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Cytometry B Clin Cytom. 2019 Sep 3. doi: 10.1002/cyto.b.21842. [Epub ahead of print]

The diagnostic and prognostic role of flow cytometry in idiopathic and clonal cytopenia of undetermined significance (ICUS/CCUS): A single-center analysis of 79 patients.

Author information

1
Department of Hematology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
2
Department of Clinical Biochemistry, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
3
Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Denmark.
4
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
5
Department of Pathology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
6
Department of Pathology, Karolinska University Hospital, Solna, Stockholm, Sweden.
7
Novo Nordisk Foundation Center for Stem Cell Biology, DanStem, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Abstract

OBJECTIVE:

The aim of this study was to evaluate the diagnostic and prognostic role of multiparameter flow cytometry (FC) in patients with idiopathic cytopenia of undetermined significance (ICUS) and clonal cytopenia of undetermined significance (CCUS).

METHODS:

We performed FC using a standardized panel and two different diagnostic algorithms (Ogata, Wells) in a well-characterized cohort of 79 patients with ICUS/CCUS and compared it with a retrospective blinded morphological evaluation and data from targeted next-generation DNA sequencing of 20 myelodysplastic syndrome (MDS)-related genes.

RESULTS:

Our data show that FC has low sensitivity in distinguishing CCUS from ICUS patients (40.5% for Ogata score and 59.5% for Wells score). The Wells score was suggestive of dysplasia in ICUS/CCUS patients with concurrent morphological signs of dysplasia in the bone marrow (following re-evaluation by two hematopathologists) and in CCUS patients with a higher mutational burden. Eight patients with ICUS/CCUS from our cohort progressed to another myeloid malignancy (MDS, acute myeloid leukemia, or chronic myelomonocytic leukemia), all showing flow cytometric signs of dysplasia.

CONCLUSION:

FC performs poorly in diagnosing CCUS versus ICUS. However, it can potentially provide prognostic information in cytopenic patients by identifying a subgroup of patients with a higher grade of dysplasia, higher mutational burden, and higher risk of progression and, together with mutational screening, also identify a group of patients who might require morphological reassessment of dysplastic changes in their bone marrow.

PMID:
31479199
DOI:
10.1002/cyto.b.21842

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