The role of flow cytometry in diagnosis of acute leukemia – pro


Acute leukemia displays characteristic patterns of surface antigen expression (CD antigens), which facilitate their identification and proper classification and hence play an important role in instituting proper treatment plans. In addition to enzyme cytochemical analysis, multiparameter flow cytometric analysis has become commonplace in most laboratories for that purpose. Aside from identification of blasts, flow cytometry is especially useful in the correct identification of AML MO, differentiation of APL from AML M1/M2, and correct identification of TdT-negative ALL and unusual variants, such as transitional B-cell ALL and undifferentiated and biphenotypic acute leukemias. Distinction between lymphoid and myeloid leukemias, most often made by flow cytometry, is crucially important. Several advances in flow cytometry, including availability of new monoclonal antibodies, improved gating strategies, and multiparameter analytic techniques, have all dramatically improved the utility of flow cytometry in the diagnosis and classification of leukemia.

Flow cytometery is very helpful in a diagnosis of any leukemic condition but is most useful for differentiating different leukemia subtypes. Final diagnosis should never relay on one report alone but should be produced by a consideration of clinical findings and history, examination of the peripheral smear and bone marrow morphology, and, if necessary special stains. Flow cytometery represents one of several sources of information that go into making a secure diagnosis. It should not be relied on in isolation to make a diagnosis.

More recenlty, it is being sued for the dteection of MRD (min ressidual disease).

However, this patient is now in a remission s/p transplant. Use of flow cytometery in surveillance and followup is not well explored and not generally accepted.
There are no guidelines that support it.

Kaleem, Zahid, Crawford, Eric, Flow cytometric analysis of acute leukemias: Diagnostic utility and critical analysis of data Arch Pathol Lab Med. 2003;127:42-48

Belurkar S, Mantravadi H, Manohar C, Kurien A. Correlation of morphologic and cytochemical diagnosis with flowcytometric analysis in acute leukemia. J Cancer Res Ther. 2013;9(1):71.

Jie Xu, MD, PhD, Jeffrey L. Jorgensen, MD, PhD, Sa A. Wang, MD et al, How Do We Use Multicolor Flow Cytometry to Detect Minimal Residual Disease in Acute Myeloid Leukemia? Clin Labor Med December 2017Volume 37, Issue 4, Pages 787–802

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