Revisiting guidelines for integration of flow cytometry results in the WHO classification of myelodysplastic syndromes—proposal from the International/European LeukemiaNet Working Group for Flow Cytometry in MDS

Definite progress has been made in the exploration of myelodysplastic syndromes (MDS) by flow cytometry (FCM) since the publication of the World Health Organization 2008 classification of myeloid neoplasms. An international working party initiated within the European LeukemiaNet and extended to include members from Australia, Canada, Japan, Taiwan and the United States has, through several workshops, developed and subsequently published consensus recommendations. The latter deal with preanalytical precautions, and propose small and large panels, which allow evaluating immunophenotypic anomalies and calculating myelodysplasia scores. The current paper provides guidelines that strongly recommend the integration of FCM data with other diagnostic tools in the diagnostic work-up of MDS.

[1]  T. Naoe,et al.  Differences in blast immunophenotypes among disease types in myelodysplastic syndromes: a multicenter validation study. , 2012, Leukemia research.

[2]  I. Baumann,et al.  Classification of childhood aplastic anemia and myelodysplastic syndrome. , 2011, Hematology. American Society of Hematology. Education Program.

[3]  A. Levis,et al.  Prognostic relevance of cytometric quantitative assessment in patients with myelodysplastic syndromes , 2011, European Journal of Haematology.

[4]  Zhaoxiang Zhang,et al.  Immunophenotypic analysis of erythroid dysplasia and its diagnostic application in myelodysplastic syndromes , 2012, Internal medicine journal.

[5]  Young-Uk Cho,et al.  A combination of CD15/CD10, CD64/CD33, CD16/CD13 or CD11b flow cytometric granulocyte panels is sensitive and specific for diagnosis of myelodysplastic syndrome. , 2012, Annals of clinical and laboratory science.

[6]  B. Smith,et al.  The utility of flow cytometric immunophenotyping in cytopenic patients with a non-diagnostic bone marrow: a prospective study. , 2009, Leukemia research.

[7]  L. Arenillas,et al.  Single nucleotide polymorphism array karyotyping: A diagnostic and prognostic tool in myelodysplastic syndromes with unsuccessful conventional cytogenetic testing , 2013, Genes, chromosomes & cancer.

[8]  K. Burbury,et al.  Role of flow cytometry in myelodysplastic syndromes: diagnosis, classification, prognosis and response assessment , 2014, Leukemia & lymphoma.

[9]  V. V. D. van der Velden,et al.  Identification of distinct prognostic subgroups in low- and intermediate-1-risk myelodysplastic syndromes by flow cytometry. , 2008, Blood.

[10]  A Orfao,et al.  EuroFlow antibody panels for standardized n-dimensional flow cytometric immunophenotyping of normal, reactive and malignant leukocytes , 2012, Leukemia.

[11]  Wolfgang Kern,et al.  Standardization of flow cytometry in myelodysplastic syndromes: report from the first European LeukemiaNet working conference on flow cytometry in myelodysplastic syndromes , 2009, Haematologica.

[12]  S. Fenu,et al.  Advanced pediatric myelodysplastic syndromes: Can immunophenotypic characterization of blast cells be a diagnostic and prognostic tool? , 2009, Pediatric blood & cancer.

[13]  F. Lanza,et al.  Flow cytometry immunophenotyping for the evaluation of bone marrow dysplasia , 2011, Cytometry. Part B, Clinical cytometry.

[14]  O. Hrusak,et al.  Antigen expression patterns reflecting genotype of acute leukemias , 2002, Leukemia.

[15]  M. Cazzola,et al.  Diagnosis and treatment of primary myelodysplastic syndromes in adults: recommendations from the European LeukemiaNet. , 2013, Blood.

[16]  R. Schots,et al.  Diagnostic potential of CD34+ cell antigen expression in myelodysplastic syndromes. , 2012, American journal of clinical pathology.

[17]  S. Fujiwara,et al.  Prediction of progression from refractory cytopenia with unilineage dysplasia by analysis of bone marrow blast cell composition. , 2012, Journal of clinical and experimental hematopathology : JCEH.

[18]  G. Ossenkoppele,et al.  Absence of aberrant myeloid progenitors by flow cytometry is associated with favorable response to azacitidine in higher risk myelodysplastic syndromes , 2014, Cytometry. Part B, Clinical cytometry.

