Original Research

Comparing morphology, flow cytometry and molecular genetics in the assessment of minimal residual disease in children with B-acute lymphoblastic leukaemia (B-ALL)

Candice L. Hendricks, Suvarna Buldeo, Dashini Pillay, Ashendran Naidoo, Rajendra Thejpal, Nadine Rapiti, Beverley Neethling, Yasmin Goga, Hamida van Staaden
South African Journal of Oncology | Vol 3 | a76 | DOI: https://doi.org/10.4102/sajo.v3i0.76 | © 2019 Candice L. Hendricks, Suvarna Buldeo, Dashini Pillay, Ashendran Naidoo, Rajendra Thejpal, Nadine Rapiti, Beverley Neethling, Yasmin Goga, Hamida van Staaden | This work is licensed under CC Attribution 4.0
Submitted: 11 March 2019 | Published: 23 October 2019

About the author(s)

Candice L. Hendricks, Department of Paediatric Haematology–Oncology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; and, Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
Suvarna Buldeo, Department of Haematology, Mahatma Gandhi Memorial hospital, Durban, South Africa; and, Department of Haematology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; and, Department of Haematology, University of KwaZulu-Natal, Durban, South Africa
Dashini Pillay, Department of Haematology, University of KwaZulu-Natal, Durban, South Africa; and, Department of Haematology, National Health Laboratory Services, Durban, South Africa
Ashendran Naidoo, Department of Haematology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; and, Department of Haematology, National Health Laboratory Services, Durban, South Africa
Rajendra Thejpal, Department of Paediatric Haematology–Oncology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; and, Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
Nadine Rapiti, Department of Haematology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; and, Department of Haematology, University of KwaZulu-Natal, Durban, South Africa
Beverley Neethling, Department of Paediatric Haematology–Oncology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; and, Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
Yasmin Goga, Department of Paediatric Haematology–Oncology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; and, Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
Hamida van Staaden, Department of Paediatric Haematology–Oncology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; and, Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa


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Abstract

ackground:Minimal residual disease (MRD) detection has been shown to be the best prognostic factor in B-acute lymphoblastic leukaemia (B-ALL). Multicolour flow cytometry (FCM) and specific molecular aberrations (MOL) are the classic techniques used to assess MRD. The former is faster and less costly.

Aim: This study compares morphology and FCM to MOL in detecting MRD.

Setting: The study was conducted at Inkosi Albert Luthuli Central Hospital (IALCH).

Methods: A retrospective review of children with B-ALL managed at IALCH from January 2013 to January 2018 was conducted. Multicolour flow cytometry was performed using Euroflow® panels. Molecular aberrations looked at common cytogenetic markers. Presentation and post-induction morphology (May–Grunwald Giemsa stain), FCM and MOL data for MRD were analysed.

Results: Eleven patients were excluded (6-demised, 5-incomplete records), leaving 64 to be analysed (54% female, median age 5 years). Five post-induction aspirates were unsuitable but the rest (92%) were in morphological remission. At diagnosis and post-induction, 62 (95%) and 61 (94%) children, respectively, had FCM performed. A positive MOL result was found in 39 (60%) patients. MOL turn-around times (TATs) averaged 14 days compared with those of FCM’s average of 3 days. MRD was found in 9 patients (FCM) and 7 patients (MOL). Of these patients, 4 had a good correlation between the two and 2 patients with negative FCM had positive MOL MRD post-induction.

Conclusion: Morphology is insensitive in MRD assessment. FCM correlated well with molecular MRD and has the shortest turn-around time. FCM has major benefit in the 40% of patients with negative MOL. It can also be safely used to guide treatment escalation in those patients awaiting molecular results.


Keywords

minimal residual disease; B-acute lymphoblastic leukaemia; paediatric; flow cytometry; molecular genetics

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