1
|
Johansson U, McIver-Brown N, Cullen M, Duetz C, Dunlop A, Oelschlägel U, Psarra K, Subirá D, Westers TM. The flow cytometry myeloid progenitor count: A reproducible parameter for diagnosis and prognosis of myelodysplastic syndromes. Cytometry B Clin Cytom 2023; 104:115-127. [PMID: 34931733 DOI: 10.1002/cyto.b.22048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/04/2021] [Accepted: 12/09/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The bone marrow blast count is central to the diagnosis and monitoring of myelodysplastic syndromes (MDS). It is an independent risk factor for worse prognosis whether based on the morphology blast count or the flow cytometry (FC) myeloid progenitor (MyP) count. It is a principal population in FC MDS analysis also because once defined; it provides significant contributions to the overall FC MDS score. METHODS We elected to investigate inter-analyst agreement for the most fundamental parameter of the FC MDS diagnostic score: the MyP count. A common gating strategy was agreed and used by seven cytometrists for blind analysis of 34 routine bone marrows sent for MDS work-up. Additionally, we compared the results with a computational approach. RESULTS Concordance was excellent: Intraclass correlation was 0.993 whether measuring %MyP of total cells or CD45+ cells, and no significant difference was observed between files from different centers or for samples with abnormal MyP phenotypes. Computational and manual results were similar. Applying the common strategy to individual laboratories' control cohorts produced similar MyP reference ranges across centers. CONCLUSION The FC MyP count offers a reliable diagnostic and prognostic measurement in MDS. The use of manual and computational approaches side by side may allow for optimizing both strategies. Considering its known prognostic power, the MyP count could be considered a useful and reliable addition to existing prognostic scoring systems.
Collapse
Affiliation(s)
- Ulrika Johansson
- Haematological Malignancy Diagnostic Service, University Hospitals and Weston NHS Foundation Trust, Bristol, UK
| | - Neil McIver-Brown
- Molecular Pathology Department, Royal Bournemouth Hospital, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Matthew Cullen
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Carolien Duetz
- Department of Haematology, Amsterdam University Medical Centres, VU University Medical Center, Amsterdam, The Netherlands
| | - Alan Dunlop
- Haematological Malignancy Diagnostic Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Uta Oelschlägel
- Department of Haematology, Medical Clinic and Policlinic I, University Hospital of TU Dresden, Dresden, Germany
| | - Katherina Psarra
- Department of Immunology and Histocompatibility, Evangelismos Hospital, Athens, Greece
| | - Dolores Subirá
- Department of Haematology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Theresia M Westers
- Department of Hematology, Amsterdam University Medical Centers, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Chauhan R, Singh J, Sharma C, Dange P, Chopra A, Mahapatra M, Pati H. The utility of a single tube 10-color flow cytometry for quantitative and qualitative analysis in myelodysplastic syndrome- a pilot study. Leuk Res 2021; 107:106651. [PMID: 34218155 DOI: 10.1016/j.leukres.2021.106651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/19/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Assessment of myelodysplasia (MDS) by flow cytometry (FCM) includes elaborate panels, and interpretation is observer-dependent. This study evaluates single tube 10-color FCM in a test cohort of clinically suspected MDS patients. METHODS We analyzed fifty-six bone marrow (BM) samples from clinically suspected MDS patients in a morphology-blinded manner along with controls using a 10-color single tube flow cytometry. We analyzed the reproducibility of Ogata score and modified FCM scores, additionally incorporating the proportion of CD15, CD11b, CD56, and CD38MFI on CD34+CD19-cluster for each patient. Patients were grouped as proven-MDS, suspected-MDS, and non-MDS groups based on morphology and cytogenetics. Optimized multi-axial radar-plots were also used to analyze maturation patterns in the granulocytic, monocytic, and blast progenitor compartments of proven-MDS cases and controls. RESULTS Flow cytometric abnormalities ≥3 were present in proven-MDS (n = 23) with a sensitivity and specificity of 78 % and 94 %, respectively, as per Ogata score. The addition of CD38 MFI to the score yielded sensitivity and specificity of 82 % and 88 %, respectively. Additional analysis of aberrant expression of CD15, CD11b, and CD56 increased the diagnostic power of the FCM score. A qualitative analysis of data also showed differences in maturation patterns in proven-MDS compared to the control group. CONCLUSION Single tube 10-color FCM scoring, including Ogata score, modified-FCM scores, and radar plots pattern analysis, showed significant abnormalities in proven-MDS cases in this pilot study. Large databases, including FCM-scoring and pattern-based analysis for normal BM maturation, could be further validated and standardized for screening MDS.
