A hierarchical approach in the diagnostic workflow of chronic myelomonocytic leukemia: Pivotal role of the "Mono-dysplasia-score" combined with flow cytometric quantification of monocyte subsets.

Autor: Zhu J; Service d'Hématologie-Immunologie-Transfusion, Hôpitaux Universitaires Paris Ile De France Ouest, Université Versailles Saint Quentin, Boulogne, France., Sourdeau E; Service d'Hématologie-Immunologie-Transfusion, Hôpitaux Universitaires Paris Ile De France Ouest, Université Versailles Saint Quentin, Boulogne, France., Aubert H; Laboratoire d'Hématologie, UNICAEN, CHU de Caen Normandie, Normandie University, Caen, France., Clauser S; Service d'Hématologie-Immunologie-Transfusion, Hôpitaux Universitaires Paris Ile De France Ouest, Université Versailles Saint Quentin, Boulogne, France., Maillon A; Service d'Hématologie-Immunologie-Transfusion, Hôpitaux Universitaires Paris Ile De France Ouest, Université Versailles Saint Quentin, Boulogne, France., Capron C; Service d'Hématologie-Immunologie-Transfusion, Hôpitaux Universitaires Paris Ile De France Ouest, Université Versailles Saint Quentin, Boulogne, France., Jondeau K; Unité fonctionnelle d'Hématologie, Service de Médecine Interne, Hôpitaux Universitaires Paris Ile De France Ouest, Université Versailles Saint Quentin, Boulogne, France., Ronez E; Service d'Hématologie-Immunologie-Transfusion, Hôpitaux Universitaires Paris Ile De France Ouest, Université Versailles Saint Quentin, Boulogne, France., Schillinger F; Laboratoire d'Hématologie, Etablissement Français du Sang de Bourgogne/Franche-Comté, Besançon, France., Garnache-Ottou F; Laboratoire d'Hématologie, Etablissement Français du Sang de Bourgogne/Franche-Comté, Besançon, France., Cornet E; Laboratoire d'Hématologie, UNICAEN, CHU de Caen Normandie, INSERM U1245, Normandie University, Caen, France., Bardet V; Service d'Hématologie-Immunologie-Transfusion, Hôpitaux Universitaires Paris Ile De France Ouest, Université Versailles Saint Quentin, Boulogne, France.
Jazyk: angličtina
Zdroj: International journal of laboratory hematology [Int J Lab Hematol] 2019 Dec; Vol. 41 (6), pp. 782-790. Date of Electronic Publication: 2019 Oct 24.
DOI: 10.1111/ijlh.13115
Abstrakt: Introduction: Monocytosis is a frequent trigger for blood smear review in a routine hematology laboratory whereas chronic myelomonocytic leukemia (CMML) is infrequent and arises mostly in elderly patients. In order to define the best workflow for monocytosis, we studied three diagnostic approaches: the classical morphology approach (blood smear review), the flow cytometry assay (quantification of monocyte subsets as described by Selimoglu-Buet et al in 2015), and the "mono-dysplasia-score" also referred to as "Monoscore (as described by our team in 2018 using the structural parameters of the Sysmex XN™ analyzers).
Methods: Studying a multicentric cohort of 196 nonclonal monocytoses and CMML patients aged over 50 years, we compared the diagnostic performance of the three approaches alone and in combination to propose a diagnostic decision tree.
Results: In patients presenting with additional criteria for slide review to monocytosis (37% of our cohort), we propose to sequentially combine morphology, Monoscore, and flow cytometry. On the contrary, for patients with isolated monocytosis (63%), slide review is not mandatory and we suggest performing flow cytometry depending on the Monoscore value. Using the proposed algorithm, 98% of CMML patients would have been correctly identified, slide review rate drastically reduced, and flow cytometry would have been carried out in 44% of patients.
Conclusion: We have shown that implementation of Monoscore is a useful input filter to significantly reduce slide reviews without losing sensitivity and that flow cytometry is a performant technique in the second step of the diagnostic workup of CMML.
(© 2019 The Authors. International Journal of Laboratory Hematology published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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