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Standardizing minimal residual disease by flow cytometry for precursor B lineage acute lymphoblastic leukemia in a developing country
Author(s) -
Patkar Nikhil,
Alex Ansu Abu,
B. Bargavi,
Ahmed Rayaz,
Abraham Aby,
George Biju,
Vishwabandya Auro,
Srivastava Alok,
Mathews Vikram
Publication year - 2012
Publication title -
cytometry part b: clinical cytometry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.646
H-Index - 61
eISSN - 1552-4957
pISSN - 1552-4949
DOI - 10.1002/cyto.b.21017
Subject(s) - minimal residual disease , immunophenotyping , medicine , cd20 , oncology , flow cytometry , leukemia , immunology , antigen
Background: In addition to standard risk criteria at diagnosis, minimal residual disease (MRD) following initiation of therapy is a well‐recognized risk factor to predict relapse. Literature from developing countries addressing therapeutic or laboratory practices related to MRD, is largely lacking. In a first paper from India, we describe our experience in establishing a flow cytometry‐based MRD assay for precursor B lineage ALL (BCP‐ALL) with emphasis on the assay standardization and cost. Methods: Normal templates for B cell development were established in 10 control patients using CD45, CD11a, CD38, CD20, CD10, CD19, CD58, CD34, CD123, and CD22. BCP‐ALL samples ( n = 42) were characterized at diagnosis to identify a suitable marker for follow‐up during mid (D+21) and end of induction (D+33). Both, multiparametric immunophenotyping and single marker detection of LAIP were used for data analysis. Results: In 95.2% of BCP‐ALL at least two informative markers could be obtained when a minimum of four cocktail combinations were used. The combination CD20, CD10, CD45, and CD19 was the most useful (71.4%) followed by combinations containing CD38 (66.7%), CD22 (57.1%), CD11a (52.4%), and CD58 (33.3%). Using our approach, 60 and 47% of patients had detectable MRD at mid and end induction time points, respectively. Conclusion: We have described a relatively cost effective MRD panel which is applicable to over 90% of patients. We hope that this data would encourage more centers in India and other resource constrained health delivery systems to develop MRD assays. © 2012 International Clinical Cytometry Society