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Clinically Useful Information Provided by the Flow Cytometric Immunophenotyping of Hematological Malignancies: Current Status and Future Directions

¹ Department of Medicine and Centro de Investigaciones del Cancer, Universidad de Salamanca, 37007 Salamanca, Spain.

² Department of Laboratory Medicine, University of Regensburg, D-93053 Regensburg, Germany.

³ Renal Transplant Unit, Niguarda-Ca' Granda Hospital, 20162 Milan, Italy.

⁴ Laboratorios Clinicos de Puebla, Puebla 72530, Mexico.

⁵ Clinica Pediatrica, 10126 Torino, Italy.

⁶ Department of Pathology, University of Florida, Gainesville, FL 32610.

⁷ Laboratoire d'Hematologie, Hopital Haut-Leveque, 33608 Pessac, France.

⁸ Institute of Hematology, Ospedale S. Anna, 44100 Ferrara, Italy.

⁹ Istituto di Scienze Morfologiche, Universita degli Study di Urbino, 61029 Urbino, Italy.

¹⁰ Serviço de Hematologia, Instituto Portugues de Oncologia, 1093 Lisbon, Portugal.
^a Address correspondence to this author at: Servicio General de Citometria, Laboratorio de Hematologia, Hospital Universitario, Paseo San Vicente s/n, 37007 Salamanca, Spain. Fax 34-23-294624; e-mail orfao{at}gugu.usal.es

Background: At present, immunophenotyping of hematological malignancies represents one of the most relevant clinical applications of flow cytometry. In recent years, its use has extended from clinical research to diagnostic laboratories. The aim of this report is to critically review the type of information provided by the flow cytometric immunophenotyping of hematological malignancies and its clinical impact as well as to highlight its potential future applications.

Methods: The currently available information, including that provided by different international consensus groups on the phenotypic characterization of hematologic malignancies, was reviewed. Additionally, recent reports on the immunophenotypic analysis of hematological malignancies published in hematology, oncology, pathology, immunology, and cell biology journals were also analyzed.

Results: A careful review of the literature showed that in spite of the well-established utility of immunophenotyping for the diagnosis, classification, prognostic stratification, and monitoring of hematological malignancies, only a small part of the information on the immunophenotypic characteristics of pathological hemopoietic cells has been used routinely. Specific and sensitive identification of neoplastic cells and their accurate enumeration and phenotypic characterization represent the major aims of these procedures. Similarities between leukemic and healthy cells allow the establishment of the lineage and maturation stage of the pathologic cells, this information being of great utility for the diagnosis, classification, and prognostic evaluation of different subtypes of hematological malignancies. On the other hand, the phenotypic aberrations displayed by leukemic cells could allow the selection of cases carrying specific genetic abnormalities in which further confirmatory molecular studies will be performed.

Conclusions: The information provided by the flow cytometric immunophenotyping of hematological malignancies is of great clinical utility, with a major challenge for the near future being the standardization of technical procedures, data interpretation, and reporting.

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