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Dussiau C, Comont T, Knosp C, Vergnolle I, Bravetti C, Canali A, Houvert A, Largeaud L, Daveaux C, Zaroili L, Friedrich C, Boussaid I, Zalmai L, Almire C, Rauzy O, Willems L, Birsen R, Bouscary D, Fontenay M, Kosmider O, Chapuis N, Vergez F. Loss of hematopoietic progenitors heterogeneity is an adverse prognostic factor in lower-risk myelodysplastic neoplasms. Leukemia 2024; 38:1131-1142. [PMID: 38575672 DOI: 10.1038/s41375-024-02234-6] [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: 12/20/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
Myelodysplastic neoplasms (MDS) are characterized by clonal evolution starting from the compartment of hematopoietic stem and progenitors cells (HSPCs), leading in some cases to leukemic transformation. We hypothesized that deciphering the diversity of the HSPCs compartment may allow for the early detection of an emergent sub-clone that drives disease progression. Deep analysis of HSPCs repartition by multiparametric flow cytometry revealed a strong disorder of the hematopoietic branching system in most patients at diagnosis with different phenotypic signatures closely related to specific MDS features. In two independent cohorts of 131 and 584 MDS, the HSPCs heterogeneity quantified through entropy calculation was decreased in 47% and 46% of cases, reflecting a more advanced state of the disease with deeper cytopenias, higher IPSS-R risk and accumulation of somatic mutations. We demonstrated that patients with lower-risk MDS and low CD34 + CD38+HSPCs entropy had an adverse outcome and that this parameter is as an independent predictive biomarker for progression free survival, leukemia free survival and overall survival. Analysis of HSPCs repartition at diagnosis represents therefore a very powerful tool to identify lower-risk MDS patients with a worse outcome and valuable for clinical decision-making, which could be fully integrated in the MDS diagnostic workflow.
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Affiliation(s)
- Charles Dussiau
- Assistance Publique-Hôpitaux de Paris. Centre-Université Paris Cité, Service d'hématologie biologique, Hôpital Cochin, Paris, France
- Université Paris Cité, Institut Cochin, CNRSUMR8104, INSERM U1016, Paris, France
| | - Thibault Comont
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Service de Médecine Interne, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
- Cancer Research Center of Toulouse, UMR1037-INSERM, ERL5294 CNRS, Toulouse, France
| | - Camille Knosp
- Université Paris Cité, Institut Cochin, CNRSUMR8104, INSERM U1016, Paris, France
| | - Inès Vergnolle
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Laboratoire d'Hématologie, Toulouse, France
| | - Clotilde Bravetti
- Université Paris Cité, Institut Cochin, CNRSUMR8104, INSERM U1016, Paris, France
| | - Alban Canali
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Laboratoire d'Hématologie, Toulouse, France
| | - Amandine Houvert
- Université Paris Cité, Institut Cochin, CNRSUMR8104, INSERM U1016, Paris, France
| | - Laetitia Largeaud
- Université Toulouse III Paul Sabatier, Toulouse, France
- Cancer Research Center of Toulouse, UMR1037-INSERM, ERL5294 CNRS, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Laboratoire d'Hématologie, Toulouse, France
| | - Christian Daveaux
- Université Paris Cité, Institut Cochin, CNRSUMR8104, INSERM U1016, Paris, France
| | - Laila Zaroili
- Université Paris Cité, Institut Cochin, CNRSUMR8104, INSERM U1016, Paris, France
| | - Chloé Friedrich
- Assistance Publique-Hôpitaux de Paris. Centre-Université Paris Cité, Service d'hématologie biologique, Hôpital Cochin, Paris, France
- Université Paris Cité, Institut Cochin, CNRSUMR8104, INSERM U1016, Paris, France
| | - Ismaël Boussaid
- Assistance Publique-Hôpitaux de Paris. Centre-Université Paris Cité, Service d'hématologie biologique, Hôpital Cochin, Paris, France
- Université Paris Cité, Institut Cochin, CNRSUMR8104, INSERM U1016, Paris, France
| | - Loria Zalmai
- Assistance Publique-Hôpitaux de Paris. Centre-Université Paris Cité, Service d'hématologie biologique, Hôpital Cochin, Paris, France
| | - Carole Almire
