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. 2016 Jul;72(3):220-30.
doi: 10.1016/j.mjafi.2016.01.002. Epub 2016 Mar 29.

Flowcytometric comparative analysis in acute leukemias between Indian and proposed minimal screening panel

Srishti Gupta  1 , Tathagata Chatterjee  2 , Sanjeevan Sharma  3 , Ajay Sharma  4 , Prosenjit Ganguly  5 , Jasjit Singh  6 , Satyaranjan Das  7
Affiliations

Flowcytometric comparative analysis in acute leukemias between Indian and proposed minimal screening panel

Srishti Gupta et al. Med J Armed Forces India. 2016 Jul.

Abstract

Background: Acute myeloid leukemia and acute lymphoid leukemia differ substantially in response to therapy and course, and accurate differentiation of the two is fundamental to therapeutic decisions. Immunophenotyping is used for this purpose, and various guidelines have been proposed regarding a minimal screening antibody panel. Most of them have been found inefficient.

Methods: Eighty-two cases of consecutive acute leukemias reporting to this hospital over a period of two years were included in the study. Peripheral blood smear, bone marrow aspirate, and bone marrow biopsy were studied using morphology, cytochemical stains, and relevant immunohistochemical stains on selected biopsy specimens. Flowcytometry analysis was carried out using Indian consensus screening panel and our proposed minimal screening panel (PMSP) for comparison.

Result: Immunophenotyping using PMSP resulted in 95.12% accurate diagnosis versus Indian consensus minimal screening panel (ICMSP) with an accuracy of 92.68%. This result was statistically significant as per Chi Square tests.

Conclusion: PMSP can be used as a substitute for ICMSP, since it includes lineage-specific cytoplasmic antibodies, as well as lesser number of monoclonal antibodies, and enables us to diagnose mixed lineage leukemia. Fewer markers can be linked to a lower cost as well, which is relevant in a developing economy.

Keywords: Acute leukemias; Flowcytometry; Indian Consensus screening panel; MPAL; Proposed minimal screening panel.

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Figures

Fig. 1
Fig. 1
Results from the flowcytometric analysis using Indian consensus minimal screening panel and proposed minimal screening panel in acute leukemia cases. Note that since some of the cases were not accurately diagnosed, this figure serves purely to represent test results.
Fig. 2
Fig. 2
Frequency of surface and cytoplasmic markers in acute leukemia.
Fig. 3
Fig. 3
Accuracy of classification using Indian consensus minimal screening panel (ICMSP) when compared against actual diagnosis. Note that in a few cases, AML, B-ALL and T-ALL diagnosis was sometimes a false positive. Moreover, all MPAL cases went under the radar and were never caught under ICMSP.
Fig. 4
Fig. 4
Accuracy of classification using proposed minimal screening panel (PMSP) when compared against actual diagnosis. Note that none of the cases diagnosed were false positives. In addition, all MPAL cases were caught using PMSP.
Fig. 5
Fig. 5
Accuracy of different diagnostic techniques used in this study plotted as a line diagram for comparison. Techniques used were (a) morphology alone (b) morphology and cytochemistry (c) Indian consensus minimal screening panel (d) proposed minimal screening panel.
See this image and copyright information in PMC

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