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Theunissen, Prisca; Mejstrikova, Ester; Sedek, Lukasz; van der Sluijs-Gelling, Alita J.; Gaipa, Giuseppe; Bartels, Marius; Sobral da Costa, Elaine; Kotrová, Michaela; Novakova, Michaela; Sonneveld, Edwin; Buracchi, Chiara; Bonaccorso, Paola; Oliveira, Elen; te Marvelde, Jeroen G.; Szczepanski, Tomasz; Lhermitte, Ludovic; Hrusak, Ondrej; Lecrevisse, Quentin; Grigore, Georgiana Emilia; Froňková, Eva; Trka, Jan; Brüggemann, Monika; Orfao, Alberto; van Dongen, Jacques J.M.; van der Velden, Vincent H.J.
Blood, 01/2017, Letnik: 129, Številka: 3Journal Article
A fully-standardized EuroFlow 8–color antibody panel and laboratory procedure was stepwise designed to measure minimal residual disease (MRD) in B-cell precursor (BCP) acute lymphoblastic leukemia (ALL) patients with a sensitivity of ≤10−5, comparable to real-time quantitative polymerase chain reaction (RQ-PCR)–based MRD detection via antigen-receptor rearrangements. Leukocyte markers and the corresponding antibodies and fluorochromes were selected based on their contribution in separating BCP-ALL cells from normal/regenerating BCP cells in multidimensional principal component analyses. After 5 multicenter design-test-evaluate-redesign phases with a total of 319 BCP-ALL patients at diagnosis, two 8-color antibody tubes were selected, which allowed separation between normal and malignant BCP cells in 99% of studied patients. These 2 tubes were tested with a new erythrocyte bulk-lysis protocol allowing acquisition of high cell numbers in 377 bone marrow follow-up samples of 178 BCP-ALL patients. Comparison with RQ-PCR–based MRD data showed a clear positive relation between the percentage concordant cases and the number of cells acquired. For those samples with >4 million cells acquired, concordant results were obtained in 93% of samples. Most discordances were clarified upon high-throughput sequencing of antigen-receptor rearrangements and blind multicenter reanalysis of flow cytometric data, resulting in an unprecedented concordance of 98% (97% for samples with MRD < 0.01%). In conclusion, the fully standardized EuroFlow BCP-ALL MRD strategy is applicable in >98% of patients with sensitivities at least similar to RQ-PCR (≤10−5), if sufficient cells (>4 × 106, preferably more) are evaluated. •Standardized flow cytometry allows highly sensitive MRD measurements in virtually all BCP-ALL patients.•If sufficient cells are measured (>4 million), flow cytometric MRD analysis is at least as sensitive as current PCR-based MRD methods.
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