Utility of peripheral blood immunophenotyping by flow cytometry in the diagnosis of pediatric acute leukemia

Abstract

PBFC has high sensitivity and specificity for the diagnosis of childhood acute leukemia. The predictive value of PBFC remains high for patients without visible circulating blasts and may enhance the diagnostic process for determining the indications for marrow testing.

Peripheral blood flow cytometry for the diagnosis of pediatric acute leukemia: Highly reliable with rare exceptions

“…Given that acute leukemia can rarely present with an absence of circulating blasts, negative results by PBFC thus require appropriate clinical correlation and, if indicated, BM evaluation, in order to safely rule out acute leukemia. These findings are consistent with previous reports in the literature …”

“…Recent data strongly support the role of PBFC as a sensitive and specific tool for the detection and immunophenotypic characterization of pediatric acute leukemia . Here, we provide further evidence corroborating the reliability of PBFC for the diagnosis of leukemia in the pediatric patient population.…”

“…In a recent series, Metrock et al demonstrated that multiparameter PBFC is highly sensitive for the identification of even very low levels leukemic blasts across all leukemia subtypes without any reported diagnostically significant immunophenotypic discrepancies . Lam et al reported similar findings in a large cohort of pediatric acute lymphoblastic leukemia (ALL) patients, with PBFC offering a sensitivity of 99.7% and specificity of 98.5% .…”

“…Historically, flow cytometry performed on the bone marrow aspirate (BMFC) has been the standard for the immunophenotypic characterization of acute leukemia. Peripheral blood flow cytometry (PBFC), however, represents a less invasive approach to the immunophenotyping of the leukemic clone, which can also facilitate a quicker diagnosis and the opportunity to subsequently perform concurrent central venous access device placement, lumbar puncture with intrathecal chemotherapy administration, and bone marrow biopsy, if necessary, under a single anesthetic . Only recently, though, have robust data begun to emerge supporting the equivalent performance of PBFC to BMFC.…”

Comment on: Value of flow cytometric analysis of peripheral blood samples in children diagnosed with acute lymphoblastic leukemia

“…We read with interest the recent brief report by Lam et al., which retrospectively evaluated paired results of peripheral blood flow cytometry (PBFC) and bone marrow (BM) evaluation in patients with newly diagnosed acute lymphoblastic leukemia (ALL) and demonstrated high concordance between the tests. Their conclusion that PBFC has a valuable role in procedural planning for patients with a new diagnosis of ALL aligns with our recently published institutional experience demonstrating the sensitivity of 4‐color PBFC for the diagnosis of acute leukemia . The results from Lam et al.…”