDS (n = 30). By pattern-based approach, all proven cases were FCM positive. In suspected MDS, 11 (84.61 %) were positive including morphology-negative cases, and two (15.38 %) were intermediate. In non-MDS cases, 27 of 30 (90 %) were FCM negative, 2 of 30 (6.67 %) intermediate, and 1 of 30 (3.33 %) a hematinic-responsive case, positive. Quantitative parameters that characterized MDS included FCM score of >3, percentage CD34(+) B cells, and expression of CD11b, CD15, and CD56 on myeloblasts. CD71 MFI on CD235a(+) erythroblasts and CD38 MFI on myeloblasts were significantly lower in MDS. The former was present in FCM-intermediate suspected MDS but not FCM-intermediate non-MDS cases. Used in the overall clinical context, both maturation pattern recognition and quantitative approaches, the latter for low-grade MDS, are sensitive methods of diagnosing MDS, including cases negative by morphology and cytogenetics, especially if combined with evaluation of selected antigens, CD71 on CD235a(+) cells and CD38 on CD34(+) cells. The value of FCM in morphology-negative cases needs better definition of specificity through more extensive evaluation of secondary dyspoiesis.
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Porwit A. Role of flow cytometry in diagnostics of myelodysplastic syndromes--beyond the WHO 2008 classification. Semin Diagn Pathol 2012; 28:273-82. [PMID: 22195405 DOI: 10.1053/j.semdp.2011.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Multiparameter flow cytometry (FCM) is an excellent method to follow the expression patterns of differentiation antigens using monoclonal antibodies to surface and cytoplasmic proteins. Although several authors described various aberrant immunophenotypic features in the bone marrow of patients with myelodysplastic syndromes (MDS), the World Health Organization 2008 classification recommended that, only if 3 or more phenotypic abnormalities are found involving 1 or more of the myeloid lineages can the aberrant FCM findings be considered suggestive of MDS. In the absence of conclusive morphologic and/or cytogenetic features, FCM abnormalities alone were considered not sufficient to establish MDS diagnosis and further follow-up of the patients was recommended. Review of the literature gives accumulating evidence that FCM has become an important part of the integrated diagnostic work-up of patients with suspected MDS. Several studies have also reported FCM findings significant for prognosis and therapy choice in MDS patients. Technical progress in multicolor FCM and new analysis programs, together with ongoing efforts to standardize the methodology, will make it possible to apply FCM in individual risk assessment and choice of best therapy for MDS patients.
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Affiliation(s)
- Anna Porwit
- Department of Laboratory Hematology, University Health Network, Toronto, Ontario, Canada.
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Matarraz S, López A, Barrena S, Fernandez C, Jensen E, Flores-Montero J, Rasillo A, Sayagues JM, Sánchez ML, Bárcena P, Hernandez-Rivas JM, Salvador C, Fernandez-Mosteirín N, Giralt M, Perdiguer L, Laranjeira P, Paiva A, Orfao A. Bone marrow cells from myelodysplastic syndromes show altered immunophenotypic profiles that may contribute to the diagnosis and prognostic stratification of the disease: a pilot study on a series of 56 patients. CYTOMETRY PART B-CLINICAL CYTOMETRY 2010; 78:154-68. [PMID: 20198685 DOI: 10.1002/cyto.b.20513] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED A heterogeneous spectrum of immunophenotypic abnormalities have been reported in myelodysplastic syndromes (MDS). However, most studies are restricted to the analysis of CD34(+) cells and/or other major subsets of CD34(-) cells, frequently not exploring the diagnostic and prognostic impact of immunophenotyping. METHODS We propose for the first time an immunophenotypic score (IS) based on the altered distribution and immunophenotypic features of maturing/mature compartments of bone marrow (BM) hematopoietic cells in 56 patients with MDS that could contribute to a refined diagnosis and prognostic evaluation of the disease. RESULTS Although MDS-associated phenotypes were detected in reactive BM, the overall immunophenotypic profile of BM cells allowed an efficient discrimination between MDS and both normal and reactive BM, once the number and degree of severity of the abnormalities detected per patient were simultaneously considered in the proposed IS. Interestingly, increasingly higher IS were found among patients with MDS showing adverse prognostic factors and in low- versus high-grade cases. The most informative prognostic factors included the number of CD34(+) cells, presence of aberrant CD34(-)/CD117(+) precursors, decreased mature neutrophils and CD34(-) erythroid precursors, and increased numbers of CD36(-/lo) erythroid precursors; in addition, the IS was an independent prognostic factor for overall survival. CONCLUSIONS Assessment of immunophenotypic abnormalities of maturing/mature BM cells allows an efficient discrimination between MDS and both normal and reactive BM, once the number and degree of severity of the abnormalities detected are simultaneously scored. Interestingly, progressively higher IS were found among patients with MDS with adverse prognostic features and shorter overall survival.