Collapse
Affiliation(s)
- Richa Chauhan
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Jay Singh
- Department of Laboratory Oncology, B.R.A.I.R.C.H., AIIMS, New Delhi, India
| | - Charu Sharma
- Department of Mathematics, Shiv Nadar University, Noida, U.P, India
| | - Prasad Dange
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Chopra
- Department of Laboratory Oncology, B.R.A.I.R.C.H., AIIMS, New Delhi, India.
| | - Manoranjan Mahapatra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Haraparasad Pati
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
3
|
Jentzsch M, Geus U, Grimm J, Vucinic V, Pönisch W, Franke GN, Behre G, Niederwieser D, Schwind S. Pretreatment CD34 +/CD38 - Cell Burden as Prognostic Factor in Myelodysplastic Syndrome Patients Receiving Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:1560-6. [PMID: 30928626 DOI: 10.1016/j.bbmt.2019.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/19/2019] [Indexed: 12/16/2022]
Abstract
Myelodysplastic syndrome (MDS) is a highly heterogeneous clonal hematopoietic disorder. Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only curative treatment and is of particular interest in patients at high risk for progression to acute myeloid leukemia (AML). In MDS, CD34+/CD38- cells possess MDS stem cell potential, and secondary AML (sAML) clones originate from the MDS disease stage. However, the prognostic impact of the pretreatment stem cell population burden in MDS remains unknown. We retrospectively analyzed the prognostic impact of the pretreatment CD34+/CD38- cell burden in 124 MDS patients who received allogeneic HSCT at our institution. A high pretreatment bone marrow CD34+/CD38- cell burden (≥1%) was associated with worse genetic risk and a higher incidence of blast excess. Patients with a high CD34+/CD38- cell burden had a significantly higher cumulative incidence of MDS relapse, a higher cumulative incidence of secondary AML, and a trend for shorter overall survival after allogeneic HSCT. In multivariable analyses this prognostic impact was shown to be independent of other clinical and cytogenetic risk factors in MDS. Patients suffering MDS relapse or progression to AML also had a higher pre-treatment CD34+/CD38- cell burden as a continuous variable. The observed prognostic impact is likely mediated by MDS stem cells within the CD34+/CD38- cell population initiating MDS relapse or progression to AML. New therapeutic strategies targeting MDS stem cells might improve outcomes.