- Assistance Publique-Hôpitaux de Paris. Centre-Université Paris Cité, Service d'hématologie biologique, Hôpital Cochin, Paris, France
| | - Odile Rauzy
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Service de Médecine Interne, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
- Cancer Research Center of Toulouse, UMR1037-INSERM, ERL5294 CNRS, Toulouse, France
| | - Lise Willems
- Université Paris Cité, Institut Cochin, CNRSUMR8104, INSERM U1016, Paris, France
- Assistance Publique-Hôpitaux de Paris. Centre-Université Paris Cité, Service d'hématologie clinique, Hôpital Cochin, Paris, France
| | - Rudy Birsen
- Université Paris Cité, Institut Cochin, CNRSUMR8104, INSERM U1016, Paris, France
- Assistance Publique-Hôpitaux de Paris. Centre-Université Paris Cité, Service d'hématologie clinique, Hôpital Cochin, Paris, France
| | - Didier Bouscary
- Université Paris Cité, Institut Cochin, CNRSUMR8104, INSERM U1016, Paris, France
- Assistance Publique-Hôpitaux de Paris. Centre-Université Paris Cité, Service d'hématologie clinique, Hôpital Cochin, Paris, France
| | - Michaela Fontenay
- Assistance Publique-Hôpitaux de Paris. Centre-Université Paris Cité, Service d'hématologie biologique, Hôpital Cochin, Paris, France
- Université Paris Cité, Institut Cochin, CNRSUMR8104, INSERM U1016, Paris, France
| | - Olivier Kosmider
- Assistance Publique-Hôpitaux de Paris. Centre-Université Paris Cité, Service d'hématologie biologique, Hôpital Cochin, Paris, France
- Université Paris Cité, Institut Cochin, CNRSUMR8104, INSERM U1016, Paris, France
| | - Nicolas Chapuis
- Assistance Publique-Hôpitaux de Paris. Centre-Université Paris Cité, Service d'hématologie biologique, Hôpital Cochin, Paris, France.
- Université Paris Cité, Institut Cochin, CNRSUMR8104, INSERM U1016, Paris, France.
| | - François Vergez
- Université Toulouse III Paul Sabatier, Toulouse, France
- Cancer Research Center of Toulouse, UMR1037-INSERM, ERL5294 CNRS, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Laboratoire d'Hématologie, Toulouse, France
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Shameli A, Dharmani-Khan P, Auer I, Shabani-Rad MT. Deep immunophenotypic analysis of the bone marrow progenitor cells in myelodysplastic syndromes. Leuk Res 2023; 134:107401. [PMID: 37774446 DOI: 10.1016/j.leukres.2023.107401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/23/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Diagnosis of myelodysplastic syndromes (MDS) is often challenging and requires integration of clinical, morphologic, cytogenetics and molecular information. Flow cytometry immunophenotyping (FCIP) can support the diagnosis by demonstration of numerical and immunophenotypic abnormalities of progenitor and maturing myelomonocytic and erythroid populations. We have previously shown that comprehensive immunophenotypic analysis of the progenitor population is valuable in the diagnosis of MDS and myelodysplastic/myeloproliferative neoplasms (MDS/MPN). This study was designed to improve the analysis method and confirm its value in a larger cohort of patients. METHODS FCIP of bone marrow samples from 105 patients with cytopenia(s) (with or without leukocytosis) and clinical concern for MDS or MDS/MPN was performed using a single-tube/10-color/13-marker assay. A modified analysis approach was used to obtain 11 progenitor parameters and 2 myelomonocytic parameters. RESULTS Significantly higher number of abnormalities were identified in MDS and MDS/MPN cases when compared to cytopenic patients not meeting the diagnostic criteria for MDS (Non-MDS). A FCIP score that combined the 13 parameters showed a sensitivity of 89.8% and specificity of 93.5% for the diagnosis of MDS and MDS/MPN. The sensitivity was 100% for both MDS/MPN and higher-risk MDS, and 81.3% for lower-risk MDS. CONCLUSION This study confirms that detailed immunophenotypic analysis of the progenitor population is powerful in the diagnosis of MDS and MDS/MPN. The combination of markers used in the panel allowed for evaluation of two relatively new parameters, namely myeloid progenitor heterogeneity and stem cell aberrancy, which improved the sensitivity of the assay for lower-risk MDS.
