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Updated: Oct 16, 2026
Flow Cytometry to Estimate Leukemia Stem Cells in Primary Acute Myeloid Leukemia and in Patient-derived-xenografts, at Diagnosis and Follow Up
Published on: March 26, 2018
A stem cell-based flow cytometry assay to predict post-transplantation relapse in patients with myelodysplastic
Wei-Bing Wu1, Ya-Wen Luo2, Si-Qi Li1
1Peking University People's Hospital & Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Cell and Gene Therapy for Hematologic Malignancies, No. 11 South Street of Xizhimen, Xicheng District, Beijing 100044, China.
Background:
We aim to investigate whether the myelodysplastic syndrome stem cell (MDS-SC)-based assay could be used to predict relapse and survival after treatment in patients with MDS with excess blasts (MDS-EB).
Methods:
A total of 143 cases receiving allografting were prospectively enrolled. A single-cell proteogenomic technique was used to evaluate the characteristics of CD34+ MDS subsets. These cells were detected using multiparameter flow cytometry (MFC) at diagnosis and post-treatment.
Results:
The phenotypically defined (PD) CD34+CD38-cocktail+ (CD56/CD22/CD11b/CD7/Tim-3/CLL-1) MDS-SCs exhibited greater stemness and quiescence than PD CD34+CD38-MDS-SCs with other immunophenotypes. A high level of pre-transplantation PD CD34+CD38-cocktail+MDS-SCs (≥0.1064%) independently predicted 3-year cumulative incidence of relapse (CIR, P<0.001). No association of pre-transplantation traditional MFC-based MDS cells with relapse was observed. Patients with positive post-transplantation PD CD34+CD38-cocktail+MDS-SCs (≥0.0081%) experienced a higher 3-year CIR (40.4% vs. 6.5%, P<0.001) and lower disease-free survival (DFS, 57.4% vs. 85.1%, P<0.001) than those negative cases. Multivariate analysis revealed that positive post-transplantation PD CD34+CD38-cocktail+MDS-SCs independently predicted CIR (P<0.001) and DFS (P<0.001). Patients with post-transplantation traditional MFC-MRD positivity also had a higher CIR (60.0% vs. 12.8%, P<0.001) and lower DFS (40.0% vs. 80.2%, P<0.001) than those negative cases. The MDS-SC-based assay has higher sensitivity and C-index for MRD detection than the traditional MFC method.
Conclusion:
Our data suggest the potential superiority of the PD MDS-SC-based assay over the traditional MFC method for outcome prediction in MDS-EB patients.
