Identifying Leukemia-associated Immunophenotypes in Acute Myeloid Leukemia Patients Using Multiparameter Flow
Hadeer Mohamed Rasheed1, Hanaa Mahmoud Donia1, Eman Attia Nadwan2
1Clinical Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Insights
Leukemia-associated immunophenotypes (LAIPs) were identified in 86% of acute myeloid leukemia (AML) patients using multiparameter flow cytometry. Specific LAIP combinations improve minimal residual disease detection, aiding prognosis in AML.
Area of Science:
- Hematology
- Immunology
- Oncology
Background:
- Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy.
- Accurate immunophenotyping is crucial for AML diagnosis and monitoring.
- Leukemia-associated immunophenotypes (LAIPs) can serve as diagnostic and prognostic markers.
Purpose of the Study:
- To identify LAIPs in AML patients at diagnosis using an eight-color multiparameter flow cytometry (MFC) panel.
- To assess alterations in LAIPs in relapsed or refractory AML cases.
- To optimize LAIP selection for enhanced minimal residual disease (MRD) detection.
Main Methods:
- Utilized an eight-color MFC panel with CD45/side scatter log gating.
- Analyzed bone marrow samples from 50 AML patients at diagnosis and relapse/refractory stages.
- Included 20 control bone marrow samples from non-malignant hematological conditions.
Main Results:
- LAIPs were detected in 86% of AML patients.
- Most patients (90.7%) exhibited 2-12 aberrant immunophenotypes.
- Specific combinations (e.g., CD2/CD4/CD56 with CD34 or CD117) yielded strong LAIPs.
- Refractory cases maintained similar LAIPs; one case showed new LAIPs upon relapse.
Conclusions:
- LAIP specificity is more critical than frequency for diagnostic utility.
- Optimized LAIP strategies enhance MFC sensitivity for MRD detection in AML.
- Accurate MRD assessment via MFC is vital for AML prognosis and clinical management.
Objectives:
We sought to identify leukemia-associated immunophenotypes (LAIPs) in 50 acute myeloid leukemia (AML) patients at diagnosis using an eight-color multiparameter flow cytometry (MFC) panel and to detect if they showed any alteration in relapsed/refractory cases.
Methods:
We used the eight-color MFC panel with CD45/side scatter log gating strategy to analyze LAIPs in 50 AML patients presenting to Alexandria University Hospitals, Egypt at diagnosis and relapse and refractory cases. Twenty age and sex matched bone marrow samples from patients performing bone marrow aspirate for non-malignant hematological indications were included as controls.
Results:
LAIPs were observed in 43 (86.0%) cases. Only one aberrant immunophenotype was identified in four cases (9.3%), while two to 12 aberrant immunophenotypes were found in the other 39 (90.7%) cases. Strong LAIPs were obtained by combining CD2, CD4, CD56, with either CD34 or CD117, in contrast to CD19, which has to be combined with CD117. Refractory cases showed the presence of the same LAIPs at both initial diagnosis and persistent disease. One case showed the acquisition of new LAIPs after relapse.
Conclusions:
The good choice of LAIPs depends on their specificity rather than their frequency. The results of this study can help in increasing the sensitivity of LAIPs strategy in minimal residual disease using MFC in AML patients, which is considered an important post-diagnosis parameter associated with prognosis and clinical outcome.
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