Hematogones as an internal control in flow cytometric analysis of suspected acute lymphoblastic leukemia
S O Vargas1, S L Hasegawa, D M Dorfman
1Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Insights
Hematogones, immature B cells, can mimic leukemia cells in flow cytometry. However, distinct CD10 staining patterns of hematogones can help detect early relapsed acute lymphoblastic leukemia (ALL) in children.
Area of Science:
- Pediatric Hematology
- Immunophenotyping
- Flow Cytometry
Background:
- Hematogones are benign, immature B cells found in pediatric bone marrow.
- Their immunophenotype often overlaps with lymphoblasts in acute lymphoblastic leukemia (ALL), complicating diagnosis.
- Flow cytometry is crucial for diagnosing childhood leukemia.
Observation:
- A case presented with a distinct hematogone population showing low-intensity CD10 staining.
- This distinct population aided in identifying early ALL relapse and disease progression.
- The observation occurred over a 4-day period.
Findings:
- Low-intensity CD10 expression differentiates hematogones from lymphoblasts.
- This differentiation is key for accurate diagnosis and monitoring of ALL.
- The study reviewed pediatric leukemia cases to assess the frequency of this diagnostic aid.
Implications:
- Hematogones can serve as a diagnostic marker in pediatric ALL, not just a confounding factor.
- Accurate immunophenotyping is essential for timely and effective leukemia treatment.
- Further research can refine flow cytometry protocols for improved leukemia detection.
Abstract:
Hematogones are benign immature B cells that commonly populate the bone marrow of children. Their presence has been noted to interfere with the flow-cytometric analysis of cases of suspected acute lymphoblastic leukemia (ALL) because their immunophenotype (positive for CD19, CD10, CD34, and terminal deoxynucleotidyl transferase) is similar to that of pre-B cell lymphoblasts. Here we report a case in which the presence of a discrete population of hematogones, characterized by low-intensity CD10 cell-surface staining compared with pre-B cell lymphoblasts, actually aided in the recognition of early relapsed ALL and disease progression over a 4-day period. We also review our experience with flow-cytometric immunophenotyping in pediatric cases of suspected leukemia to evaluate the frequency of this occurrence.
