Abstract
ackground: Minimal residual disease (MRD) detection has been shown to be the best prognostic factor in B-acute lymphoblastic leukaemia (B-ALL). Multicolour flow cytometry (FCM) and specific molecular aberrations (MOL) are the classic techniques used to assess MRD. The former is faster and less costly. Aim: This study compares morphology and FCM to MOL in detecting MRD. Setting: The study was conducted at Inkosi Albert Luthuli Central Hospital (IALCH). Methods: A retrospective review of children with B-ALL managed at IALCH from January 2013 to January 2018 was conducted. Multicolour flow cytometry was performed using Euroflow® panels. Molecular aberrations looked at common cytogenetic markers. Presentation and post-induction morphology (May–Grunwald Giemsa stain), FCM and MOL data for MRD were analysed. Results: Eleven patients were excluded (6-demised, 5-incomplete records), leaving 64 to be analysed (54% female, median age 5 years). Five post-induction aspirates were unsuitable but the rest (92%) were in morphological remission. At diagnosis and post-induction, 62 (95%) and 61 (94%) children, respectively, had FCM performed. A positive MOL result was found in 39 (60%) patients. MOL turn-around times (TATs) averaged 14 days compared with those of FCM’s average of 3 days. MRD was found in 9 patients (FCM) and 7 patients (MOL). Of these patients, 4 had a good correlation between the two and 2 patients with negative FCM had positive MOL MRD post-induction. Conclusion: Morphology is insensitive in MRD assessment. FCM correlated well with molecular MRD and has the shortest turn-around time. FCM has major benefit in the 40% of patients with negative MOL. It can also be safely used to guide treatment escalation in those patients awaiting molecular results.
Highlights
The survival of children diagnosed with B-acute lymphoblastic leukaemia (B-ALL) has increased markedly, reaching > 80% in developed countries.[1,2,3]
Sixty-four patients (Figure 1) were included in the study, and at diagnosis morphological assessment, flow cytometry (FCM) and molecular aberrations (MOL) testing were http://www.sajo.org.za performed in 81%, 97% and 100%, respectively, of all the study participants
The impact of minimal residual disease (MRD) on patient management has led to the need for standardised practices to be implemented, culminating in the recent publication of the AIEOP-Berlin–Frankfurt– Munich (BFM) Consensus Guidelines 2016 for Flow Cytometric Immunophenotyping of Paediatric Acute Lymphoblastic Leukaemia.[29]
Summary
The survival of children diagnosed with B-acute lymphoblastic leukaemia (B-ALL) has increased markedly, reaching > 80% in developed countries.[1,2,3] These outcomes are largely attributed to better risk stratification of patients, allowing therapy to be tailored .[2]. Morphology is usually assessed by a peripheral blood blast count on Day 8 and by an FCM at Day 8 and Day 33 (post-induction chemotherapy).[5] The Day 33 sample is a bone marrow aspirate sample. The latter plays a major role in stratifying these patients, even in the absence of other poor risk factors.[5]. Multicolour flow cytometry (FCM) and specific molecular aberrations (MOL) are the classic techniques used to assess MRD. The former is faster and less costly
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