Flow Cytometric Immunophenotyping Research Articles

TMIC-83. ABERRANT EGFR ACTIVATION SUPPORTS ENHANCED TUMOR-MYELOID CROSSTALK AND IMPAIRS EFFECTOR T CELL INFILTRATION AND FUNCTION IN GLIOBLASTOMA

Abstract Glioblastoma (GBM) is known to display a highly suppressive tumor immune microenvironment (TIME) dominated by myeloid cells with low T cell infiltration. Aberrant epidermal growth factor receptor (EGFR) activation is observed in ~50% of GBM patients via amplification and the constitutively active EGFRvIII variant, however the impact of EGFR activation on the brain TIME and T cell-mediated anti-tumor immunity remains poorly understood. Single cell transcriptomic and receptor-ligand interaction analyses of paired newly diagnosed GBM tumor and intratumoral CD45+ immune cells revealed increased crosstalk between EGFR activated tumors and EGFR ligand-expressing tumor-associated myeloid cells. Therefore, a novel orthotopic murine EGFRvIII-expressing glioma model wherein the mEGFRvIII gene is under a tetracycline-off system (MADR-mEGFRvIII) was leveraged to identify how EGFR signaling impacts overall TIME composition and the phenotype of intratumoral and systemic T cells in vivo. Temporal flow cytometric immunophenotyping following tumor or mock (saline) implantation identified no significant shift in T cell infiltration within the brain or cervical lymph nodes (cLNs). In contrast, one week of doxycycline-mediated genetic EGFR ablation conferred a significant survival benefit and was associated with enhanced intratumoral T cell infiltration as well as diminished tumor-associated F4/80+ myeloid cells compared to vehicle treated animals. Further characterization revealed genetic EGFR ablation enhanced recruitment of CXCR3+, TNFα+, and TIGIT+ CD4 T cells to the tumor, while the prevalence of these populations contracted in CD4 and CD8 T cells within the draining cLNs. In vitro, pharmacologic EGFR inhibition enhanced antigen-specific Pmel-1 T cell killing of gp100-expressing MADR-mEGFRvIII tumor cells and was associated with increased IFNγ secretion by ELISA. Collectively, our work demonstrates that aberrant EGFR signaling promotes an immunosuppressive brain TIME with reduced T cell infiltration potentially via tumor-myeloid signaling. Targeting this oncogenic axis may therefore reprogram the TIME and directly enable enhanced trafficking of effector T cells to the tumor.

Kinetics of Blast Clearance in Cerebrospinal Fluid (CSF) Detected on Flow Cytometric Immunophenotyping (FCM), but Negative By Cytopathology in Newly Diagnosed Acute Lymphoblastic Leukemia Patients

Kinetics of Blast Clearance in Cerebrospinal Fluid (CSF) Detected on Flow Cytometric Immunophenotyping (FCM), but Negative By Cytopathology in Newly Diagnosed Acute Lymphoblastic Leukemia Patients

Flow Cytometric Immunophenotyping: Minimal Differences in Fresh and Cryopreserved Peripheral Blood Mononuclear Cells versus Whole Blood.

Background/Objectives: Flow cytometry is a convenient tool in immunophenotyping for monitoring the status of immunological conditions and diseases. The aim of this study was to investigate the effect of isolation and cryopreservation by flow cytometric analysis on subpopulations of CD4+ T helper (Th), T regulatory (Treg), CD8+ T cytotoxic (Tc), CD56+ NK, CD19+ B and monocytes. Freshly isolated and cryopreserved peripheral blood mononuclear cells (PBMCs) were compared to fresh whole blood. Methods: Peripheral blood was collected from healthy donors and prepared for flow cytometric analysis using the same panels of antibodies throughout the study. Results: Comparisons between fresh (F)- and cryopreserved (C)-PBMCs showed no major differences in percentages of CD4+, Th1, Th2 and CD4+CD25+CD127low Treg cells. No differences in percentage of CD8+ or subpopulations of naive/stem, central or effector memory cells were observed between F- and C-PBMCs. The percentage of CD56+ NK cells, CD19+ B cells or classical and nonclassical monocytes did not differ between F-and C-PBMCs either. On the contrary, whole blood had lower percentages of Th and NK cells but higher percentages of Th1, Th17, Th1Th17, Tregs, Tc and B cells compared to C-PBMCs, while it had a higher proportion of Tc compared to F-PBMCs. Conclusions: Flow cytometric immunophenotyping minimally differs between freshly isolated and cryopreserved PBMCs. This implies the possibility of cryostorage of cohorts for later analysis. Importantly, care must be taken when comparing results from whole blood with isolated and cryopreserved PBMCs. Collectively, these results can contribute to the standardization of flow cytometric protocols in both clinical and research settings.