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Affiliation(s)
- Afshin Shameli
- Department of Laboratory Medicine and Pathology, University of Washington, WA, United States.
| | - Poonam Dharmani-Khan
- Division of Hematopathology, Alberta Precision Laboratories, South Zone, and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Iwona Auer
- Division of Hematopathology, Alberta Precision Laboratories, South Zone, and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Meer-Taher Shabani-Rad
- Division of Hematopathology, Alberta Precision Laboratories, South Zone, and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
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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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Wagner-Ballon O, Kosmider O. [MDS & CMML: Diagnostic and classification]. Bull Cancer 2023; 110:1106-1115. [PMID: 37453834 DOI: 10.1016/j.bulcan.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 07/18/2023]
Abstract
In 2023, a diagnosis process of myelodysplastic syndrome (MDS) or chronic myelomonocytic leukemia (CMML) is mainly based on morphological results obtained on bone marrow and blood smears which could be completed by cytogenetical analyses. Due to recent finding, flow cytometry data are recognized as useful for the diagnosis of CMML especially. Actual classifications and prognostic scoring systems have changed and nowadays include results of high-throughput sequencing approaches in addition to cytogenetical results. All together, these data allow the medical world to correctly evaluate the prognosis of these patients and to provide some information for targeted therapies. This chapter will provide the most important modifications recently published in the field of diagnosis and prognosis of MDS and CMML.
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Affiliation(s)
- Orianne Wagner-Ballon
- Université Paris Est Créteil, Inserm, IMRB, 94010 Créteil, France; AP-HP, hôpital Henri-Mondor, département d'hématologie et immunologie, 94010 Créteil, France
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5
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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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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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7
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Simoni Y, Chapuis N. Diagnosis of Myelodysplastic Syndromes: From Immunological Observations to Clinical Applications. Diagnostics (Basel) 2022; 12:diagnostics12071659. [PMID: 35885563 PMCID: PMC9324119 DOI: 10.3390/diagnostics12071659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
Myelodysplastic syndromes (MDS) constitute a very heterogeneous group of diseases with a high prevalence in elderly patients and a propensity for progression to acute myeloid leukemia. The complexity of these hematopoietic malignancies is revealed by the multiple recurrent somatic mutations involved in MDS pathogenesis and the paradoxical common phenotype observed in these patients characterized by ineffective hematopoiesis and cytopenia. In the context of population aging, the incidence of MDS will strongly increase in the future. Thus, precise diagnosis and evaluation of the progression risk of these diseases are imperative to adapt the treatment. Dysregulations of both innate and adaptive immune systems are frequently detected in MDS patients, and their critical role in MDS pathogenesis is now commonly accepted. However, different immune dysregulations and/or dysfunctions can be dynamically observed during the course of the disease. Monitoring the immune system therefore represents a new attractive tool for a more precise characterization of MDS at diagnosis and for identifying patients who may benefit from immunotherapy. We review here the current knowledge of the critical role of immune dysfunctions in both MDS and MDS precursor conditions and discuss the opportunities offered by the detection of these dysregulations for patient stratification.
