The utility of a single tube 10-color flow cytometry for quantitative and qualitative analysis in myelodysplastic syndrome- a pilot study

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.

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.

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.

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.