Near missed aggressive natural killer cell leukaemia – importance of extensive immunophenotyping

Aggressive natural killer cell leukaemia (ANKL) is a rare neoplasm of NK cells with poor prognosis, varied morphology and positivity for CD2, CD3 epsilon and CD56, negative for surface CD3 and CD5. A 32-yearold man presented with high grade fever, generalized weakness, significant weight loss in the last 2 months and a lower limb mass, diagnosed elsewhere as Ewing sarcoma. He initially presented with TLC of 8000/uL which drastically increased to 52000/uL, with presence of atypical lymphoid cells. Bone marrow aspiration and biopsy was performed, bone marrow aspirate showed 44% atypical lymphoid cells that were 1.5 to 2 times the size of red blood cells with scant blue agranular cytoplasm, clumped chromatin and inconspicuous nucleoli, and flow cytometric immunophenotyping showed atypical lymphoid cells that were positive for CD45, CD38 and CD 56 and negative for CD34, CD3, CD4, CD5, CD7, CD8, CD20, CD10, CD19, CD138, kappa and lambda. Since a definitive diagnosis could not be reached on this, IHC on bone marrow biopsy was done, which showed the atypical lymphoid cells to be positive for CD45, CD3, CD2, CD56, CD38 and negative for CD117, CD5, CD7, CD30, CD20, CD57 and EBV. A diagnosis of aggressive natural killer lymphoma was reached. The diagnosis was difficult as the morphology and flow cytometry did not show any specific features of ANKL. The diagnosis was made after extensive immunophenotyping on bone marrow biopsy. This highlights the importance of doing NK cell markers when basic panel of antibodies are not supportive.

Updates on germline predisposition in pediatric hematologic malignancies: What is the role of flow cytometry?

Hematologic neoplasms with germline predisposition have been increasingly recognized as a distinct category of tumors over the last few years. As such, this category was added to the World Health Organization (WHO) 4th edition as well as maintained in the WHO 5th edition and International Consensus Classification (ICC) 2022 classification systems. In practice, these tumors require a high index of suspicion and confirmation by molecular testing. Flow cytometry is a cost-effective diagnostic tool that is routinely performed on peripheral blood and bone marrow samples. In this review, we sought to summarize the current body of research correlating flow cytometric immunophenotype to assess its utility in diagnosis of and clinical decision making in germline hematologic neoplasms. We also illustrate these findings using cases mostly from our own institution. We review some of the more commonly mutated genes, including CEBPA, DDX41, RUNX1, ANKRD26, GATA2, Fanconi anemia, Noonan syndrome, and Down syndrome. We highlight that flow cytometry may have a role in the diagnosis (GATA2, Down syndrome) and screening (CEBPA) of some germline predisposition syndromes, although appears to show nonspecific findings in others (DDX41, RUNX1). In many of the others, such as ANKRD26, Fanconi anemia, and Noonan syndrome, further studies are needed to better understand whether specific flow cytometric patterns are observed. Ultimately, we conclude that further studies such as large case series and organized data pipelines are needed in most germline settings to better understand the flow cytometric immunophenotype of these neoplasms.

The unnecessary use of short tandem repeat testing on bone marrow samples in patients after 1 year following allogeneic hematopoietic stem cell transplant.

