Skip to main content

Morphology and Flow Cytometry

  • Chapter
  • First Online:
Myelodysplastic Syndromes

Part of the book series: Hematologic Malignancies ((HEMATOLOGIC))

  • 823 Accesses

Abstract

Despite the rapid development of molecular markers during the last years, the morphology of blood and bone marrow cells still keeps the crucial role for diagnosis and subclassification of the different subtypes of myelodysplastic syndromes (MDS), as recently confirmed by the new 2016 WHO classification [1]. Nevertheless, morphologic diagnosis is not always self-evident. While increased blast cells are often in-line with advanced MDS subtypes, early forms with mild morphological changes can represent a diagnostic challenge. Especially in these cases, morphologic experience is crucial but should be embedded into further information on disease history, exclusion of other underlying diseases, as well as additional cytogenetic, molecular, and immunophenotypic data to confirm diagnosis of MDS.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Arber DA, Orazi A, Hasserjian R, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016;127:2391–405.

    Article  CAS  PubMed  Google Scholar 

  2. Bennett JM, Catovsky D, Daniel MT, et al. Proposals for the classification of the myelodysplastic syndromes. Br J Haematol. 1982;51(2):189–99.

    Article  CAS  PubMed  Google Scholar 

  3. Vardiman JW, Harris NL, Brunning RD, et al. The World Health Organization (WHO) classification of the myeloid neoplasms. Blood. 2002;100(7):2292–302.

    Article  CAS  PubMed  Google Scholar 

  4. Vardiman JW, Thiele J, Arber DA, et al. The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood. 2009;114(5):937–51.

    Article  CAS  PubMed  Google Scholar 

  5. Greenberg PL, Tuechler H, Schanz J, et al. Cytopenia levels for aiding establishment of the diagnosis of myelodysplastic syndromes. Blood. 2016;128:2096–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Valent P, Horny H-P, Bennett JM, et al. Definitions and standards in the diagnosis and treatment of the myelodysplastic syndromes: consensus statements and report from a working conference. Leuk Res. 2007;31:727–36.

    Article  PubMed  Google Scholar 

  7. Valent P, Horny HP. Minimal diagnostic criteria for myelodysplastic syndromes and separation from ICUS and IDUS: update and open questions. Eur J Clin Investig. 2009;39(7):548–53.

    Article  CAS  Google Scholar 

  8. Greenberg PL, Tuechler H, Schanz J, et al. Revised international prognostic scoring system for myelodysplastic syndromes. Blood. 2012;120:2454–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Malcovati L, Hellström-Lindberg E, Bowen D, et al. Diagnosis and treatment of primary myelodysplastic syndromes in adults: recommendations from the European LeukemiaNet. Blood. 2013;122:2943–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Mufti GJ, Bennett JM, Goasguen J, et al. Diagnosis and classification of myelodysplastic syndrome: International Working Group on Morphology of myelodysplastic syndrome (IWGM-MDS) consensus proposals for the definition and enumeration of myeloblasts and ring sideroblasts. Haematologica. 2008;93(11):1712–7.

    Article  PubMed  Google Scholar 

  11. Parmentier S, Schetelig J, Lorenz K, et al. Assessment of dysplastic hematopoiesis: lessons from healthy bone marrow donors. Haematologica. 2012;97(5):723–30.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Goasguen JE, Bennett JM, Bain BJ, et al. Proposal for refining the definition of dysgranulopoiesis in acute myeloid leukemia and myelodysplastic syndromes. Leuk Res. 2014;38(4):447–53.

    Article  PubMed  Google Scholar 

  13. Bowen D, Culligan D, Jowitt S, et al. Guidelines for the diagnosis and therapy of adult myelodysplastic syndromes. Br J Haematol. 2003;120:187–200.

    Article  PubMed  Google Scholar 

  14. Lai JL, Preudhomme C, Zandecki M, et al. Myelodysplastic syndromes and acute myeloid leukemia with 17p deletion. An entity characterized by specific dysgranulopoïesis and a high incidence of P53 mutations. Leukemia. 1995;9(3):370–81.