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Affiliation(s)
- Sergio Matarraz
- Centro de Investigación del Cáncer (Instituto de Biología Molecular y Celular del Cáncer; CSIC-USAL), Servicio General de Citometría and Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
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Moon HW, Huh JW, Lee M, Hong KS, Chung WS. Immunophenotypic Features of Granulocytes, Monocytes, and Blasts in Myelodysplastic Syndromes. Ann Lab Med 2010; 30:97-104. [DOI: 10.3343/kjlm.2010.30.2.97] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hee Won Moon
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jung Won Huh
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Miae Lee
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ki Sook Hong
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Wha Soon Chung
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Huang M, Li J, Zhao G, Sui X, Zhao X, Xu H. Immunophenotype of myeloid granulocytes: a pilot study for distinguishing myelodysplastic syndrome and aplastic anemia by flow cytometry. Int J Lab Hematol 2009; 32:275-81. [PMID: 19968721 DOI: 10.1111/j.1751-553x.2009.01192.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
It is often difficult to distinguish myelodysplastic syndrome (MDS) from aplastic anemia (AA) because of the considerable clinical, cytologic histologic similarities between these two disorders; however, distinguishing between AA and MDS is of great importance because there is a higher risk of progression to acute leukemia in patients with MDS compared with AA. Up to now, CD34(+) cells in MDS and AA patients have been studied extensively; however, little information is available on myeloid granulocytes. The aim of this study was to determine whether immunophenotype of myeloid granulocytes in AA patients was different from that of MDS. Flow cytometry was used to assess the immunophenotype of myeloid granulocytes in 22 patients with MDS, 12 with AA, and 10 normal subjects. Our data showed that the percentages of CD13(+) granulocytes, CD33(+) granulocytes, CD34(+) granulocytes, and HLA-DR(+) granulocytes were significantly higher in patients with MDS than in AA patients and normal subjects (P < 0.05). The percentages of CD15(+) granulocytes and CD10(+) granulocytes were significantly lower in patients with MDS than in AA patients and normal subjects (P < 0.05). There were no significant differences in the expression of these markers between patients with AA and normal subjects (P > 0.05). As refractory anemia progressing to refractory anemia with excess blasts, the percentages of CD13(+) granulocytes, CD33(+) granulocytes, CD34(+) granulocytes and HLA-DR(+) granulocytes were significantly increased, whereas, the percentage of CD15(+) granulocytes was significantly decreased (P < 0.05). These data suggest that immunophenotype of myeloid granulocytes may be a useful parameter for the differential diagnosis of MDS and AA.
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Affiliation(s)
- M Huang
- Department of Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan City, China.