To determine whether the information provided by short tandem repeat (STR) testing and bone marrow (BM) biopsy specimens following hematopoietic stem cell transplant (HSCT) provides redundant information, leading to test overutilization, without additional clinical benefit. Cases with synchronous STR and flow cytometric immunophenotyping (FCI) testing, as part of the BM evaluation, were assessed for STR/FCI concordance. Of 1199 cases (410 patients), we found the overall concordance between STR and FCI was 93%, with most cases (1063) classified as STR-/FCI-. Of all discordant cases, 75 (6%) were STR+/FCI-, with only 5 (6.7%) cases best explained as identification of disease relapse. Eight cases were STR-/FCI+, representing relapsed/residual disease. Analysis of cases 1 year or more from transplant (54% of all cases) indicated only 9 (1.5%) were STR+/FCI-, and none uniquely identified relapse. These data suggest that STR analysis performed 1 year or more post-HSCT does not identify unknown cases of relapse. Furthermore, while STR testing is critical for identifying graft failure/rejection within the first year posttransplant, FCI appears superior to STR at detecting late relapses with low-level disease. Therefore, STR testing from patients 1 year or more post-HSCT may be unnecessary, as BM biopsy evaluation is sufficient to identify disease relapse.

Frequency and Aberrant CD Marker Profile of Acute Leukaemias.

To determine the frequency of different types of acute leukaemia and their subtypes along with associated aberrant CD markers. Descriptive study. Place and Duration of the Study: Department of Immunology Armed Forces Institute of Pathology,National University of Medical Sciences, Rawalpindi, Pakistan, from November 2021 to October 2023. All samples received for flow cytometric immunophenotyping with suspicion of acute leukaemia were included in the study. Cells were stained with fluorochrome labelled monoclonal antibodies against lineage-specific cluster of differentiation (CD) markers through a lyse-wash procedure. Acquisition and analysis were done using multi-parameter BD FACS Canto II Flow cytometer and BD FACS Diva software, respectively. Data were entered and analysed using SPSS v 23.0. Over a period of 2 years, a total of 1,115 suspected patients were tested for acute leukaemia. Among them, 728 (65.3%) were males and 387 (34.7%) were females, with mean age 28 ± 21 years, ranging from 1 week to 87 years. Among a total of 875/1115 (78.5%) diagnosed cases of acute leukaemia, AML was the most common leukaemia present in 408/875 (46.6%) patients followed by B-ALL and T-ALL in 384/875 (43.8%) and 70/87 (8%) patients, respectively (p = 0.5712). Aberrant CD markers were detected in 109/875 (12.5%) leukaemias (p = 0.0628). The most common aberrant CD markers in B-ALL were CD13 and CD33 present in 30/384 (7.8%) cases separately. Among AML and T-ALL most common aberrant CD markers were CD7 and CD33 present in 25/408 (6.13%) and 7/70 (10%) cases, respectively. Special consideration should be given to the presence of aberrant CD markers when assigning lineages to acute leukaemias. They may be important diagnostic, prognostic, and management tools for institution of immunotherapy. Aberrant CD markers, Acute leukaemia, CD Markers, Flow cytometry, Immunophenotyping.

Oral PD-L1 inhibitor GS-4224 selectively engages PD-L1 high cells and elicits pharmacodynamic responses in patients with advanced solid tumors

BackgroundCheckpoint inhibitors targeting the programmed cell death 1 (PD-1)/programmed cell death 1 ligand 1 (PD-L1) pathway are effective therapies in a range of immunogenic cancer types. Blocking this pathway with...

Multicolor flow cytometric immunophenotyping is highly sensitive and specific in identifying aberrant mast cells in the diagnostic workup of systemic mastocytosis.

Flow cytometric immunophenotyping (FCI) is a fast and sensitive method for characterizing hematolymphoid neoplasms. It is not widely used in the workup of systemic mastocytosis (SM), in part because of the technical challenges and in part because the utility of FCI in assessing mast cells is not well understood. The objectives of this study were to assess the diagnostic utility of FCI in establishing a diagnosis of SM and distinguishing SM from nonneoplastic mast cells and to examine the immunophenotypic findings among SM subtypes. We performed FCI on bone marrow samples suspicious for SM using a panel consisting of CD2, CD25, CD30, CD45, CD117, and HLA-DR. The cohort included 88 SM cases: 67 without an associated hematologic neoplasm (AHN) (PureSM) and 21 with an AHN (SM-AHN). We also assessed 40 normal/reactive controls. Overall, FCI was adequate for interpretation in 87 of 88 (99%) cases and detected at least 1 immunophenotypic aberrancy in 100% of SM cases. CD2, CD25, and CD30 were positive in 78%, 98%, and 90% of SM cases vs 0%, 13%, and 13% of cases with normal/reactive mast cells (P < .0001 for all). Two or 3 abnormalities were observed in 92% of SM cases but not in normal/reactive mast cells. Among SM cases, SM-AHN showed statistically significant less CD2 (38% vs 91%, P < .0001) and less co-expression of all 3 aberrant markers (CD2, CD25, and CD30 positive in 38% vs 86% of cases; P < .0001) than PureSM. Immunohistochemical analysis showed consistently weaker or focal expression of CD2, CD25, and CD30 than FCI, with CD2 and CD30 being falsely negative in 40% and 50% cases, respectively. A KIT D816V mutation was detected in 67% of PureSM cases and 76% of SM-AHN cases. Flow cytometric immunophenotyping is a quick, sensitive, high-yield tool for evaluating the immunophenotype of mast cells. An abnormal FCI finding should prompt careful histologic evaluation and sensitive KIT D816V mutation testing to address the possibility of SM. CD2, CD25, and CD30 are important markers for the detection of immunophenotypic aberrancy of mast cells, and their frequencies of aberrancy differ across SM subtypes.

