Role of flow cytometry in diagnostics of myelodysplastic syndromes—beyond the WHO 2008 classification

Is There a Role for Flow Cytometry in the Evaluation of Patients With Myelodysplastic Syndromes?

“…Several studies validated the utility of myeloid compartment analysis by comparing results obtained in MDS patients with results from patients with non-clonal cytopenia(s). FCM abnormalities in early progenitor and myeloid compartments were shown to herald MDS diagnosis in patients with borderline morphology and normal cytogenetics (reviewed in [1,2,5,43]). …”

“…Multiple flow cytometry (FCM) studies of antigen expression in bone marrow (BM) of patients with myelodysplastic syndromes (MDS) have been published using various preanalytical methods, antigen combinations, and FCM systems (early studies reviewed in [1][2][3][4][5]). There is a wide agreement in the literature that FCM can detect antigen expression abnormalities in erythroid [6][7][8], immature precursor [9][10][11][12], maturing granulocyte and monocyte [13][14][15], and in lymphoid BM cell compartments [11].…”

The classification of MDS: From FAB to WHO and beyond

“…The finding of a cytogenetic abnormality would, in the appropriate setting, confirm the diagnosis, but cytogenetic abnormalities are found in only 20-40% of cases, and none are specific. Flow cytometry is reported to be valuable in supporting the diagnosis of CMML if the monocytes exhibit at least two or more abnormalities in expression of monocyte-related antigens, such as underexpression of CD14, HLA-DR, or CD15, overexpression of CD56, or aberrant expression of CD2 [45,46].…”

“…Furthermore, the diagnostic criteria were later revised to allow a presumptive diagnosis of MDS if specific myelodysplasia-related cytogenetic abnormalities are present when the morphologic findings are inconclusive [27]. The detection of phenotypic aberrations, particularly the dyssynchronous expression of three or more maturation-associated antigens is also accepted as at least suggestive of MDS in the appropriate clinical context [46]. More recently, application of newer genetic techniques, such as SNP array karyotyping and next generation sequencing have uncovered a complex infrastructure of genetic aberrations in MDS.…”

Age-related changes of healthy bone marrow cell signaling in response to growth factors provide insight into low risk MDS

“…The classification of MDS has evolved with time from a morphology based classification (The French-American-British (FAB) which subdivided MDS into five disease entities -refractory anemia[RA], RA ringedsideroblasts[RARS], RA excess blasts[RAEB], RAEB-in transformation [RAEB-t] and chronic myelomonocytic leukemia [CMML] -based on BM morphology and presence or absence of BM blasts or peripheral monocytosis) to a newer World Health Organization (WHO) morphologic classification based on the combination of a refined morphologic classification with cytogenetics. More recently, multiparametric flow cytometry has been used to follow the expression patterns of both surface and cytoplasmic differentiation antigens and many believe this technology will be used for improved classification and ultimately therapeutic selection in MDS (10). More recently, multiparametric flow cytometry has been used to follow the expression patterns of both surface and cytoplasmic differentiation antigens, and many believe this technology will be used for improved classification and ultimately therapeutic selection in MDS (10).…”