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Affiliation(s)
- Yannick Simoni
- Institut Cochin, Université Paris Cité, CNRS UMR8104, INSERM U1016, 75014 Paris, France;
| | - Nicolas Chapuis
- Institut Cochin, Université Paris Cité, CNRS UMR8104, INSERM U1016, 75014 Paris, France;
- Assistance Publique-Hôpitaux de Paris, Centre-Université Paris Cité, Service d’Hématologie Biologique, Hôpital Cochin, 75014 Paris, France
- Correspondence:
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8
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Nirmalanantham P, Sakhi R, Beck R, Oduro K, Gadde R, Ryder C, Yoest J, Sadri N, Meyerson HJ. Flow Cytometric Findings in Clonal Cytopenia of Undetermined Significance. Am J Clin Pathol 2022; 157:219-230. [PMID: 34542558 DOI: 10.1093/ajcp/aqab116] [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: 04/04/2021] [Accepted: 05/28/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To examine flow cytometric (FCM) findings in clonal cytopenia of undetermined significance (CCUS) in relation to variant allele fraction (VAF) and mutation risk. METHODS Nine FCM parameters, including 5 FCM metrics (Meyerson-Alayed scoring scheme [MASS] parameters) we previously used to identify myelodysplastic syndromes (MDS), were compared among 96 CCUS samples, 100 low-grade MDS samples and 100 samples from patients without somatic alterations (controls). RESULTS FCM findings did not differ between CCUS samples with less than 20% VAF and controls. CCUS samples with more than 20% VAF (CCUS >20% VAF) demonstrated more than 1 abnormal FCM parameter at a frequency between MDS and controls. Abnormalities in CCUS with high-risk alterations (CCUS(hi)) were similar to MDS, with no statistical difference in the percentage of cases with more than 1 FCM abnormality or a positive MASS score. The positive predictive value (PPV) for clinically significant myeloid processes; MDS, CCUS(hi), and CCUS >20% VAF compared with other CCUS samples and controls was 94.8%, with 96.5% specificity and 61% sensitivity using a modified MASS score. A subset of MDS (43%) was distinguished from CCUS(hi) and CCUS >20% VAF using 3 parameters, with a 93.5% PPV and 83.3% specificity. CONCLUSIONS FCM abnormalities can distinguish high-risk CCUS based on VAF or alteration type from low-risk CCUS and MDS in many cases. The findings are of potential utility in the evaluation of patients with cytopenias.
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Affiliation(s)
- Priyatharsini Nirmalanantham
- Department of Pathology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH, USA
| | - Ramen Sakhi
- Department of Pathology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH, USA
| | - Rose Beck
- Department of Pathology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH, USA
| | - Kwadwo Oduro
- Department of Pathology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH, USA
| | - Ramya Gadde
- Department of Pathology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH, USA
| | - Chris Ryder
- Department of Pathology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH, USA
| | - Jennifer Yoest
- Department of Pathology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH, USA
| | - Navid Sadri
- Department of Pathology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH, USA
| | - Howard J Meyerson
- Department of Pathology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH, USA
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9
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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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10
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Aladily TN, Obiedat S, Bustami N, Alhesa A, Altantawi AM, Khader M, Mansour AT. Combined utility of CD177, P53, CD105 and c-kit immunohistochemical stains improves the detection of myelodysplastic syndrome. Ann Diagn Pathol 2021; 55:151810. [PMID: 34482217 DOI: 10.1016/j.anndiagpath.2021.151810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/01/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
The diagnosis of myelodysplastic syndrome (MDS) relies primarily on identifying peripheral blood cytopenia and morphologic dysplasia as well as detecting cytogenetic aberrations in a subset of patients. Accumulating data points to the importance of examining certain immunophenotypic changes characteristic of MDS, most of which are tested by flow cytometry. The role of immunohistochemistry in the diagnostic workup of MDS is less known. In this study, we used immunohistochemistry to survey the expression patterns of CD177, P53, CD105 and c- kit in a cohort of MDS bone marrow specimens (n = 57) and compared the results with a control group of patients who had cytopenia for other benign conditions (n = 49). MDS cases showed significant higher rates of: CD177-loss (13/57, 23% vs 1/49, 2%; P = .0016), P53 overexpression (8/57, 14% vs none; P = .005) and the presence of clusters of CD105-positive cells (6/57, 11% vs none; P = .021). Increased c-kit-positive cells was more common in MDS patients, but not statistically significant (17/57, 30% vs 8/49, 16%; P = .102). On multivariate analysis, only loss of CD177 expression was significantly higher in MDS group (P = .014). These findings suggest that a panel of immunohistochemical stains could serve as an adjunct tool in investigating unexplained cytopenias and warrant further comparative studies with flow cytometry.
