Normal or reactive minor cell populations in bone marrow and peripheral blood mimic minimal residual leukemia by flow cytometry.

Creator(s)

Weijie Li, Children's Mercy HospitalFollow
Ruth Morgan, Children's Mercy HospitalFollow
Roxanne Nieder, Children's Mercy HospitalFollow
Sa Truong, Children's Mercy HospitalFollow
Sahibu Sultan M Habeebu, Children's Mercy HospitalFollow
Atif Ahmed, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

9-2021

Identifier

DOI: 10.1002/cyto.b.21968

Abstract

BACKGROUND: Measurable residual disease (MRD) is a strong independent poor prognostic factor for acute leukemia. Multiparameter flow cytometry (FCM) is a commonly used MRD detection method. However, FCM MRD detection is not well standardized, and the interpretation is subjective. There are normal/reactive minor cell populations in bone marrow (BM) and peripheral blood (PB), which could be confused with MRD.

METHODS: The FCM data of 231 BM and 44 PB pediatric samples performed in a recent 15-month period were retrospectively reviewed. These samples were from 56 B-lymphoblastic leukemia (B-ALL) patients, 11 T-lymphoblastic leukemia (T-ALL) patients, 28 acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) patients, 44 cytopenia/leukocytosis patients, and five patients with mycosis fungoides.

RESULTS: There were over 10 normal or reactive minor cell populations identified with certain phenotypes mimicking MRD of acute leukemia. These mimickers included CD19+ NK cells, CD22+ basophils, CD22+ dendritic cells (DCs), and plasma cells for B-ALL MRD; CD4/8 double-negative T cells, CD4/8 double-positive T cells, cytoplasmic CD3+ NK cells, CD2- T cells, CD7- T cells, CD5- gamma delta T cells, CD56+ NKT cells for T-ALL MRD; CD33+ NK cells, CD117+ NK cells, basophils, plasmacytoid DCs, non-classical monocytes, CD56+ and/or CD61+ monocytes for AML MRD.

CONCLUSIONS: These data confirm the presence of a variety of normal/reactive minor cell populations that could mimic MRD of acute leukemia by FCM. Recognizing these MRD mimickers is important for correct FCM MRD interpretation.

Journal Title

Cytometry. Part B, Clinical cytometry

Volume

100

Issue

5

First Page

590

Last Page

601

Keywords

MRD mimickers; acute leukemia; flow cytometry; minimal residual disease

Recommended Citation

Li W, Morgan R, Nieder R, Truong S, Habeebu SSM, Ahmed AA. Normal or reactive minor cell populations in bone marrow and peripheral blood mimic minimal residual leukemia by flow cytometry. Cytometry B Clin Cytom. 2021;100(5):590-601. doi:10.1002/cyto.b.21968