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Related Experiment Video

Updated: Aug 10, 2025

Flow Cytometry to Estimate Leukemia Stem Cells in Primary Acute Myeloid Leukemia and in Patient-derived-xenografts, at Diagnosis and Follow Up
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Blastoid B-Cell Neoplasms: Diagnostic Challenges and Solutions.

Lianqun Qiu1,2, Sa A Wang1, Guilin Tang1

  • 1Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.

Cancers
|February 11, 2023
PubMed
Summary

This study validates flow cytometry and immunohistochemistry scoring systems for classifying blastoid B-cell neoplasms. Combining both systems significantly improves diagnostic accuracy for challenging cases, aiding in distinguishing high-grade B-cell lymphoma from B-lymphoblastic leukemia.

Keywords:
B-lymphoblastic leukemia/lymphomablastoid morphologygene expression signaturehigh grade B-cell lymphomasix-point scoring systemthree-point immunohistochemistry scoring systemtranscriptome profile

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Area of Science:

  • Hematopathology
  • Flow Cytometry
  • Immunohistochemistry

Background:

  • Blastoid B-cell neoplasms, including B-lymphoblastic leukemia/lymphoma (B-ALL) and high-grade B-cell lymphoma (HGBL), present diagnostic challenges.
  • Previous scoring systems (6-point flow cytometry, 3-point immunohistochemistry) aid differentiation but require validation across all tissue types.

Purpose of the Study:

  • To validate the 6-point flow cytometry scoring system in extramedullary blastoid HGBL cases.
  • To compare the diagnostic performance of the flow cytometry and immunohistochemistry scoring systems.
  • To assess the combined accuracy of both systems for classifying blastoid B-cell neoplasms.

Main Methods:

  • Analysis of 121 blastoid HGBL cases (including 84 extramedullary) and 47 B-ALL cases.
  • Validation of the 6-point flow cytometry scoring system across all tissue origins.
  • Comparative analysis of the 6-point flow cytometry and 3-point immunohistochemistry scoring systems.
  • Gene transcriptome profiling for validation of discordant cases.

Main Results:

  • The 6-point flow cytometry scoring system demonstrated 100% sensitivity for blastoid HGBL.
  • Concordance between the two scoring systems was 88% in a subset of cases (n=101).
  • Simultaneous use of both scoring systems improved classification accuracy to 99%.

Conclusions:

  • The 6-point flow cytometry scoring system is effective regardless of tissue origin.
  • Combining flow cytometry and immunohistochemistry scoring systems enhances the accuracy of blastoid B-cell neoplasm classification.
  • Discordant cases require comprehensive clinical and genetic correlation for definitive diagnosis.