[19]  T. Seth,et al.  Flow cytometry in myelodysplastic syndrome: analysis of diagnostic utility using maturation pattern-based and quantitative approaches , 2012, Annals of Hematology.

[20]  J. Maciejewski,et al.  The need for additional genetic markers for myelodysplastic syndrome stratification: what does the future hold for prognostication? , 2013, Expert review of hematology.

[21]  Raavi Gupta,et al.  Myelodysplastic syndrome with isolated deletion of chromosome 20q: an indolent disease with minimal morphological dysplasia and frequent thrombocytopenic presentation , 2007, British journal of haematology.

[22]  E. Estey,et al.  Coalesced multicentric analysis of 2,351 patients with myelodysplastic syndromes indicates an underestimation of poor-risk cytogenetics of myelodysplastic syndromes in the international prognostic scoring system. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[23]  M. Béné,et al.  Flow cytometric detection of dyserythropoiesis: a sensitive and powerful diagnostic tool for myelodysplastic syndromes , 2013, Leukemia.

[24]  M. Cazzola,et al.  Predictive factors for the outcome of allogeneic transplantation in patients with MDS stratified according to the revised IPSS-R. , 2014, Blood.

[25]  M. Loken,et al.  Flow cytometric scoring system as a diagnostic and prognostic tool in myelodysplastic syndromes. , 2011, Leukemia research.

[26]  Landscape Of Genetic Lesions In 944 Patients With Myelodysplastic Syndromes , 2013 .

[27]  Xiao Li,et al.  Diagnostic application and clinical significance of FCM progress scoring system based on immunophenotyping in CD34+ blasts in myelodysplastic syndromes , 2013, Cytometry. Part B, Clinical cytometry.

[28]  A. A. van de Loosdrecht,et al.  Cutting edge: flow cytometry in myelodysplastic syndromes. , 2013, Journal of the National Comprehensive Cancer Network : JNCCN.

[29]  V. V. D. van der Velden,et al.  Implementation of flow cytometry in the diagnostic work-up of myelodysplastic syndromes in a multicenter approach: report from the Dutch Working Party on Flow Cytometry in MDS. , 2012, Leukemia research.

[30]  M. Cazzola,et al.  Flow cytometry evaluation of erythroid dysplasia in patients with myelodysplastic syndrome , 2006, Leukemia.

[31]  A. Órfão,et al.  Altered immunophenotypic features of peripheral blood platelets in myelodysplastic syndromes , 2012, Haematologica.

[32]  C Haferlach,et al.  Landscape of genetic lesions in 944 patients with myelodysplastic syndromes , 2013, Leukemia.

[33]  H. Deeg,et al.  Myeloid and monocytic dyspoiesis as determined by flow cytometric scoring in myelodysplastic syndrome correlates with the IPSS and with outcome after hematopoietic stem cell transplantation. , 2003, Blood.

[34]  A. Órfão,et al.  The immunophenotype of different immature, myeloid and B-cell lineage-committed CD34+ hematopoietic cells allows discrimination between normal/reactive and myelodysplastic syndrome precursors , 2008, Leukemia.

[35]  G. Garcia-Manero CME Information: Myelodysplastic syndromes: 2014 update on diagnosis, risk-stratification and management , 2014 .

[36]  C. Pascutto,et al.  Multicenter validation of a reproducible flow cytometric score for the diagnosis of low-grade myelodysplastic syndromes: results of a European LeukemiaNET study , 2012, Haematologica.

[37]  M. Rossol,et al.  CD56+ monocytes have a dysregulated cytokine response to lipopolysaccharide and accumulate in rheumatoid arthritis and immunosenescence , 2013, Arthritis Research & Therapy.

[38]  M. Stratton,et al.  Clinical and biological implications of driver mutations in myelodysplastic syndromes. , 2013, Blood.

[39]  L. Malcovati,et al.  Diagnostic utility of flow cytometry in low-grade myelodysplastic syndromes: a prospective validation study , 2009, Haematologica.

[40]  C. Corrado,et al.  Increased immature hematopoietic progenitor cells CD34+/CD38dim in myelodysplasia , 2006, Cytometry. Part B, Clinical cytometry.

[41]  T. Haferlach,et al.  Multiparameter flow cytometry reveals myelodysplasia‐related aberrant antigen expression in myelodysplastic/myeloproliferative neoplasms , 2013, Cytometry. Part B, Clinical cytometry.