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Affiliation(s)
- Tariq N Aladily
- Department of Hematopathology, The University of Jordan, Amman 11910, Jordan.
| | - Sara Obiedat
- Department of Hematopathology, The University of Jordan, Amman 11910, Jordan
| | - Nadwa Bustami
- Department of Hematopathology, The University of Jordan, Amman 11910, Jordan
| | - Ahmad Alhesa
- Department of Hematopathology, The University of Jordan, Amman 11910, Jordan
| | - Ahmad M Altantawi
- Department of Hematopathology, The University of Jordan, Amman 11910, Jordan
| | - Majd Khader
- Department of Hematopathology, The University of Jordan, Amman 11910, Jordan
| | - Ahmad T Mansour
- Department of Hematopathology, The University of Jordan, Amman 11910, Jordan; Department of Pathology and Laboratory Medicine, University of Cincinnati, OH 45220, USA.
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11
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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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12
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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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13
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Alayed K, Meyerson JB, Osei ES, Blidaru G, Schlegelmilch J, Johnson M, Meyerson HJ. CD177 Enhances the Detection of Myelodysplastic Syndrome by Flow Cytometry. Am J Clin Pathol 2020; 153:554-565. [PMID: 32011681 DOI: 10.1093/ajcp/aqz196] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Previously we demonstrated that a decreased percentage of CD177-positive granulocytes detected by flow cytometry (FCM) was associated with myelodysplastic syndrome (MDS). Here we expand on those findings to more rigorously evaluate the utility of CD177 for the detection of MDS. METHODS Two hundred patient samples (100 MDS and 100 controls) were evaluated for granulocyte expression of CD177 and 11 other flow cytometric parameters known to be associated with MDS. RESULTS We show that CD177, as a single analyte, is highly correlated with MDS with a receiver operating characteristic area under curve value of 0.8. CD177 expression below 30% demonstrated a sensitivity of 51% and a specificity of 94% for detecting MDS with a positive predictive value of 89.5%. In multivariate analysis of 12 MDS-associated FCM metrics, CD177 and the Ogata parameters were significant indicators of MDS, and CD177 increased sensitivity of the Ogata score by 16% (63%-79%) for predicting MDS. Finally, diagnostic criteria incorporating these parameters with a 1% blast cutoff level and CD177 resulted in a sensitivity of 90% and specificity of 91% for detecting MDS. CONCLUSIONS The findings indicate CD177 is a useful FCM marker for MDS.
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Affiliation(s)
- Khaled Alayed
- Department of Pathology, King Saud University, Riyadh, Saudi Arabia
| | | | - Ebenezer S Osei
- Department of Pathology, Case Western Reserve University, Cleveland, OH
| | - Georgeta Blidaru
- Department of Pathology, Case Western Reserve University, Cleveland, OH
| | | | - Michael Johnson
- Department of Pathology, Case Western Reserve University, Cleveland, OH
| | - Howard J Meyerson
- Department of Pathology, Case Western Reserve University, Cleveland, OH
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14
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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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15
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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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16
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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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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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18
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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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19
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Duetz C, Westers TM, van de Loosdrecht AA. Clinical Implication of Multi-Parameter Flow Cytometry in Myelodysplastic Syndromes. Pathobiology 2018; 86:14-23. [PMID: 30227408 DOI: 10.1159/000490727] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/08/2018] [Indexed: 12/16/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are a challenging group of diseases for clinicians and researchers, as both disease course and pathobiology are highly heterogeneous. In (suspected) MDS patients, multi-parameter flow cytometry can aid in establishing diagnosis, risk stratification and choice of therapy. This review addresses the developments and future directions of multi-parameter flow cytometry scores in MDS. Additionally, we propose an integrated diagnostic algorithm for suspected MDS.