Collapse
|
4
|
Chen-Liang TH, Casado-Prieto AM, Campos-Rodríguez V, Hurtado AM, Amigo ML, García-Malo MD, Vicente V, Ortuño FJ, Jerez A. An increased percentage of myeloid CD34+ bone marrow cells stratifies intermediate IPSS-R myelodysplastic syndrome patients into prognostically significant groups. Int J Lab Hematol 2018; 40:549-555. [PMID: 29774987 DOI: 10.1111/ijlh.12860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/11/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The Revised International Prognostic Scoring System (IPSS-R) for myelodysplastic syndromes (MDS) has established an intermediate category where a disease-modifying intervention is a matter of debate. Flow cytometry allows us to determine a fraction of immature myeloid cells in a semiautomated procedure. The aim of this study, mirroring IPSS-R study inclusion criteria, was to test whether bone marrow (BM) CD34+My percentage has independent prognostic value in the MDS setting. METHODS BM CD34+My cells were quantified, at diagnosis, selecting CD34+/CD45+/CD11b±/CD13+. Patients were excluded when receiving treatment for altering the natural course of the disease and when IPSS-R could not be calculated due to the lack of metaphases. Finally, Cox analyses were performed, on a series of 260 patients, for overall survival (OS) and time to acute myeloid leukemia (AML) transformation. RESULTS By analyzing ROC curves, the most accurate prognostic variable, regarding blasts by cytology and CD34+ by cytometry, was the percentage of blasts by microscopy. The percentage of CD34+My in BM showed an AUC of 0.767 and 0.576 for time to AML transformation and OS, respectively. When performing a multivariate regression including the IPSS-R and the percentage of BM CD34+My cells >1%, both factors predicted for a shorter time to AML transformation. In addition, CD34+My percentage successfully stratified the intermediate IPSS-R category into two prognostic groups with a relative risk of 5.73 (95% CI [1.2-27.8]; P = .03). CONCLUSION We found that BM CD34+My percentage has an independent value concerning the IPSS-R, especially relevant for the prediction of transformation to AML and within the intermediate group.
Collapse
Affiliation(s)
- T-H Chen-Liang
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - A M Casado-Prieto
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - V Campos-Rodríguez
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - A M Hurtado
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - M L Amigo
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - M D García-Malo
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - V Vicente
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - F J Ortuño
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - A Jerez
- Hematology and Medical Oncology Department, Morales Meseguer University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| |
Collapse
|
5
|
|
6
|
Xiong B, Nie Y, Tang Z, Xue M, Zuo X. Prognostic evaluation of ALIP and CD34 immunostaining in IPSS-R subgroups of myelodysplastic syndromes. Pathology 2017; 49:526-533. [PMID: 28669578 DOI: 10.1016/j.pathol.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/07/2017] [Accepted: 05/01/2017] [Indexed: 11/30/2022]
Abstract
In order to evaluate the prognostic value of abnormal localisation of immature precursors (ALIP) and CD34 immunostaining in myelodysplastic syndromes (MDS), bone marrow histopathological features in 187 MDS patients were retrospectively analysed and the prognostic significance of ALIP and CD34 immunostaining on overall survival (OS) and progression to leukaemia-free survival (PFS) in total patients and different Revised-International Prognostic Scoring System (IPSS-R) subgroups were evaluated. In univariate analysis, age ≥60, ALIP, ≥5% CD34+ cells, CD34+ clusters and IPSS-R subgroups were associated with shorter OS (p = 0.027, p < 0.0001, p < 0.0001, p < 0.0001, p < 0.0001, respectively) and PFS (p = 0.029, p = 0.006, p = 0.001, p < 0.0001, p < 0.0001, respectively). Haemoglobin level had a significant impact on OS (p < 0.0001) but not on PFS (p = 0.054). In multivariate analysis, ALIP, haemoglobin level, ≥5% CD34+ cells, CD34+ clusters and IPSS-R subgroups had independent influence on OS (p = 0.012, p < 0.0001, p = 0.010, p < 0.0001, p < 0.0001, respectively), while only CD34+ clusters and IPSS-R subgroups had independent influence on PFS (p < 0.0001, p = 0.016, respectively). In different IPSS-R subgroups, ALIP could maintain its prognostic impact in lower IPSS-R risk subgroups, while ≥5% CD34+ cells and CD34+ clusters had significant prognostic value in both lower and intermediate-higher IPSS-R risk subgroups. Therefore, CD34+ clusters showed more important prognostic impact on survival and progression to leukaemia.