Acute panmylelosis with myelofibrosis - A rare case report with review of literature.

Acute panmyelosis with myelofibrosis (APMF) corresponds to <1% cases of acute myeloid leukemia, which could be an underestimation due to missed diagnosis. Due to its rapidly fatal course, it warrants a timely and correct diagnosis. We present a case of a 44-year male who came with a short history of fever, generalised weakness, revealed pancytopenia with occasional circulating blast in the peripheral blood smear. Bone marrow aspirate was dry tap,biopsy revealed panmyelosis with myelofibrosis with increased (22%) blasts. Flowcytometric immunophenotyping, cytogenetics and molecular tests were undertaken. Together with clinical details, immunophenotypic profile, cytogenetics and molecular studies, the diagnosis of Acute panmyelosis with myelofibrosis was made and managed accordingly. 32 The WHO 2017 describes APMF as an acute panmyeloid proliferation with increased blasts (≥20% in the bone marrow or peripheral blood) and accompanying marrow fibrosis. APMF is rare with poor prognosis thus, must be differentiated especially from Acute megakaryoblastic leukemia to arrive at the correct diagnosis which will help reduce/prevent the early mortality by providing timely chemotherapy followed by upfront hemopoietic stem cell transplantation.

Abstract PR16: Neutrophil-intrinsic tumor necrosis factor (TNF) is a novel driver of T-cell and cancer-associated fibroblast (CAF) dysfunction in pancreatic cancer