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20
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Revising flow cytometric mini-panel for diagnosing low-grade myelodysplastic syndromes: Introducing a parameter quantifying CD33 expression on CD34+ cells. Leuk Res 2018; 71:75-81. [DOI: 10.1016/j.leukres.2018.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 11/18/2022]
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21
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Buccisano F, Dillon R, Freeman SD, Venditti A. Role of Minimal (Measurable) Residual Disease Assessment in Older Patients with Acute Myeloid Leukemia. Cancers (Basel) 2018; 10:cancers10070215. [PMID: 29949858 PMCID: PMC6070940 DOI: 10.3390/cancers10070215] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 12/22/2022] Open
Abstract
Minimal (or measurable) residual (MRD) disease provides a biomarker of response quality for which there is robust validation in the context of modern intensive treatment for younger patients with Acute Myeloid Leukemia (AML). Nevertheless, it remains a relatively unexplored area in older patients with AML. The lack of progress in this field can be attributed to two main reasons. First, physicians have a general reluctance to submitting older adults to intensive chemotherapy due to their frailty and to the unfavourable biological disease profile predicting a poor outcome following conventional chemotherapy. Second, with the increasing use of low-intensity therapies (i.e., hypomethylating agents) differing from conventional drugs in mechanism of action and dynamics of response, there has been concomitant skepticism that these schedules can produce deep hematological responses. Furthermore, age dependent differences in disease biology also contribute to uncertainty on the prognostic/predictive impact in older adults of certain genetic abnormalities including those validated for MRD monitoring in younger patients. This review examines the evidence for the role of MRD as a prognosticator in older AML, together with the possible pitfalls of MRD evaluation in older age.
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Affiliation(s)
- Francesco Buccisano
- Hematology, Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy.
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London SE1 9RT, UK.
| | - Sylvie D Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK.
| | - Adriano Venditti
- Hematology, Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy.
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22
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Lorand-Metze I, Longhini AL, Oliveira-Duarte G, Correia RP, Santos-Silva MC, Yamamoto M, Sandes AF, Oliveira AF, Souto EX, Ikoma MRV, Pereira-Cunha FG, Beltrame M, Metze K. Normal variation of bone marrow B-cell precursors according to age - reference ranges for studies in myelodysplastic syndromes in Brazil. CYTOMETRY PART B-CLINICAL CYTOMETRY 2017; 94:644-650. [DOI: 10.1002/cyto.b.21604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 12/21/2022]
Affiliation(s)
- I. Lorand-Metze
- Hematology - Hemotherapy Center, University of Campinas, Campinas; São Paulo Brazil
| | - A. L. Longhini
- Hematology - Hemotherapy Center, University of Campinas, Campinas; São Paulo Brazil
| | - G. Oliveira-Duarte
- Hematology - Hemotherapy Center, University of Campinas, Campinas; São Paulo Brazil
| | - R. P. Correia
- Laboratory of Hematology, Hospital Albert Einstein; São Paulo Brazil
| | - M. C. Santos-Silva
- Laboratory of Experimental Oncology; Federal University of Santa Catarina; Florianópolis Brazil
| | - M. Yamamoto
- Department of Hematology; Federal University of São Paulo; São Paulo Brazil
| | - A. F. Sandes
- Laboratory of Hematology; Laboratórios Fleury; São Paulo Brazil
| | - A. F. Oliveira
- Laboratory of Hematology; Childrens' Cancer Hospital, Barretos Cancer Center; Barretos Brazil
| | - E. X. Souto
- Laboratory of Hematology; DASA; São Paulo Brazil
| | - M. R. V. Ikoma
- Laboratory of Cytometry; Hospital Amaral Carvalho; Jaú, São Paulo Brazil
| | | | - M. Beltrame
- Department of Hematology; Federal University of Paraná; Curitiba Brazil
