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Immunophenotypic expression and immunomodulation in minimal residual disease analysis of pediatric B acute
Jhansi Rani Arumugam1, Karthik Bommannan1, Venkatraman Radhakrishnan1
1Departments of Oncopathology, Cancer Institute (Women's India Association), Chennai, India.
Insights
Minimal residual disease detection in B-acute lymphoblastic leukemia (B-ALL) is challenging due to antigen modulation post-treatment. Understanding these immunomodulation shifts is crucial for accurate MRD analysis and avoiding diagnostic errors.
Area of Science:
- Immunology
- Hematology
- Oncology
Background:
- Minimal residual disease (MRD) detection is critical for B-acute lymphoblastic leukemia (B-ALL) treatment monitoring.
- Antigen modulation in post-treatment samples poses a significant challenge for reliable MRD detection using immunophenotypic (IP) signatures.
Purpose of the Study:
- To investigate antigen expression changes in B-ALL patients post-treatment.
- To assess the extent of immunomodulation affecting diagnostic IP signatures for MRD detection.
Main Methods:
- Studied IP expression of 10 antigens in 167 pediatric B-ALL patients compared to hematogones.
- Analyzed antigen modulation in 60 post-treatment MRD-positive B-ALL cases.
Main Results:
- Significant upregulation of CD73, CD86, CD19, and CD20 observed.
- Significant downregulation of CD10, CD38, CD58, and CD34 noted.
- CD123 showed no significant trend; CD45 upregulation was not statistically significant.
Conclusions:
- Post-treatment B-ALL exhibits aberrant antigen expression compared to diagnostic patterns due to immunomodulation.
- Awareness of antigen immunomodulation is essential to prevent misinterpretation during MRD analysis.
Abstract:
The major challenge in minimal residual disease (MRD) detection is the antigen modulation in post treated samples restraining the use of diagnostic immunophenotypic (IP) signature of leukemic blasts for MRD detection. The IP expression of 10 antigens in 167 children diagnosed as B-acute lymphoblastic leukemia (B-ALL) in comparison to hematogones and the extent of immunomodulation in 60 post treated MRD positive cases were studied. Upregulation was the predictable shift noted in antigens like CD73, CD86, CD19, CD20 and CD45 which was statistically significant for all except CD45. Downregulation was the predictable shift noted in antigens like CD10, CD38, CD58 and CD34 and was statistically significant in all. CD123 showed no significant trend. This immunomodulation in B-ALL results in aberrant expression of antigens during follow-up compared to the diagnostic phenotypic pattern. Hence it is necessary to be aware of the immunomodulations of antigens used in primary diagnosis to avoid being misled during MRD analysis.
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