Abstract INTRODUCTION: We have recently shown that neutrophilic myeloid-derived suppressor cells (MDSC) are the dominant source of TNF in the pancreatic ductal adenocarcinoma (PDAC) tumor microenvironment (TME). Moreover, neutrophil-derived TNF amplifies stromal fibrosis and immune tolerance via transmembraneTNF-TNFR2 interactions to promote therapeutic resistance in PDAC. Here, we develop a novel tumor-bearing murine model with efficient neutrophil lineage-restricted inactivation of Tnf to mechanistically dissect the impact of neutrophil-intrinsic TNF on stromal and T-cell dysfunction in PDAC. METHODS: We generated a neutrophil-lineage restricted MRP8Cre/+Tnfflox/flox model (Neu-TnfKO) by crossing Tnfflox/flox mice with mice bearing Cre-recombinase under control of MRP8 neutrophilic promoter, and confirmed &amp;gt;98% Tnf reduction in circulating neutrophils. Orthotopically implanted KPC tumors in Neu-TnfKO vs. littermates (MRP8Cre+/−Tnf+/+ or MRP8Cre-/−Tnffl/fl) were subjected to single-cell RNAseq (scRNAseq), flow cytometric immunophenotyping, and tissue histology. RESULTS: Compared with littermate controls, primary tumor weights and frequency of liver metastasis were significantly reduced in Neu-TnfKO mice. ScRNAseq in CD45− fraction of d21 tumors in Neu-TnfKO vs. control mice revealed downregulation of myofibroblastic features (i.e., Ccn2, Tgfb1), hypoxia signaling, and metabolic dysregulation in CAF single-cell transcriptomes. Tissue histology in Neu-TnfKO tumors revealed striking attenuation in fibrotic collagen deposition, and myofibril organization. Moreover, Lrrc15—implicated as a central regulator of CAF-driven immunotherapy resistance—was downregulated in Neu-TnfKO CAFs. This remodeling of stromal fibrosis manifested in increased trafficking of T-cells into Neu-TnfKO vs. littermate tumors via immunostaining and flow cytometry. ScRNAseq in CD45+ fractions of Neu-TnfKO mice corroborated enrichment in effector/helper T-cell and attenuation of MDSC and macrophage populations. In investigating if neutrophil-restricted Tnf silencing invokes reprogramming of T-cell single-cell transcriptomes, we observed global skewness towards effector vs exhausted programming in Neu-TnfKO tumors; enrichment of pathways related to ribosomal activation, interferon signaling, and negative regulation of T-cell apoptosis; and overexpression of multiple effector function genes—e.g., Adgre5, Cam1kd, Dgka—together indicating functional T-cell activation. Flow cytometry validated this activated CD8+ T-cell phenotype in Neu-TnfKO tumor-infiltrating by highlighting increased antigen-experienced (PD1+CD39neg) and short-lived effector populations (P&amp;lt;0.0001), and also revealed reduction in terminally exhausted (CD69+Ly108− in PD1hi) CD8+ T-cell subsets (P=0.028). CONCLUSIONS: Conditional silencing of neutrophilic-restricted TNF reprograms the immunotherapy-restrictive CAF and T-cell landscapes in the PDAC TME. Compartment-specific inhibition of TNF may be a provocative strategy to overcome immunotherapy resistance in PDAC. Citation Format: Anna Bianchi, Haleh Amirian, Iago De Castro Silva, Ifeanyichukwu Ogobuiro, Karthik Rajkumar, Andrew Mark Adams, Vanessa Garrido, Samara Singh, Siddharth Mehra, Christine Rafie, Nagarj Nagathihalli, Erietta Stelekati, Nipun Merchant, Jashodeep Datta. Neutrophil-intrinsic tumor necrosis factor (TNF) is a novel driver of T-cell and cancer-associated fibroblast (CAF) dysfunction in pancreatic cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr PR16.

Label-free cell detection of acute leukemia using ghost cytometry.

Early diagnosis and prompt initiation of appropriate treatment are critical for improving the prognosis of acute leukemia. Acute leukemia is diagnosed by microscopic morphological examination of bone marrow smears and flow cytometric immunophenotyping of bone marrow cells stained with fluorophore-conjugated antibodies. However, these diagnostic processes require trained professionals and are time and resource-intensive. Here, we present a novel diagnostic approach using ghost cytometry, a recently developed high-content flow cytometric approach, which enables machine vision-based, stain-free, high-speed analysis of cells, leveraging their detailed morphological information. We demonstrate that ghost cytometry can detect leukemic cells from the bone marrow cells of patients diagnosed with acute lymphoblastic leukemia and acute myeloid leukemia without relying on biological staining. The approach presented here holds promise as a precise, simple, swift, and cost-effective diagnostic method for acute leukemia in clinical practice.

Ultrasound-Guided Fine Needle Biopsy of Human Axillary Lymph Nodes to Assess B Cell Responses to Vaccination.

Ultrasound-guided fine needle biopsy, also known as fine needle aspiration, of human axillary lymph nodes is a safe and effective procedure to assess the immune response within the lymph nodes following vaccination. Once acquired, lymph node cells can be characterized via flow cytometric immunophenotyping and/or single-cell RNA sequencing for gene expression and T and B cell receptors. Analysis of the immune cells from the lymph nodes enables the investigation of T and B cells that may interact at this site. These interactions may lead to germinal center formation and expansion, critical for the generation of effective immunity to vaccination. Directly studying the dynamic processes and interaction of the key cells has been challenging in humans due to the anatomically protected location of these cells. Here, we describe the methods involved in ultrasound-guided fine needle biopsy of human axillary lymph nodes in response to vaccination and subsequent analyses of the B cell populations.

Flow cytometric-based detection of CD80 is a useful diagnostic marker of acute myeloid leukemia in dogs.