    PubMed  CAS  Google Scholar 

  15. Della Porta MG, Malcovati L. Myelodysplastic syndromes with bone marrow fibrosis. Haematologica. 2011;96(2):180–3.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Buesche G, Teoman H, Wilczak W, et al. Marrow fibrosis predicts early fatal marrow failure in patients with myelodysplastic syndromes. Leukemia. 2012;22(2):313–22.

    Article  CAS  Google Scholar 

  17. Verhoef GE, De Wolf-Peeters C, Ferrant A, et al. Myelodysplastic syndromes with bone marrow fibrosis: a myelodysplastic disorder with proliferative features. Ann Hematol. 1991;63(5):235–41.

    Article  CAS  PubMed  Google Scholar 

  18. Valent P, Bain BJ, Bennett JM, et al. Idiopathic cytopenia of undetermined significance (ICUS) and idiopathic dysplasia of uncertain significance (IDUS), and their distinction from low risk MDS. Leuk Res. 2012;36(1):1–5.

    Article  PubMed  Google Scholar 

  19. Wimazal F, Fonatsch C, Thalhammer R, Schwarzinger I, Müllauer L, Sperr WR, Bennett JM, Valent P. Idiopathic cytopenia of undetermined significance (ICUS) versus low risk MDS: the diagnostic interface. Leuk Res. 2007;31(11):1461–8.

    Article  PubMed  Google Scholar 

  20. Porwit A, van de Loosdrecht AA, Bettelheim P, et al. Revisiting guidelines for integration of flow cytometry results in the WHO classification of myelodysplastic syndromes-proposal from the International/European LeukemiaNet Working Group for Flow Cytometry in MDS. Leukemia. 2014;28(9):1793–8.

    Article  CAS  PubMed  Google Scholar 

  21. van de Loosdrecht AA, Alhan C, Bene MC, et al. Standardization of flow cytometry in myelodysplastic syndromes: report from the first European LeukemiaNet working conference on flow cytometry in myelodysplastic syndromes. Haematologica. 2009;94(8):1124–34.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Westers TM, Ireland R, Kern W, et al. Standardization of flow cytometry in myelodysplastic syndromes: a report from an international consortium and the European LeukemiaNet Working Group. Leukemia. 2012;26:1730–41.

    Article  CAS  PubMed  Google Scholar 

  23. Kussick SJ, Wood BL. Using 4-color flow cytometry to identify abnormal myeloid populations. Arch Pathol Lab Med. 2003;127:1140–7.

    PubMed  Google Scholar 

  24. Kussick SJ, Fromm JR, Rossini A, et al. Four-color flow cytometry shows strong concordance with bone marrow morphology and cytogenetics in the evaluation for myelodysplasia. Am J Clin Pathol. 2005;124:170–81.

    Article  PubMed  Google Scholar 

  25. Loken MR, van de Loosdrecht AA, Ogata K, et al. Flow cytometry in myelodysplastic syndromes: report from a working conference. Leuk Res. 2008;32:5–17.

    Article  PubMed  Google Scholar 

  26. Wells DA, Benesch M, Loken MR, et al. Myeloid and monocytic dyspoiesis as determined by flow cytometric scoring in myelodysplastic syndrome correlates with the IPSS and with outcome after hematopoietic stem cell transplantation. Blood. 2003;102:394–403.

    Article  CAS  PubMed  Google Scholar 

  27. Della Porta MG, Picone C, Pascutto C, et al. Multicenter validation of a reproducible flow cytometric score for the diagnosis of low-grade myelodysplastic syndromes: results of a European LeukemiaNET study. Haematologica. 2012;97(8):1209–17.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ogata K, Della Porta MG, Malcovati L, et al. Diagnostic utility of flow cytometry in low-grade myelodysplastic syndromes: a prospective validation study. Haematologica. 2009;94(8):1066–74.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Cremers EMP, Westers TM, Alhan C, et al. Implementation of erythroid lineage analysis by flow cytometry in diagnostic models for myelodysplastic syndromes. Haematologica. 2017;102(2):320–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Westers TM, Cremers EMP, Oelschlaegel U, et al. Immunophenotypic analysis of erythroid dysplasia in myelodysplastic syndromes. A report from the IMDSFlow working group. Haematologica. 2017;102(2):308–19.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Scott BL, Wells D, Loken MR, et al. Validation of a flow cytometric scoring system as a prognostic indicator for posttransplantation outcome in patients with myelodysplastic syndrome. Blood. 2008;112:2681–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. van de Loosdrecht AA, Westers TM, Westra AH, et al. Identification of distinct prognostic subgroups in low- and intermediate-1-risk myelodysplastic syndromes by flow cytometry. Blood. 2008;111(3):1067–77.