Collapse
Affiliation(s)
- Bei Xiong
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Yanbo Nie
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zehai Tang
- Department of Hematology, The Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Mei Xue
- Department of Hematology, The Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xuelan Zuo
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China.
| |
Collapse
|
7
|
|
8
|
Reis-Alves SC, Traina F, Metze K, Lorand-Metze I. Improving the differential diagnosis between myelodysplastic syndromes and reactive peripheral cytopenias by multiparametric flow cytometry: the role of B-cell precursors. Diagn Pathol 2015; 10:44. [PMID: 25924846 PMCID: PMC4428240 DOI: 10.1186/s13000-015-0259-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/31/2015] [Indexed: 11/17/2022] Open
Abstract
Background Immunophenotyping is a valuable ancillary technique for the differential diagnosis between myelodysplastic syndromes (MDS) with low bone marrow (BM) blast counts and a normal karyotype, and reactive peripheral (PB) cytopenias. Our aim was to search for the most important variables for this purpose. We also analyzed the age variation of BM B-cell precursors (BCP) and its differences in reactive and clonal cytopenias. Methods Immunophenotypic analyzes were performed in BM of 54 patients with MDS (76% with BM blasts <5%) and 35 cases of reactive cytopenias. Healthy allogeneic BM transplantation donors (n = 41) were used as controls. We used a four-color panel of antibodies analyzing 9 granulocytic, 8 monocytic and 6 CD34+ cell features. Results Asynchronous shift to the left in maturing granulocytes and increase in CD16+ monocytes were also found in reactive PB cytopenias, but the most important aberrancies in MDS were seen in myeloid CD34+ cells. Decrease in BCP, that is a hallmark of MDS, could also be found in reactive cytopenias, especially in patients >55 years. % BM BCP could be calculated by the formula: (−7.97 × log age) + (4.24 × log % CD34+cells) – (0.22 x nr. alterations CD34+cells) + 0.577. Corrected R2 = 0.467. Conclusion Analysis of myelomonocytic precursors and CD34+ cells was satisfactory for the differential diagnosis between reactive PB cytopenias and MDS. The most specific alterations were found in CD34+ cells. Comparison of the values obtained with those of normal age-matched controls is recommended.
Collapse
Affiliation(s)
- Suiellen C Reis-Alves
- Hematology and Hemotherapy Center, University of Campinas, Carlos Chagas Street, 480, 13083-878 Campinas, São Paulo, Brazil.
| | - Fabiola Traina
- Faculty of Medicine of Ribeirão Preto, University of São Paulo, Vila Monte Alegre, 14048-900, Ribeirão Preto, Sao Paulo, Brazil.
| | - Konradin Metze
- Faculty of Medicine, University of Campinas, Tessália Vieira de Camargo Street 126, 13083-887, Campinas, São Paulo, Brazil.
| | - Irene Lorand-Metze
- Hematology and Hemotherapy Center, University of Campinas, Carlos Chagas Street, 480, 13083-878 Campinas, São Paulo, Brazil. .,Faculty of Medicine, University of Campinas, Tessália Vieira de Camargo Street 126, 13083-887, Campinas, São Paulo, Brazil.
| |
Collapse
|
9
|
Porwit A, van de Loosdrecht AA, Bettelheim P, Brodersen LE, Burbury K, Cremers E, Della Porta MG, Ireland R, Johansson U, Matarraz S, Ogata K, Orfao A, Preijers F, Psarra K, Subirá D, Valent P, van der Velden VHJ, Wells D, Westers TM, Kern W, Béné MC. Revisiting guidelines for integration of flow cytometry results in the WHO classification of myelodysplastic syndromes-proposal from the International/European LeukemiaNet Working Group for Flow Cytometry in MDS. Leukemia 2014; 28:1793-8. [PMID: 24919805 DOI: 10.1038/leu.2014.191] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 04/06/2014] [Accepted: 05/02/2014] [Indexed: 12/22/2022]
Abstract
Definite progress has been made in the exploration of myelodysplastic syndromes (MDS) by flow cytometry (FCM) since the publication of the World Health Organization 2008 classification of myeloid neoplasms. An international working party initiated within the European LeukemiaNet and extended to include members from Australia, Canada, Japan, Taiwan and the United States has, through several workshops, developed and subsequently published consensus recommendations. The latter deal with preanalytical precautions, and propose small and large panels, which allow evaluating immunophenotypic anomalies and calculating myelodysplasia scores. The current paper provides guidelines that strongly recommend the integration of FCM data with other diagnostic tools in the diagnostic work-up of MDS.