| | - K. Metze
- Department of Pathology; University of Campinas; Campinas Brazil
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23
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Diagnostic Utility of Flow Cytometry in Myelodysplastic Syndromes. Mediterr J Hematol Infect Dis 2017; 9:e2017017. [PMID: 28293405 PMCID: PMC5333741 DOI: 10.4084/mjhid.2017.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/20/2017] [Indexed: 12/19/2022] Open
Abstract
The pathological hallmark of myelodysplastic syndromes (MDS) is marrow dysplasia, which represents the basis of the WHO classification of these disorders. This classification provides clinicians with a useful tool for defining the different subtypes of MDS and individual prognosis. The WHO proposal has raised some concern regarding minimal diagnostic criteria particularly in patients with normal karyotype without robust morphological markers of dysplasia (such as ring sideroblasts or excess of blasts). Therefore, there is clearly need to refine the accuracy to detect marrow dysplasia. Flow cytometry (FCM) immunophenotyping has been proposed as a tool to improve the evaluation of marrow dysplasia. The rationale for the application of FCM in the diagnostic work up of MDS is that immunophenotyping is an accurate method for quantitative and qualitative evaluation of hematopoietic cells and that MDS have been found to have abnormal expression of several cellular antigens. To become applicable in clinical practice, FCM analysis should be based on parameters with sufficient specificity and sensitivity, data should be reproducible between different operators, and the results should be easily understood by clinicians. In this review, we discuss the most relevant progresses in detection of marrow dysplasia by FCM in MDS
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24
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Cremers EMP, Westers TM, Alhan C, Cali C, Visser-Wisselaar HA, Chitu DA, van der Velden VHJ, Te Marvelde JG, Klein SK, Muus P, Vellenga E, de Greef GE, Legdeur MCCJC, Wijermans PW, Stevens-Kroef MJPL, Silva-Coelho PD, Jansen JH, Ossenkoppele GJ, van de Loosdrecht AA. Implementation of erythroid lineage analysis by flow cytometry in diagnostic models for myelodysplastic syndromes. Haematologica 2016; 102:320-326. [PMID: 27658438 DOI: 10.3324/haematol.2016.147843] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 09/14/2016] [Indexed: 12/17/2022] Open
Abstract
Flow cytometric analysis is a recommended tool in the diagnosis of myelodysplastic syndromes. Current flow cytometric approaches evaluate the (im)mature myelo-/monocytic lineage with a median sensitivity and specificity of ~71% and ~93%, respectively. We hypothesized that the addition of erythroid lineage analysis could increase the sensitivity of flow cytometry. Hereto, we validated the analysis of erythroid lineage parameters recommended by the International/European LeukemiaNet Working Group for Flow Cytometry in Myelodysplastic Syndromes, and incorporated this evaluation in currently applied flow cytometric models. One hundred and sixty-seven bone marrow aspirates were analyzed; 106 patients with myelodysplastic syndromes, and 61 cytopenic controls. There was a strong correlation between presence of erythroid aberrancies assessed by flow cytometry and the diagnosis of myelodysplastic syndromes when validating the previously described erythroid evaluation. Furthermore, addition of erythroid aberrancies to two different flow cytometric models led to an increased sensitivity in detecting myelodysplastic syndromes: from 74% to 86% for the addition to the diagnostic score designed by Ogata and colleagues, and from 69% to 80% for the addition to the integrated flow cytometric score for myelodysplastic syndromes, designed by our group. In both models the specificity was unaffected. The high sensitivity and specificity of flow cytometry in the detection of myelodysplastic syndromes illustrates the important value of flow cytometry in a standardized diagnostic approach. The trial is registered at www.trialregister.nl as NTR1825; EudraCT n.: 2008-002195-10.
