Abstract
Purpose: This study summarizes a four-year experience from the analysis of hematolymphoid malignancies in Pakistani population using a database of six-colored flow cytometry.Methods:A cross-sectional survey of 323 specimens of hematolymphoid malignancies using six-colored flow cytometry (FC) was carried out in Shifa International Hospital, Islamabad, Pakistan from June 2012 to June 2016. The criterion for specimen adequacy was that the cases have abnormal populations by FC, and the specimen age (time from biopsy to being examined by the six-color FC tube) of three days or less was to be included in the study. Clinical follow-up of greater than six months was required for a negative flow cytometric study without a subsequent biopsy. Data analysis was done using Statistical Package for the Social Sciences (SPSS) version 21. One-way analysis of variance (ANOVA) was used to compare diagnosis with some antibodies used.Results: The number of specimen within certain age groups included were: 0-15 years; 111 (34.3%), 16-30 years; 65 (20.12%), 31-45 years; 47 (14.5%), 46-60 years; 46 (14.2%) and ≥ 60 years; 54 (16.7%). Hematological malignancies were documented in descending order of sequence with B-cell acute lymphoblastic leukemia (27.9%), acute myeloid leukemia (26.3%), chronic lymphocytic leukemia (13.3%), T cell acute lymphoblastic leukemia (7.7%), non-Hodgkin's lymphomas (5%), hairy cell leukemia (1.9%), chronic myeloid leukemia (0.3%), paroxysmal nocturnal hemoglobinuria (0.6%) and plasma cell dyscrasias (0.6%). The mean number of antibodies used were 12.68 ± 2.97. One-way ANOVA was used to compare diagnosis with some antibodies used. Statistical significance was found between diagnosis and number of antibodies used (F= 5.23 p<0.001).Conclusion: B cell acute lymphoblastic leukemia is most commonly diagnosed at tertiary care units in Pakistan using six-colored flow cytometry. Adoption of these complicated techniques has reinforced the need for optimization and further enhancement of flow cytometric procedures.
Highlights
The flow cytometry (FC) is a technology where normal and abnormal components of cells in a tissue are detected
The total sum of 323 cases of various hematolymphoid malignancies was seen in our laboratory
In the evaluation of hematologic malignancies, several measures are adopted in the interpretation and application of this immunophenotypic information: (a) detection of cells from different lineages and recognition of whether they are mature or immature; (b) finding abnormal cells through recognition of antigen expression that varies significantly from normal cells; (c) thorough records of the phenotype of abnormal cell populations, in comparison to their normal cell counterpart, a documentation of the increased or decreased intensity of staining by antibodies labeled by fluorochrome; (d) evaluation of whether the information is diagnostic of a distinct disease, and if not
Summary
The flow cytometry (FC) is a technology where normal and abnormal components of cells in a tissue are detected. The conditions in which flow cytometry is indicated includes an increased leukocyte count (eosinophilia, lymphocytosis, monocytosis), the presence of blasts or atypical cells in the peripheral blood, body fluids or bone marrow (cytopenias, especially bi-cytopenia and pancytopenia), plasmacytosis or monoclonal gammopathy and organomegaly or enlargement of tissue masses. In these clinical situations, flow cytometric immunophenotyping (FCI) emerges as a useful screening tool to differentiate between neoplastic and non-neoplastic conditions. It is a necessary technology to stage an already-diagnosed hematolymphoid neoplasm, to monitor the response to treatment that involves the detection of minimal residual disease (MRD) [3]
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