CD80, a co-stimulatory molecule required for optimal T cell activation, is expressed on antigen-presenting cells, including monocytes and dendritic cells, in dogs and humans. We hypothesized that CD80 would be expressed on tumor cells in dogs from acute myeloid leukemia (AML) but not dogs with lymphoid neoplasms. We first evaluated the cellular staining pattern of a hamster anti-murine CD80 antibody (clone 16-10A1, ThermoFisher Scientific Cat# 17-0801-82, RRID: AB_469417) in blood and bone marrow aspirates from healthy dogs. Using flow cytometric analysis and examination of modified Wright's-stained cytologic smears of unsorted and flow cytometric or immunomagnetic bead-sorted leukocytes, we show that the antibody binds to mature and immature neutrophils and monocytes, but not lymphocytes or eosinophils, in blood and bone marrow. We then added the antibody to routine flow cytometric panels for immunophenotyping hematopoietic neoplasms in dogs. We found that the antibody labeled tumor cells in 72% of 39 dogs with AML and 36% of 11 dogs with acute leukemia expressing lymphoid and myeloid markers ("mixed lineage") but none of the dogs with B (n = 37) or T (n = 35) lymphoid neoplasms. A higher proportion of tumor cells in dogs with AML were labeled with the anti-CD80 antibody vs antibodies against other myeloid-associated antigens, including CD4 (36%, p = 0.003), CD11b (44%), CD11c (46%), CD14 (38%, p = 0.006) and CD18 (59%, clone YFC118). In contrast, antibodies against CD11b and CD11c bound to tumor cells in 8-32% of the lymphoid neoplasms. We show that CD80, as detected by antibody clone 16-10A1, is a sensitive and specific marker for AML and would be useful to include in flow cytometric immunophenotyping panels in dogs.

Current Status of Flow Cytometric Immunophenotyping of Hematolymphoid Neoplasms in Korea.

Flow cytometric immunophenotyping of hematolymphoid neoplasms (FCI-HLN) is essential for diagnosis, classification, and minimal residual disease (MRD) monitoring. FCI-HLN is typically performed using in-house protocols, raising the need for standardization. Therefore, we surveyed the current status of FCI-HLN in Korea to obtain fundamental data for quality improvement and standardization. Eight university hospitals actively conducting FCI-HLN participated in our survey. We analyzed responses to a questionnaire that included inquiries regarding test items, reagent antibodies (RAs), fluorophores, sample amounts (SAs), reagent antibody amounts (RAAs), acquisition cell number (ACN), isotype control (IC) usage, positive/negative criteria, and reporting. Most hospitals used acute HLN, chronic HLN, plasma cell neoplasm (PCN), and MRD panels. The numbers of RAs were heterogeneous, with a maximum of 32, 26, 12, 14, and 10 antibodies used for acute HLN, chronic HLN, PCN, ALL-MRD, and multiple myeloma-MRD, respectively. The number of fluorophores ranged from 4 to 10. RAs, SAs, RAAs, and ACN were diverse. Most hospitals used a positive criterion of 20%, whereas one used 10% for acute and chronic HLN panels. Five hospitals used ICs for the negative criterion. Positive/negative assignments, percentages, and general opinions were commonly reported. In MRD reporting, the limit of detection and lower limit of quantification were included. This is the first comprehensive study on the current status of FCI-HLN in Korea, confirming the high heterogeneity and complexity of FCI-HLN practices. Standardization of FCI-HLN is urgently needed. The findings provide a reference for establishing standard FCI-HLN guidelines.

Clinico-Hematological Profile of Acute Myeloid Leukemia: Experience From a Tertiary Care Cancer Center in North India.