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Affiliation(s)
- Eline M P Cremers
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - Theresia M Westers
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - Canan Alhan
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - Claudia Cali
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | | | - Dana A Chitu
- HOVON Data Center, Erasmus MC Cancer Institute, Clinical Trial Center, Rotterdam, The Netherlands
| | | | - Jeroen G Te Marvelde
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Saskia K Klein
- Department of Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands
| | - Petra Muus
- Department of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Edo Vellenga
- Department of Hematology, University Medical Center Groningen, The Netherlands
| | - Georgina E de Greef
- Department of Hematology Erasmus MC Cancer Institute Rotterdam, The Netherlands
| | | | - Pierre W Wijermans
- Department of Internal Medicine, Haga Ziekenhuis, The Hague, The Netherlands
| | | | - Pedro da Silva-Coelho
- Laboratory of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Joop H Jansen
- Laboratory of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gert J Ossenkoppele
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
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25
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Aanei CM, Picot T, Tavernier E, Guyotat D, Campos Catafal L. Diagnostic Utility of Flow Cytometry in Myelodysplastic Syndromes. Front Oncol 2016; 6:161. [PMID: 27446807 PMCID: PMC4921489 DOI: 10.3389/fonc.2016.00161] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/14/2016] [Indexed: 12/20/2022] Open
Abstract
Myelodysplastic syndromes (MDSs) are clonal disorders of hematopoiesis that exhibit heterogeneous clinical presentation and morphological findings, which complicates diagnosis, especially in early stages. Recently, refined definitions and standards in the diagnosis and treatment of MDS were proposed, but numerous questions remain. Multiparameter flow cytometry (MFC) is a helpful tool for the diagnostic workup of patients with suspected MDS, and various scores using MFC data have been developed. However, none of these methods have achieved the sensitivity that is required for a reassuring diagnosis in the absence of morphological abnormalities. One reason may be that each score evaluates one or two lineages without offering a broad view of the dysplastic process. The combination of two scores (e.g., Ogata and Red Score) improved the sensitivity from 50-60 to 88%, but the positive (PPV) and negative predictive values (NPV) must be improved. There are prominent differences between study groups when these scores are tested. Further research is needed to maximize the sensitivity of flow cytometric analysis in MDS. This review focuses on the application of flow cytometry for MDS diagnosis and discusses the advantages and limitations of different approaches.
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Affiliation(s)
- Carmen Mariana Aanei
- CNRS UMR5239, Université de Lyon, Saint-Etienne, France
- Laboratoire d’Hématologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - Tiphanie Picot
- CNRS UMR5239, Université de Lyon, Saint-Etienne, France
- Laboratoire d’Hématologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - Emmanuelle Tavernier
- CNRS UMR5239, Université de Lyon, Saint-Etienne, France
- Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France
| | - Denis Guyotat
- CNRS UMR5239, Université de Lyon, Saint-Etienne, France
- Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France
| | - Lydia Campos Catafal
- CNRS UMR5239, Université de Lyon, Saint-Etienne, France
- Laboratoire d’Hématologie, CHU de Saint-Etienne, Saint-Etienne, France
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26
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Porwit A. Is There a Role for Flow Cytometry in the Evaluation of Patients With Myelodysplastic Syndromes? Curr Hematol Malig Rep 2015; 10:309-17. [DOI: 10.1007/s11899-015-0272-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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27
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Oelschlaegel U, Alexander Röhnert M, Mohr B, Sockel K, Herold S, Ehninger G, Bornhäuser M, Thiede C, Platzbecker U. Clonal architecture of del(5q) myelodysplastic syndromes: aberrant CD5 or CD7 expression within the myeloid progenitor compartment defines a subset with high clonal burden. Leukemia 2015; 30:517-20. [PMID: 26104659 PMCID: PMC4740451 DOI: 10.1038/leu.2015.158] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- U Oelschlaegel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - M Alexander Röhnert
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - B Mohr
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - K Sockel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - S Herold
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - G Ehninger
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - M Bornhäuser
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - C Thiede
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - U Platzbecker
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
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