Collapse
Affiliation(s)
- A Porwit
- Department of Pathobiology and Laboratory Medicine, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - A A van de Loosdrecht
- Department of Hematology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - P Bettelheim
- First Medical Department, Elisabethinen Hospital, Linz, Austria
| | | | - K Burbury
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Melbourne, Victoria, Australia
| | - E Cremers
- Department of Hematology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - M G Della Porta
- Department of Hematology and Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, and University of Pavia, Pavia, Italy
| | | | | | - S Matarraz
- Servicio Central de Citometría, Centro de Investigación del Cáncer, Instituto de Biologia Celular y Molecular del Cáncer CSIC/USAL/IBSAL) and Department of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - K Ogata
- Metropolitan Research Center for Blood Disorders MRC JAPAN, Midorigaoka, Chofu, Tokyo, Japan
| | - A Orfao
- Servicio Central de Citometría, Centro de Investigación del Cáncer, Instituto de Biologia Celular y Molecular del Cáncer CSIC/USAL/IBSAL) and Department of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - F Preijers
- Department of Hematology, St Radboud University Medical Center, Nijmegen, The Netherlands
| | - K Psarra
- Department of Immunology-Histocompatibility, Evangelismos Hospital, Athens, Greece
| | - D Subirá
- Department of Hematology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - P Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - V H J van der Velden
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D Wells
- HematoLogics, Inc., Seattle, WA, USA
| | - T M Westers
- Department of Hematology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - W Kern
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - M C Béné
- Service d'Hématologie Biologique, CHU de Nantes, Nantes, France
| |
Collapse
|
10
|
Walenda T, Stiehl T, Braun H, Fröbel J, Ho AD, Schroeder T, Goecke TW, Rath B, Germing U, Marciniak-Czochra A, Wagner W. Feedback signals in myelodysplastic syndromes: increased self-renewal of the malignant clone suppresses normal hematopoiesis. PLoS Comput Biol 2014; 10:e1003599. [PMID: 24763223 PMCID: PMC3998886 DOI: 10.1371/journal.pcbi.1003599] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 03/18/2014] [Indexed: 12/20/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are triggered by an aberrant hematopoietic stem cell (HSC). It is, however, unclear how this clone interferes with physiologic blood formation. In this study, we followed the hypothesis that the MDS clone impinges on feedback signals for self-renewal and differentiation and thereby suppresses normal hematopoiesis. Based on the theory that the MDS clone affects feedback signals for self-renewal and differentiation and hence suppresses normal hematopoiesis, we have developed a mathematical model to simulate different modifications in MDS-initiating cells and systemic feedback signals during disease development. These simulations revealed that the disease initiating cells must have higher self-renewal rates than normal HSCs to outcompete normal hematopoiesis. We assumed that self-renewal is the default pathway of stem and progenitor cells which is down-regulated by an increasing number of primitive cells in the bone marrow niche – including the premature MDS cells. Furthermore, the proliferative signal is up-regulated by cytopenia. Overall, our model is compatible with clinically observed MDS development, even though a single mutation scenario is unlikely for real disease progression which is usually associated with complex clonal hierarchy. For experimental validation of systemic feedback signals, we analyzed the impact of MDS patient derived serum on hematopoietic progenitor cells in vitro: in fact, MDS serum slightly increased proliferation, whereas maintenance of primitive phenotype was reduced. However, MDS serum did not significantly affect colony forming unit (CFU) frequencies indicating that regulation of self-renewal may involve local signals from the niche. Taken together, we suggest that initial mutations in MDS particularly favor aberrant high self-renewal rates. Accumulation of primitive MDS cells in the bone marrow then interferes with feedback signals for normal hematopoiesis – which then results in cytopenia. Myelodysplastic syndromes are diseases which are characterized by ineffective blood formation. There is accumulating evidence that they are caused by an aberrant hematopoietic stem cell. However, it is yet unclear how this malignant clone suppresses normal hematopoiesis. To this end, we generated mathematical models under the assumption that feedback signals regulate self-renewal and proliferation of normal and diseased stem cells. The simulations demonstrate that the malignant cells must have particularly higher self-renewal rates than normal stem cells – rather than higher proliferation rates. On the other hand, down-regulation of self-renewal by the increasing number of malignant cells in the bone marrow niche can explain impairment of normal blood formation. In fact, we show that serum of patients with myelodysplastic syndrome, as compared to serum of healthy donors, stimulates proliferation and moderately impacts on maintenance of hematopoietic stem and progenitor cells in vitro. Thus, aberrant high self-renewal rates of the malignant clone seem to initiate disease development; suppression of normal blood formation is then caused by a rebound effect of feedback signals which down-regulate self-renewal of normal stem and progenitor cells as well.
