When Flow Is Turbulent: CD19 Intensity Is a Pitfall in Acute Leukemia Classification

IF 0.1 Q4 PATHOLOGY AJSP: reviews & reports Pub Date : 2022-05-01 DOI:10.1097/PCR.0000000000000502
M. Kallen, A. Emadi, V. Duong, M. Baer, Y. Ning, Z. Singh, R. Koka
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Abstract

Abstract Mixed phenotype acute leukemias (MPALs) are a rare category of acute leukemia with biologic and genetic heterogeneity and a prognosis generally inferior to those of single lineage leukemias. The diagnosis depends on immunophenotypic assessment with a comprehensive panel of monoclonal antibodies by multiparameter flow cytometry and lineage assignment by the World Health Organization criteria. CD19 assessment is required for establishing a B-cell component in MPALs, as is determination of its intensity of expression, and assessment of the additional B-cell markers CD79a, cytoplasmic CD22, and CD10. We report the case of an MPAL, initially classified as an acute myeloid leukemia with weak CD19 expression and later reclassified upon clear demonstration of a B-cell component; such cases highlight a pitfall in classification of acute leukemias, particularly given heterogeneous antigen expression between fluorochromes and subjectivity in judgment of intensity. Practical take-away points include the need for hypervigilance in marker performance patterns in flow cytometry, both between fluorochromes and over time, the benefits of repeat sampling and blast assessment between laboratories, and the potential quality improvements unlocked by expanded flow cytometry panels in diagnostic hematopathology.
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当流动是湍流:CD19强度是急性白血病分类的一个缺陷
摘要混合表型急性白血病(MPALs)是一种罕见的急性白血病类型,具有生物学和遗传异质性,预后通常不如单一谱系白血病。诊断依赖于免疫表型评估,通过多参数流式细胞术对单克隆抗体进行综合评估,并根据世界卫生组织标准进行谱系分配。要在MPALs中建立b细胞成分,需要评估CD19,确定其表达强度,以及评估其他b细胞标志物CD79a、细胞质CD22和CD10。我们报告一例MPAL,最初被归类为CD19弱表达的急性髓性白血病,后来在明确显示b细胞成分后重新分类;这些病例突出了急性白血病分类的一个缺陷,特别是考虑到荧光染料抗原表达的异质性和强度判断的主观性。实际的要点包括对流式细胞术中标记物表现模式的高度警惕,无论是在荧光染料之间还是随着时间的推移,实验室之间重复取样和母细胞评估的好处,以及在血液病理学诊断中扩大流式细胞术面板所释放的潜在质量改进。
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