Monitoring of acute myeloid leukemia by flow cytometry

Abstract

Monitoring of minimal residual disease (MRD) becomes increasingly important in the risk-adapted management of patients with acute myeloid leukemia (AML). In selected patients with AML, multiparameter flow cytometry has shown accuracy and sensitivity in the quantification of MRD levels with independent prognostic impact. The applicability of this approach is superior to that of other methods such as quantitative polymerase chain reaction: Up to 80% of all patients can be monitored by flow cytometry. Nonetheless, significant technical advances are anticipated to extend the applicability of flow cytometry to 100% and to improve its sensitivity. Large clinical trials will determine the role of immunologic monitoring in the prognostic stratification of patients with AML.

Determination of relapse risk based on assessment of minimal residual disease during complete remission by multiparameter flow cytometry in unselected patients with acute myeloid leukemia

“…9,10,18 Previous studies on the flow cytometric assessment of MRD in patients with AML in complete remission indicate a significant gain in prognostic information by MRD levels 13,14,17 ; however, about 25% of the cases analyzed were considered not to express an aberrant immunophenotype and therefore were excluded from the analysis. The present study for the first time followed the approach of analyzing by multiparameter flow cytometry unselected patients with AML for MRD by the application of a comprehensive panel of monoclonal antibodies at diagnosis to optimize the identification of LAIPs.…”

“…[1][2][3][4][5][6][7] The occurrence of relapse is considered the result of persisting leukemic cells during complete remission giving rise to regrowth of the leukemic clone. 8,9 This minimal residual disease (MRD) is not detectable by the standard method used to define complete remission (ie, cytomorphology), and therefore more sensitive methods such as quantitative polymerase chain reaction (PCR) and multiparameter flow cytometry are increasingly applied to quantify the degree of both response to therapy and MRD. [10][11][12][13][14] As a consequence, new standards for the definition of remission have been proposed taking into consideration these novel applications.…”

Clonal Karyotype Evolution Involving Ring Chromosome 1 with Myelodysplastic Syndrome Subtype RAEB-t Progressing into Acute Leukemia

“…only potentially curative treatment for these patients is allogeneic hematopoietic SCT [15,16] . Relapses after transplantation, however, occur and are due to a reemerging of the malignant cell clones, regularly detectable by an increase of blast cells in PB or BM, reduction of blast phenotypes and/or clonal markers [4,[17][18][19] . Isoenzyme studies are good means for follow-up analyses of chimerism after SCT.…”

Immunophenotyping in leukemia and its diagnostic significance

“…[31][32][33] Up to 80% of all patients can be monitored by flowcytometry . 34 One of the strategies of detecting MRD by immunologic methods takes advantages of the observation that leukocyte markers may be found on malignant cells in combinations that are not normally found in peripheral blood or bone marrow. 10,16,32,35 Once such a combination has been identified, thereafter the bone marrow can be screened for persistence of leukemic cells that display that differentiation antigen combination.…”

“…We considered these cases as a separate subgroup which might probably have a different prognostic property, and for the moment we classify them as acute leukemia with co-expression of antigens of different lineage (cross lineage) or AMLL as suggested by earlier studies. 34,37 The prognostic value of these aberrant expression of antigens for these cases has yet to be established, but earlier studies revealed the association of mixed lineage leukemia with poorer clinical response or shorter survival. 27,38,39,40 These data suggest that immunophenotyping was a very useful tool to classify and sub-classify leukemia, complementary to morphologic evaluation and cytochemical staining.…”