Improved Recognition of Hematogones From Precursor B-Lymphoblastic Leukemia by a Single Tube Flow Cytometric Analysis

• Published in: American journal of clinical pathology Vol. 153; no. 6; pp. 790 - 798
• Main Authors: Don, Michelle D, Lim, Washington, Lo, Amanda, Cox, Brian, Huang, Qin, Kitahara, Sumire, Lopategui, Jean, Alkan, Serhan
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01-06-2020
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; B cells; B-Lymphocytes - immunology; Bone marrow transplantation; CD19 antigen; CD34 antigen; CD38 antigen; CD45 antigen; CD58 antigen; CD81 antigen; Child; Child, Preschool; Cytodiagnosis; Diagnosis; Female; Flow Cytometry; Health aspects; Humans; Immunophenotyping; Leukemia; Lymphatic leukemia; Lymphocytic leukemia; Lymphoma; Male; Methods; Middle Aged; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - diagnosis; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - immunology; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - pathology; Young Adult; United States; Flow cytometry; Minimal residual disease (MRD); Hematogones; B-lymphoblastic leukemia
• ISSN: 0002-9173; 1943-7722; 1943-7722
• DOI: 10.1093/ajcp/aqaa007

Abstract
Objectives
To improve diagnostic accuracy in differentiating hematogones from leukemic blasts in cases of precursor B-lymphoblastic leukemia/lymphoma (B-ALL), particularly those that are posttreatment or after bone marrow transplant, and to provide an algorithmic approach to this diagnostic challenge.
Methods
A seven-color antibody panel including CD10, CD19, CD45, CD38, CD34, CD58, and CD81 was generated to assess the feasibility of a single tube panel and provide an algorithmic approach to distinguish hematogones from B-ALL. Fifty-three cases were analyzed, and results were correlated with histology and ancillary studies.
Results
There was a significant difference in mean fluorescent intensity (MFI) for CD81 and CD58 when comparing hematogones and B-ALL populations (P < .001). B-ALL cases had a mean (SD) MFI of 24.6 (27.5; range, 2-125) for CD81 and 135.6 (72.6; range, 48-328) for CD58. Hematogones cases had a mean (SD) MFI of 70.2 (19.2; range, 42-123) for CD81 and 38.8 (9.4; range, 23-58) for CD58.
Conclusions
The flow cytometry panel with the above markers and utilization of the proposed algorithmic approach provide differentiation of hematogones from B-ALL. This includes rare cases of hematogones and B-ALL overlap where additional ancillary studies are necessary.
1. In cases of B-lymphoblastic leukemia (B-ALL), particularly those posttreatment or after bone marrow transplant, differentiating hematogones from leukemic blasts can be a diagnostic challenge.
2. A single multicolor flow cytometry tube including the markers for CD58 and CD81 can be used to distinguish hematogones from leukemic blasts in such cases.
3. This study provides a novel algorithmic approach using a single multicolor flow cytometry tube for distinguishing hematogones form leukemic blasts in everyday practice.