Complete diagnosis of acute myeloid leukemia (AML) requires knowledge of clinical information combined with morphologic evaluation, immunophenotyping, karyotyping, and molecular genetic testing. The study intends to evaluate the demographic profile, clinical workup, and investigation, including flow cytometric immunophenotyping, in adult and pediatric age groups of AML. This is a retrospective study of AML patients treated between January 2017 and December 2021. Clinical and demographic characteristicsand investigation findings were recorded from case files and the hematology database. A total of 896 cases of AML were registered during the given period, of which 819 cases were de-novo AML. Among those 819 cases, more than two-thirds of cases, i.e., 78.9% (N = 646), received induction chemotherapy. A significantly higher male-to-female ratio was observed (1.5:1). The median age was 22 years. The median time for diagnosis was three days and the median time for treatment intervention was four days. There were significant differences in the Eastern Cooperative Oncology Group (ECOG) performance status scores between pediatric and adult AML patients. Pediatric AML patients presented with better ECOG performance scores (ECOG performance scores 0 and 1) than adult patients (74.76% vs. 43.14%, p < 0.001). Further comparing adult vs. pediatric AML patients, normal karyotype (60.56% vs. 31.93%, p < 0.001) and NPM1 (22.25% vs. 6.72%, p < 0.001)and FLT3-ITD mutations (20.28% vs. 7.98%, p<0.001) were more common in the adult group, whereas AML-ETO (40.76% vs. 16.34%, p < 0.001) was more common in the pediatric group. The study highlights the presenting age is lower than global figures. The median time for initial diagnosis and the start of treatment is within the acceptable norms. Normal karyotype andNPM1and FLT3 mutations were common in adult AML patients, whereas AML-ETO was more common in the pediatric cohort. These findings will help plan prospective studies and see the correlation with treatment outcomes. The laboratory workup practice currently complies with the standard guidelines at our center.

Cluster analysis of flowcytometric immunophenotyping with extended T cell subsets in suspected immunodeficiency.

Patients with immunodeficiencies commonly experience diagnostic delays resulting in morbidity. There is an unmet need to identify patients earlier, especially those with high risk for complications. Compared to immunoglobulin quantification and flowcytometric B cell subset analysis, expanded T cell subset analysis is rarely performed in the initial evaluation of patients with suspected immunodeficiency. The simultaneous interpretation of multiple immune variables, including lymphocyte subsets, is challenging. To evaluate the diagnostic value of cluster analyses of immune variables in patients with suspected immunodeficiency. Retrospective analysis of 38 immune system variables, including seven B cell and sixteen T cell subpopulations, in 107 adult patients (73 with immunodeficiency, 34 without) evaluated at a tertiary outpatient immunology clinic. Correlation analyses of individual variables, k-means cluster analysis with evaluation of the classification into "no immunodeficiency" versus "immunodeficiency" and visual analyses of hierarchical heatmaps were performed. Binary classification of patients into groups with and without immunodeficiency was correct in 54% of cases with the full data set and increased to 69% and 75% of cases, respectively, when only 16 variables with moderate (p < .05) or 7 variables with strong evidence (p < .01) for a difference between groups were included. In a cluster heatmap with all patients but only moderately differing variables and a heatmap with only immunodeficient patients restricted to T cell variables alone, segregation of most patients with common variable immunodeficiency and combined immunodeficiency was observed. Cluster analyses of immune variables, including detailed lymphocyte flowcytometry with T cell subpopulations, may support clinical decision making for suspected immunodeficiency in daily practice.

Machine Learning Enhancement of Flow Cytometry Data Accelerates the Identification of Minimal Residual Acute Myeloid Leukemia