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Vikentiou M, Psarra K, Kapsimali V, Liapis K, Michael M, Tsionos K, Lianidou E, Papasteriades C. Distinct neutrophil subpopulations phenotype by flow cytometry in myelodysplastic syndromes. Leuk Lymphoma 2009; 50:401-9. [DOI: 10.1080/10428190902755497] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stachurski D, Smith BR, Pozdnyakova O, Andersen M, Xiao Z, Raza A, Woda BA, Wang SA. Flow cytometric analysis of myelomonocytic cells by a pattern recognition approach is sensitive and specific in diagnosing myelodysplastic syndrome and related marrow diseases: Emphasis on a global evaluation and recognition of diagnostic pitfalls. Leuk Res 2008; 32:215-24. [PMID: 17675229 DOI: 10.1016/j.leukres.2007.06.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 06/04/2007] [Accepted: 06/07/2007] [Indexed: 02/05/2023]
Abstract
Published data on flow cytometry (FCM) in diagnosing myelodysplastic syndromes (MDS) varies greatly in analytic methods and interpretational approaches. We tested the diagnostic utility of the pattern recognition approach by a retrospective review of 180 MDS, 31 myelodysplastic/myeloproliferative disease (MDS/MPD), 37 non-MDS cytopenia and 20 myeloproliferative disease (MPD) cases. Cases were placed into "positive", "intermediate", and "negative" FCM categories based upon the antigenic aberrations observed on myelomonocytic cells. By exclusion or inclusion of the intermediate category as indicative of MDS or MDS/MPD, the overall sensitivity and specificity were 84% and 97% or 98% and 78%, respectively. The overall abnormalities detected by FCM correlated with the severity of morphological dysplasia and clonal cytogenetic abnormalities. MPD also demonstrated immunophenotypic aberrancy. Based on a global evaluation of myelomonocytic abnormalities, and recognition of diagnostic pitfalls and caveats, the pattern recognition approach of FCM is sensitive and reliable in diagnosing MDS and related myeloid diseases.
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Affiliation(s)
- Dariusz Stachurski
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts, Worcester, MA, USA
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Lorand-Metze I, Ribeiro E, Lima CSP, Batista LS, Metze K. Detection of hematopoietic maturation abnormalities by flow cytometry in myelodysplastic syndromes and its utility for the differential diagnosis with non-clonal disorders. Leuk Res 2007; 31:147-55. [PMID: 16750852 DOI: 10.1016/j.leukres.2006.04.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Revised: 04/24/2006] [Accepted: 04/25/2006] [Indexed: 10/24/2022]
Abstract
The diagnosis of myelodysplastic syndromes (MDS) is based on peripheral cytopenias, bone marrow (BM) morphology and karyotyping. This may be difficult in cases with few dysplastic elements in BM and a normal karyotype. We examined the utility of flow cytometric analysis for the differential diagnosis between MDS and non-clonal disorders (NCD) presenting peripheral cytopenias. Quantitative assessment of CD45, CD16, CD13, CD11b, CD10 and CD64 in granulocytes and monocytes, and CD71 and glycophorin A in erythroblasts besides CD34+ cell count was performed in BM of 31 consecutive newly diagnosed patients with MDS, 11 patients with NCD and 11 healthy controls (BM donors). In MDS, the median number of phenotypic abnormalities found was 3 (1-8). The WPSS score showed a correlation with the total number of changes per case (r=0.48; p=0.002). Decreased SSC in promyelocytes correlated with the peripheral neutrophil count (r=-0.46; p=0.007). In NCD, the normal variation of antigen expression along granulocytic and erythroblast maturation was always maintained. In the discriminant analysis, SSC of CD34+ cells, together with that of promyelocytes and metamyelocytes were able to correctly classify 87% of the cases as clonal or non-clonal. Our quantitative approach permitted to detect at least one abnormality in antigen expression in every case of MDS. However, the most important parameters for differential diagnosis with NCD were the analysis of the granularity in immature cells, especially of the granulocytic series.
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Affiliation(s)
- Irene Lorand-Metze
- Department of Internal Medicine, Hemocentro, State University of Campinas, P.O. Box 6198, BR-13081-970 Campinas, São Paulo, Brazil.
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Farmakis D, Polymeropoulos E, Polonifi A, Deftereos S, Giakoumi X, Floudas H, Grapsa A, Aessopos A. Myelodysplastic syndrome associated with multiple autoimmune disorders. Clin Rheumatol 2005; 24:428-30. [PMID: 15827686 DOI: 10.1007/s10067-004-1059-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Accepted: 11/23/2004] [Indexed: 10/25/2022]
Abstract
The association between myelodysplastic syndromes (MDS) and autoimmune manifestations is not uncommon. As a rule, autoimmune abnormalities follow the diagnosis of MDS. We describe here a patient with MDS who developed a striking spectrum of diverse autoimmune disorders, including dermatitis, polyarthritis, and vasculitis, which preceded the clinical appearance of MDS.
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Affiliation(s)
- Dimitrios Farmakis
- First Department of Internal Medicine, Laiko General Hospital, University of Athens Medical School, Greece.
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