[42]  B. Smith,et al.  Utility of peripheral blood flow cytometry in differentiating low grade versus high grade myelodysplastic syndromes (MDS) and in the evaluation of cytopenias. , 2012, International journal of clinical and experimental pathology.

[43]  M. Cazzola,et al.  Rationale for the clinical application of flow cytometry in patients with myelodysplastic syndromes: position paper of an International Consortium and the European LeukemiaNet Working Group , 2012, Leukemia & lymphoma.

[44]  T. Haferlach,et al.  Clinical utility of multiparameter flow cytometry in the diagnosis of 1013 patients with suspected myelodysplastic syndrome , 2010, Cancer.

[45]  Xiao Li,et al.  Flow cytometric scoring system (FCMSS) assisted diagnosis of myelodysplastic syndromes (MDS) and the biological significance of FCMSS‐based immunophenotypes , 2010, British journal of haematology.

[46]  F. Locatelli,et al.  Applicability of a reproducible flow cytometry scoring system in the diagnosis of refractory cytopenia of childhood , 2013, Leukemia.

[47]  D C Arthur,et al.  Diagnostic utility of flow cytometric immunophenotyping in myelodysplastic syndrome. , 2001, Blood.

[48]  M. Béné Immunophenotyping of myelodysplasia. , 2005, Haematologica.

[49]  C. Bloomfield,et al.  Myelodysplastic syndromes: clinical practice guidelines in oncology. , 2013, Journal of the National Comprehensive Cancer Network : JNCCN.

[50]  F. Naeim 8 – Myelodysplastic Syndromes/Neoplasms—Overview , 2013 .

[51]  H. Tamura,et al.  Diagnostic application of flow cytometric characteristics of CD34+ cells in low-grade myelodysplastic syndromes. , 2006, Blood.

[52]  Luca Malcovati,et al.  Revised international prognostic scoring system for myelodysplastic syndromes. , 2012, Blood.

[53]  G. Ossenkoppele,et al.  Aberrant immunophenotype of blasts in myelodysplastic syndromes is a clinically relevant biomarker in predicting response to growth factor treatment. , 2010, Blood.

[54]  Jean Feuillard,et al.  Four‐ and five‐color flow cytometry analysis of leukocyte differentiation pathways in normal bone marrow: A reference document based on a systematic approach by the GTLLF and GEIL , 2009, Cytometry. Part B, Clinical cytometry.

[55]  T. Haferlach,et al.  Definitions and standards in the diagnosis and treatment of the myelodysplastic syndromes: Consensus statements and report from a working conference. , 2007, Leukemia research.

[56]  A. Porwit Role of flow cytometry in diagnostics of myelodysplastic syndromes--beyond the WHO 2008 classification. , 2011, Seminars in diagnostic pathology.

[57]  A. Órfão,et al.  Standardization of flow cytometry in myelodysplastic syndromes: a report from an international consortium and the European LeukemiaNet Working Group , 2012, Leukemia.

[58]  Ming Yan,et al.  Validation of cell‐based fluorescence assays: Practice guidelines from the ICSH and ICCS – part V – assay performance criteria , 2013, Cytometry. Part B, Clinical cytometry.

[59]  E. Hellström-Lindberg,et al.  Erythropoiesis stimulating agents and other growth factors in low-risk MDS. , 2013, Best practice & research. Clinical haematology.

[60]  C. Bloomfield,et al.  NCCN Clinical Practice Guidelines in Oncology: myelodysplastic syndromes. , 2011, Journal of the National Comprehensive Cancer Network : JNCCN.

[61]  Y. Li,et al.  Four-color flow cytometry shows strong concordance with bone marrow morphology and cytogenetics in the evaluation for myelodysplasia. , 2005, American journal of clinical pathology.

[62]  J. Hernández-Rivas,et al.  Bone marrow cells from myelodysplastic syndromes show altered immunophenotypic profiles that may contribute to the diagnosis and prognostic stratification of the disease: A pilot study on a series of 56 patients , 2010, Cytometry. Part B, Clinical cytometry.

[63]  A. Órfão,et al.  Combined flow cytometric assessment of CD45, HLA‐DR, CD34, and CD117 expression is a useful approach for reliable quantification of blast cells in myelodysplastic syndromes , 2013, Cytometry. Part B, Clinical cytometry.