Collapse
Affiliation(s)
- Thomas Walenda
- Helmholtz Institute for Biomedical Engineering, RWTH Aachen University Medical School, Aachen, Germany
| | - Thomas Stiehl
- Interdisciplinary Center of Scientific Computing (IWR), Institute of Applied Mathematics, University of Heidelberg, Heidelberg, Germany
| | - Hanna Braun
- Helmholtz Institute for Biomedical Engineering, RWTH Aachen University Medical School, Aachen, Germany
| | - Julia Fröbel
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Anthony D. Ho
- Department of Medicine V, Medical Center, University of Heidelberg, Heidelberg, Germany
| | - Thomas Schroeder
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Tamme W. Goecke
- Department of Obstetrics and Gynecology, RWTH Aachen University Medical School, Aachen, Germany
| | - Björn Rath
- Department for Orthopedics, RWTH Aachen University Medical School, Aachen, Germany
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Anna Marciniak-Czochra
- Interdisciplinary Center of Scientific Computing (IWR), Institute of Applied Mathematics, University of Heidelberg, Heidelberg, Germany
| | - Wolfgang Wagner
- Helmholtz Institute for Biomedical Engineering, RWTH Aachen University Medical School, Aachen, Germany
- * E-mail:
| |
Collapse
|
11
|
De Smet D, Trullemans F, Jochmans K, Renmans W, Smet L, Heylen O, Bael AM, Schots R, Leus B, De Waele M. Diagnostic potential of CD34+ cell antigen expression in myelodysplastic syndromes. Am J Clin Pathol 2012; 138:732-43. [PMID: 23086775 DOI: 10.1309/ajcpagvo27rptotv] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The World Health Organization introduced flow cytometry as an additional criterion for diagnosis of myelodysplastic syndromes (MDS). Aberrant antigen expression on bone marrow (BM) blasts may identify "low-grade MDS." This study aimed to examine differences in antigen expression on CD34+ BM cells between patients with MDS and those with secondary cytopenia. BM aspirates of 175 patients with cytopenia were classified as MDS or secondary cytopenia. Expression of stem cell antigens (CD34, CD133), myeloid antigens (CD13, CD33), B-cell antigens (CD19, CD10), growth factor receptors (CD117, CD123), and chemokine receptor (CD184) was examined. Thirty-two normal adults and 49 patients with CD34+ acute myeloid leukemia (AML) were also examined. High percentage of CD34+ cells, CD117 and CD123 overexpression, and abnormal CD45 expression on these cells are the best markers for MDS. These phenotypic aberrancies correlate with number of blasts and degree of dysplasia, and were similar to those in CD34+ AML, thus reflecting the relationship between these disorders.