    Article  CAS  PubMed  Google Scholar 

  33. Alhan C, Westers TM, van der Helm LH, et al. Absence of aberrant myeloid progenitors by flow cytometry is associated with favorable response to azacitidine in higher risk myelodysplastic syndromes. Cytometry B Clin Cytom. 2014;86(3):207–15.

    Article  PubMed  Google Scholar 

  34. Alhan C, Westers TM, Cremers EMP, et al. High flow cytometric scores identify adverse prognostic subgroups within the revised international prognostic scoring system for myelodysplastic syndromes. Br J Haematol. 2014;167:100–9.

    Article  PubMed  Google Scholar 

  35. Malcovati L, Porta MG, Pascutto C, et al. Prognostic factors and life expectancy in myelodysplastic syndromes classified according to WHO criteria: a basis for clinical decision making. J Clin Oncol. 2005;23:7594–609.

    Article  PubMed  Google Scholar 

  36. Burbury KL, Westerman DA. Role of flow cytometry in myelodysplastic syndromes: diagnosis, classification, prognosis and response assessment. Leuk Lymphoma. 2014;55(4):749–60.

    Article  CAS  PubMed  Google Scholar 

  37. Alhan C, Westers TM, Cremers EMP, et al. The myelodysplastic syndromes flow cytometric score: a three parameter prognostic flow cytometric scoring system. Leukemia. 2016;30:658–65.

    Article  CAS  PubMed  Google Scholar 

  38. Kern W, Bacher U, Haferlach C, et al. Multiparameter flow cytometry provides independent prognostic information in patients with suspected myelodysplastic syndromes: a study on 804 patients. Cytometry B Clin Cytom. 2015;88:154–64.

    Article  PubMed  Google Scholar 

  39. Cutler JA, Wells DA, van de Loosdrecht AA, et al. Phenotypic abnormalities strongly reflect genotype in patients with unexplained cytopenias. Cytometry B Clin Cytom. 2011;80(3):150–7.

    Article  CAS  PubMed  Google Scholar 

  40. Oelschlaegel U, Westers TM, Mohr B, et al. Myelodysplastic syndromes with a deletion 5q display a characteristic immunophenotypic profile suitable for diagnostics and response monitoring. Haematologica. 2015;100(3):e93–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Oelschlaegel U, Alexander Röhnert M, Mohr B, Sockel K, Herold S, Ehninger G, Bornhäuser M, Thiede C, Platzbecker U. Clonal architecture of del(5q) myelodysplastic syndromes: aberrant CD5 or CD7 expression within the myeloid progenitor compartment defines a subset with high clonal burden. Leukemia. 2016;30(2):517–20.

    Article  CAS  PubMed  Google Scholar 

  42. Hellström-Lindberg E, Gulbrandsen N, Lindberg G, et al. A validated decision model for treating the anaemia of myelodysplastic syndromes with erythropoietin + granulocyte colony-stimulating factor: significant effects on quality of life. Br J Haematol. 2003;120:1037–46.

    Article  PubMed  Google Scholar 

  43. Westers TM, Alhan C, Chamuleau ME, et al. Aberrant immunophenotype of blasts in myelodysplastic syndromes is a clinically relevant biomarker in predicting response to growth factor treatment. Blood. 2010;115(9):1779–84.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Arjan A. van de Loosdrecht .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sockel, K., Kroschinsky, F., Oelschlaegel, U., van de Loosdrecht, A.A. (2018). Morphology and Flow Cytometry. In: Platzbecker, U., Fenaux, P. (eds) Myelodysplastic Syndromes . Hematologic Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-319-76879-3_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-76879-3_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-76878-6

  • Online ISBN: 978-3-319-76879-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics