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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
[Evaluation of polymorphic post-allotransplant lymphoproliferative disorder by flow cytometry.]
Hui Wang1, Chun-Rong Tong, Jing-Bo Wang
1Special Diagnosis Center, Beijing Daopei Hospital, Beijing 100049, China.
Insights
Flow cytometry (FCM) effectively detects polymorphic post-transplant lymphoproliferative disorders (PTLD) in allogeneic hematopoietic stem cell transplant (allo-HSCT) patients. Bone marrow monitoring is more suitable than peripheral blood for tracking PTLD.
Area of Science:
- Immunology
- Hematology
- Oncology
Background:
- Post-transplant lymphoproliferative disorders (PTLD) are serious complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT).
- Early and accurate diagnosis of PTLD is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the utility of flow cytometry (FCM) in detecting and monitoring polymorphic PTLD.
- To compare the effectiveness of peripheral blood (PB) versus bone marrow (BM) analysis for PTLD assessment.
Main Methods:
- Serial FCM analysis of PB and/or BM samples from two allo-HSCT patients with suspected PTLD.
- Immunophenotyping to identify specific cell subsets, including B cells and plasma cells.
- Treatment involved adjusting immunosuppression, antiviral drugs, anti-CD20 antibodies, and cytotoxic T cell infusion.
Main Results:
- Two patients developed PTLD post-allo-HSCT, presenting with fever and lymphadenopathy.
- FCM detected monoclonal plasma cells in PB and/or BM, despite undetectable B cells in some cases.
- Bone marrow analysis proved more informative than peripheral blood for monitoring disease status.
- One patient did not survive, while the other remained under treatment with ongoing monitoring.
Conclusions:
- Flow cytometry is a valuable tool for detecting and monitoring polymorphic PTLD.
- Bone marrow sampling is superior to peripheral blood for PTLD surveillance in allo-HSCT recipients.
- FCM can identify B-cell abnormalities in peripheral blood, complementing lymph node biopsy findings.
Objective:
To study the role of flow cytometry (FCM) in detection of polymorphic post-transplant lymphoproliferative disorders (PTLD).
Methods And Results:
Two patients presented with fever and multiple lymphadenopathy on day 46 and day 50 respectively after successful allogeneic hematopoietic stem cell transplantation (allo-HSCT). The symptoms couldn't be controlled by antibiotics. The polymorphic PTLD was diagnosed based on the elevation of bone marrow EB virus DNA and detection of subsets of light chain restricted B cells and/or plasma cells in peripheral blood (PB) samples. The lymphocyte immunophenotypes from PB and/or bone marrow (BM) samples were serially tested by FCM after lowering the dose of immunosupressive agents and treating with antivirus drugs, anti-CD20 antibodies, and cytotoxic T cell infusion. B cells were undetable in two patient, but monoclonal plasma cells appeared or maintained. One patient died after two weeks. Another patient was still on treatment. B cells and plasms cells couldn't be detected in her PB, but there were monoclonal plasma cells in her BM. FCM have a prominent advantage in detect polymorphic PTLD, since it can effectively recognize different cell groups in blood and identify monoclonal subsets. Besides, the immunophenotype of plasma cells in polymorphic PTLD might be different from that in typical plasma cell myeloma.
Conclusion:
Polymorphic PTLD can be detected and followed up by FCM. BM is more suitable than PB for monitoing the disease. Besides lymph node biopsy, B cell abnormaliity could be detected in PB in allo-HSCT patients.