Collapse
|
12
|
Bellos F, Alpermann T, Gouberman E, Haferlach C, Schnittger S, Haferlach T, Kern W. Evaluation of flow cytometric assessment of myeloid nuclear differentiation antigen expression as a diagnostic marker for myelodysplastic syndromes in a series of 269 patients. Cytometry B Clin Cytom 2012; 82:295-304. [PMID: 22508616 DOI: 10.1002/cyto.b.21026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 03/30/2012] [Accepted: 04/06/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Myeloid nuclear differentiation antigen (MNDA) is expressed in myelomonocytic cells with highest levels in mature granulocytes and monocytes. It is suggested to be expressed more weakly in patients with myelodysplastic syndromes (MDS). The analysis of MNDA therefore may improve diagnostic capabilities of multiparameter flow cytometry (MFC) in MDS. METHODS We used MFC for detection of MNDA expression in 269 patients with suspected or known MDS, acute myeloid leukemia (AML) or chronic myelomonocytic leukemia (CMML), cytopenia of unknown cause or without malignancy (negative controls). Results were compared with the diagnoses revealed by cytomorphology (CM) and cytogenetics (CG). RESULTS Percentages of granulocytes and monocytes with diminished MNDA expression (dimG and dimM) were higher in patients with MDS (mean ± SD, 20% ± 20%, P < 0.001 and 31% ± 24%, P < 0.001) and AML (27% ± 27%, P = 0.007 and 45% ± 31%, P = 0.001) diagnosed by CM, vs. patients without MDS (8% ± 10% and 16% ± 11%), respectively. Significant differences were also found for mean fluorescence intensity (MFI) of MNDA in monocytes which was lower in MDS (mean ± SD, 71 ± 36, P = 0.004) and AML (55 ± 39, P < 0.001) vs. no MDS samples (85 ± 28), respectively. Within patients with MDS, cases with cytogenetic aberrations showed a trend to higher %dimG (24% ± 18%, P = 0.083) compared with those without (16% ± 21%). Cut-off values for %dimG (12%) and %dimM (22%) as well as for MFI in monocytes (72) were defined capable of discriminating between MDS and non-MDS. CONCLUSION MNDA expression in bone marrow cells can be assessed reliably by MFC and may facilitate evaluation of dyspoiesis when added to a standard MDS MFC panel.
Collapse
|
13
|
Westers TM, Ireland R, Kern W, Alhan C, Balleisen JS, Bettelheim P, Burbury K, Cullen M, Cutler JA, Della Porta MG, Dräger AM, Feuillard J, Font P, Germing U, Haase D, Johansson U, Kordasti S, Loken MR, Malcovati L, te Marvelde JG, Matarraz S, Milne T, Moshaver B, Mufti GJ, Ogata K, Orfao A, Porwit A, Psarra K, Richards SJ, Subirá D, Tindell V, Vallespi T, Valent P, van der Velden VHJ, de Witte TM, Wells DA, Zettl F, Béné MC, van de Loosdrecht AA. Standardization of flow cytometry in myelodysplastic syndromes: a report from an international consortium and the European LeukemiaNet Working Group. Leukemia 2012; 26:1730-41. [PMID: 22307178 DOI: 10.1038/leu.2012.30] [Citation(s) in RCA: 181] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Flow cytometry (FC) is increasingly recognized as an important tool in the diagnosis and prognosis of myelodysplastic syndromes (MDS). However, validation of current assays and agreement upon the techniques are prerequisites for its widespread acceptance and application in clinical practice. Therefore, a working group was initiated (Amsterdam, 2008) to discuss and propose standards for FC in MDS. In 2009 and 2010, representatives from 23, mainly European, institutes participated in the second and third European LeukemiaNet (ELN) MDS workshops. In the present report, minimal requirements to analyze dysplasia are refined. The proposed core markers should enable a categorization of FC results in cytopenic patients as 'normal', 'suggestive of', or 'diagnostic of' MDS. An FC report should include a description of validated FC abnormalities such as aberrant marker expression on myeloid progenitors and, furthermore, dysgranulopoiesis and/or dysmonocytopoiesis, if at least two abnormalities are evidenced. The working group is dedicated to initiate further studies to establish robust diagnostic and prognostic FC panels in MDS. An ultimate goal is to refine and improve diagnosis and prognostic scoring systems. Finally, the working group stresses that FC should be part of an integrated diagnosis rather than a separate technique.
Collapse
Affiliation(s)
- T M Westers
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|