Radar plots facilitate differential diagnosis of acute promyelocytic leukemia and NPM1+ acute myeloid leukemia by flow cytometry
(2021) In Cytometry Part B - Clinical Cytometry 100(4). p.409-420- Abstract
Background: Acute promyelocytic leukemia (APL) is one of the most life-threatening hematological emergencies and requires a prompt correct diagnosis by cytomorphology and flow cytometry (FCM) with later confirmation by cytogenetics/molecular genetics. However, nucleophosmin 1 muted acute myeloid leukemia (NPM1+ AML) can mimic APL, especially the hypogranular variant of APL. Our study aimed to develop a novel, Radar plot-based FCM strategy to distinguish APLs and NPM1+ AMLs quickly and accurately. Method: Diagnostic samples from 52 APL and 32 NPM1+ AMLs patients were analyzed by a 3-tube panel of 10-color FCM. Radar plots combining all markers were constructed for each tube. Percentages of positive leukemic cells and mean fluorescence... (More)
Background: Acute promyelocytic leukemia (APL) is one of the most life-threatening hematological emergencies and requires a prompt correct diagnosis by cytomorphology and flow cytometry (FCM) with later confirmation by cytogenetics/molecular genetics. However, nucleophosmin 1 muted acute myeloid leukemia (NPM1+ AML) can mimic APL, especially the hypogranular variant of APL. Our study aimed to develop a novel, Radar plot-based FCM strategy to distinguish APLs and NPM1+ AMLs quickly and accurately. Method: Diagnostic samples from 52 APL and 32 NPM1+ AMLs patients were analyzed by a 3-tube panel of 10-color FCM. Radar plots combining all markers were constructed for each tube. Percentages of positive leukemic cells and mean fluorescence intensity were calculated for all the markers. Results: APL showed significantly higher expression of CD64, CD2, and CD13, whereas more leukemic cells were positive for CD11b, CD11c, CD15, CD36, and HLA-DR in NPM1+ AMLs. Radar plots featured CD2 expression, a lack of a monocytic component, lack of expression of HLA-DR and CD15, and a lack of a prominent CD11c+ population as recurring characteristics of APL. The presence of blasts with low SSC, presence of at least some monocytes, some expression of HLA-DR and/or CD15, and a prominent CD11c population were recurrent characteristics of NPM1+ AMLs. Radar plot analysis could confidently separate all hypergranular APL cases from any NPM1+ AML and in 90% of cases between variant APL and blastic NPM1+ AML. Conclusion: Radar plots can potentially add to differential diagnostics as they exhibit characteristic patterns distinguishing APL and different types of NPM1+ AMLs.
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- author
- Gupta, Monali ; Jafari, Katayoon ; Rajab, Amr ; Wei, Cuihong ; Mazur, Joanna ; Tierens, Anne ; Hyjek, Elizabeth ; Musani, Rumina and Porwit, Anna LU
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- acute promyelocytic leukemia, flow cytometry, mean fluorescence intensity, NPM1 mutated acute myeloid leukemia, radar plot
- in
- Cytometry Part B - Clinical Cytometry
- volume
- 100
- issue
- 4
- pages
- 409 - 420
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- scopus:85097490795
- pmid:33301193
- ISSN
- 1552-4949
- DOI
- 10.1002/cyto.b.21979
- language
- English
- LU publication?
- yes
- id
- 2ba60af1-0881-40e1-bfe6-b9a685f524b4
- date added to LUP
- 2020-12-23 09:24:43
- date last changed
- 2024-05-01 22:56:58
@article{2ba60af1-0881-40e1-bfe6-b9a685f524b4,
abstract = {{<p>Background: Acute promyelocytic leukemia (APL) is one of the most life-threatening hematological emergencies and requires a prompt correct diagnosis by cytomorphology and flow cytometry (FCM) with later confirmation by cytogenetics/molecular genetics. However, nucleophosmin 1 muted acute myeloid leukemia (NPM1+ AML) can mimic APL, especially the hypogranular variant of APL. Our study aimed to develop a novel, Radar plot-based FCM strategy to distinguish APLs and NPM1+ AMLs quickly and accurately. Method: Diagnostic samples from 52 APL and 32 NPM1+ AMLs patients were analyzed by a 3-tube panel of 10-color FCM. Radar plots combining all markers were constructed for each tube. Percentages of positive leukemic cells and mean fluorescence intensity were calculated for all the markers. Results: APL showed significantly higher expression of CD64, CD2, and CD13, whereas more leukemic cells were positive for CD11b, CD11c, CD15, CD36, and HLA-DR in NPM1+ AMLs. Radar plots featured CD2 expression, a lack of a monocytic component, lack of expression of HLA-DR and CD15, and a lack of a prominent CD11c+ population as recurring characteristics of APL. The presence of blasts with low SSC, presence of at least some monocytes, some expression of HLA-DR and/or CD15, and a prominent CD11c population were recurrent characteristics of NPM1+ AMLs. Radar plot analysis could confidently separate all hypergranular APL cases from any NPM1+ AML and in 90% of cases between variant APL and blastic NPM1+ AML. Conclusion: Radar plots can potentially add to differential diagnostics as they exhibit characteristic patterns distinguishing APL and different types of NPM1+ AMLs.</p>}},
author = {{Gupta, Monali and Jafari, Katayoon and Rajab, Amr and Wei, Cuihong and Mazur, Joanna and Tierens, Anne and Hyjek, Elizabeth and Musani, Rumina and Porwit, Anna}},
issn = {{1552-4949}},
keywords = {{acute promyelocytic leukemia; flow cytometry; mean fluorescence intensity; NPM1 mutated acute myeloid leukemia; radar plot}},
language = {{eng}},
number = {{4}},
pages = {{409--420}},
publisher = {{John Wiley & Sons Inc.}},
series = {{Cytometry Part B - Clinical Cytometry}},
title = {{Radar plots facilitate differential diagnosis of acute promyelocytic leukemia and NPM1+ acute myeloid leukemia by flow cytometry}},
url = {{http://dx.doi.org/10.1002/cyto.b.21979}},
doi = {{10.1002/cyto.b.21979}},
volume = {{100}},
year = {{2021}},
}