AJHE2505 - CME/CMLE - Flow cytometry evaluation of acute myeloid leukemia minimal residual disease based on an understanding of the normal maturation patterns in the blast compartments-Flow cytometry evaluation of acute myeloid leukemia minimal residual disease based on an understanding of the normal maturation patterns in the blast compartments

Flow cytometry evaluation of acute myeloid leukemia minimal residual disease based on an understanding of the normal maturation patterns in the blast compartments

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The review article discusses the use of flow cytometry (FC) for detecting minimal or measurable residual disease (MRD) in patients with acute myeloid leukemia (AML). Accurate detection of MRD is crucial for clinical decision-making and prognosis in AML. The article emphasizes the need to distinguish between normal hematopoietic developmental patterns and abnormal AML phenotypes, stressing that understanding these differences enhances the sensitivity and specificity of MRD detection.

The article outlines two main approaches for FC MRD detection:
1. <strong>Leukemia-Associated Immunophenotype (LAIP) Approach:</strong> This method involves defining rare leukemia-specific antigen expression patterns in patients and monitoring these patterns to detect residual disease. It assumes that detected phenotypic patterns at diagnosis will persist during treatment.
2. <strong>Difference From Normal (DFN) Approach:</strong> Here, the focus is on understanding and mapping normal hematopoietic maturation patterns to identify deviations that signify leukemic cells. This approach does not rely on the original diagnostic sample and is favored by the European Leukemia Network (ELN) for its comprehensive nature.

Key points from the review include:
- Abnormal expression of antigens, such as CD19 on myeloid blasts or asynchronous expression patterns, can indicate MRD.
- FC excels in rapidly evaluating single-cell antigen expression levels but requires rigorous technical validation to ensure sensitivity and accuracy.
- Both approaches (LAIP and DFN) have their merits and limitations. However, combining these methods could potentially offer a more robust framework for MRD detection.
- The article also highlights the need for well-designed FC panels and expert interpretation to distinguish subtle alterations in antigen expression that may result due to therapy or disease evolution.

This detailed review demonstrates FC's utility in AML MRD detection and suggests that advancements in molecular techniques may complement but not yet replace flow cytometric analysis in the near future.

Keywords

flow cytometry

minimal residual disease

acute myeloid leukemia

leukemia-associated immunophenotype

difference from normal approach

antigen expression

European Leukemia Network

single-cell analysis

hematopoietic patterns

molecular techniques