Background: Identification of minimal residual disease (MRD) in acute myeloid leukemia (AML) is essential for assessing risk of relapse and guiding therapeutic management. While molecular assays have streamlined AML MRD detection, flow cytometric immunophenotyping (FCI) remains the only available test modality for approximately 50% of patients lacking traceable molecular MRD targets. Unfortunately, due to the high level of expertise required, long manual analysis time and complexity of AML MRD FCI data, only a few reference laboratories offer this as an orderable test. Methods: To facilitate the analysis of AML MRD by FCI, we devised an unsupervised machine learning (ML) pipeline that intakes raw FCI data, eliminates acquisition errors (FlowCut), performs state-of-the-art clustering (PARC) and dimensionality reduction (UMAP), estimates how aberrant or different-from-normal each cluster is compared to a cohort of controls (15 donor and 15 reactive marrow aspirates), downsamples clusters with high event counts without significant loss of low-event clusters, and corrects for downsampling using an upsampling factor. This CCADDAS (Clinically-intended Clustering of All events, Dimensionality reduction, Downsampling and Aberrancy Scaling) pipeline was containerized, deployed in a cloud environment (Google Cloud Vertex AI), and used to process raw FCI files from 50 AML MRD FCI assays (3-tube/10-color panel) with 0.1% to &amp;lt;5% leukemic subsets, and 20 assays with no detectable leukemic subsets by prior conventional analysis. Machine learning-enhanced data files were analyzed using a commercially available FCI analysis software (Kaluza v 2.1, Beckman Coulter). Results: Cluster-informed downsampling reduced the total number of events needed to be analyzed from 1 million cells to 179,531 cells per tube on average (82% data reduction), while preserving low event subsets (clusters smaller than 5000 cells) and allowing for accurate quantitative estimates for any gated population [# events x mean (upsampling factor)]. MRD was detected in all positive cases, and absent on all negative cases when analyzed using the enhanced downsampled data (100% correlation with original data), with accurate quantitative estimates (Spearman r = 0.85). Analysis time was dramatically reduced from 73 minutes to 8 minutes per case on average (89% reduction of manual analysis time). Dimensionality reduction parameters simplified gating of lineage- and maturation-defined subsets. Cluster comparison against control samples facilitated the rapid identification of MRD subsets, based on a calculated aberrancy scale parameter that helped distinguish MRD blasts (mean ± 2SD: 0.85 ± 0.3) from benign blasts (mean ± 2SD: 0.26 ± 0.3) (p&amp;lt;0.0001). Conclusion: We introduce CCADDAS, an unsupervised containerized cloud ML pipeline that enhances raw AML-MRD FCI data with ML annotations, cluster-informed downsampling and comparison to normal controls to create markedly smaller and software-agnostic FCI files. CCADDAS simplifies and accelerates detection of AML-MRD in clinical diagnostics, reducing number of cells analyzed by 82% and manual analysis time by 89%, without impacting test performance. Moreover, CCADDAS can be deployed on any laboratory-developed AML-MRD assay, and its small-sized export is compatible with any clinical FCI software, computing platform and analysis strategy. Adoption of CCADDAS is likely to facilitate the implementation of AML MRD FCI analysis by more clinical laboratories.

Development and implementation of natural killer cell simultaneous ADCC and direct killing assay

Assays to quantify natural killer (NK) cell killing efficacy have traditionally focused on assessing either direct killing or antibody dependent cell-mediated cytotoxicity (ADCC) independently. Due to the probability that immunotherapeutic interventions affect NK cell-mediated direct killing and NK cell-mediated ADCC differently, we developed an assay with the capacity to measure NK cell-mediated direct killing and ADCC simultaneously with cells from the same human donor. Specifically, this design allows for a single NK cell population to be split into several experimental conditions (e.g., direct killing, ADCC), thus controlling for potential confounders associated with human-to-human variation when assessing immunotherapy impacts. Our Natural Killer cell Simultaneous ADCC and Direct Killing Assay (NK-SADKA) allows researchers to reproducibly quantify both direct killing and ADCC by human NK cells. Furthermore, this optimized experimental design allows for concurrent analysis of the NK cells via flow cytometric immunophenotyping of NK cell populations which will facilitate the identification of relationships between NK cell phenotype and the subsequent killing potential. This assay will be valuable for assessing the broader impact(s) of immunotherapy strategies on both modes of NK cell killing.

The role of flow cytometry in the classification of myeloid disorders.

The World Health Organization classification (WHO-HAEM5) and the International Consensus Classification (ICC 2022) of myeloid neoplasms are based on the integration of clinical, morphologic, immunophenotypic, and genomic data. Flow cytometric immunophenotyping (FCIP) allows the identification, enumeration, and characterization of hematopoietic cells, and is therefore apowerful tool in the diagnosis, classification, and monitoring of hematological neoplasms. The vast majority of flow cytometry (FCM) studies in chronic myeloid neoplasms focus on its role in myelodysplastic neoplasms (MDS). FCM can also be helpful for the assessment of myeloproliferative neoplasms (MPN) and MDS/MPN, including the early detection of evolving myeloid or lymphoid blast crisis and the characterization of monocytic subsets. The classification of acute myeloid leukemia (AML) is primarily based on cytogenetic and molecular findings; however, FCIP is needed for subclassification of AML, not otherwise specified (NOS; ICC)/AML defined by differentiation (WHO-HAEM5). The main role of FCM in AML remains in making arapid diagnosis and as atool for measurable residual disease monitoring. Machine learning and artificial intelligence approaches can be used to analyze and classify FCM data. This article, based on an invited lecture at the 106th Annual Meeting of the German Society of Pathology in 2023, reviews the role of FCM in the classification of myeloid neoplasms, including recent publications on the application of artificial intelligence.