Das Nupur, Gupta Ritu, Gupta Sanjeev Kumar, Bakhshi Sameer, Seth Rachna, Kumar Chandan, Rai Sandeep, Singh Saroj, Prajapati Vijay Kumar, Gogia Ajay, Sahoo Ranjit Kumar, Sharma Atul, Kumar Lalit
Laboratory Oncology Unit, Dr B.R. Ambedkar IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
Department of Medical Oncology, Dr B.R. Ambedkar IRCH, AIIMS, New Delhi, India.
Ann Hematol. 2021 Oct;100(10):2487-2500. doi: 10.1007/s00277-021-04580-2. Epub 2021 Jul 8.
Measurable residual disease (MRD) is an important parameter to predict outcome in B-cell acute lymphoblastic leukemia (B-ALL). Two different approaches have been used for the assessment of MRD by multiparametric flow cytometry that include the "Leukemia Associated Aberrant Immunophenotype (LAIP)" and "Difference from Normal (DFN)" approach. In this retrospective study, we analyzed 539 samples obtained from 281 patients of which 258 were paired samples and the remaining 23 samples were from post-induction time point only, to explore the utility of baseline immunophenotype (IPT) for MRD assessment. Single-tube 10-color panel was used both at diagnosis and MRD time points. Out of 281 patients, 31.67% (n = 89) were positive and 68.32% (n = 192) were negative for MRD. Among 258 paired diagnostic and follow-up samples, baseline IPT was required in only 9.31% (24/258) cases which included cases with hematogone pattern and isolated dim to negative CD10 expression patterns. Comparison of baseline IPT with post-induction MRD positive samples showed a change in expression of at least one antigen in 94.04% cases. Although the immunophenotypic change in expression of various antigens is frequent in post-induction samples of B-ALL, it does not adversely impact the MRD assessment. In conclusion, the baseline IPT is required in less than 10% of B-ALL, specifically those with hematogone pattern and/or dim to negative expression of CD10. Hence, a combination of DFN and LAIP approach is recommended for reliable MRD assessment.
微小残留病（MRD）是预测B细胞急性淋巴细胞白血病（B-ALL）预后的重要参数。多参数流式细胞术评估MRD有两种不同方法，即“白血病相关异常免疫表型（LAIP）”和“与正常的差异（DFN）”方法。在这项回顾性研究中，我们分析了从281例患者中获得的539份样本，其中258份为配对样本，其余23份样本仅来自诱导后时间点，以探讨基线免疫表型（IPT）在MRD评估中的作用。诊断和MRD时间点均使用单管10色面板。在281例患者中，MRD阳性者占31.67%（n = 89），阴性者占68.32%（n = 192）。在258对诊断和随访样本中，仅9.31%（24/258）的病例需要基线IPT，这些病例包括造血细胞模式以及孤立的CD10低表达至阴性表达模式的病例。基线IPT与诱导后MRD阳性样本的比较显示，94.04%的病例中至少有一种抗原的表达发生了变化。尽管B-ALL诱导后样本中各种抗原表达的免疫表型变化很常见，但这对MRD评估没有不利影响。总之，不到10%的B-ALL病例需要基线IPT，特别是那些具有造血细胞模式和/或CD10低表达至阴性表达的病例。因此，建议联合使用DFN和LAIP方法进行可靠的MRD评估。
