Identification of leptomeningeal disease in aggressive B-cell non-Hodgkin's lymphoma: improved sensitivity of flow cytometry.
OBJECTIVE
Here, we evaluate the sensitivity and specificity of a new 11-parameter flow cytometry (FCM) approach versus conventional cytology (CC) for detecting neoplastic cells in stabilized CSF samples from newly diagnosed aggressive B-cell non-Hodgkin's lymphoma (B-NHL) at high risk of CNS relapse, using a prospective, multicentric study design.


METHODS
Moreover, we compared the distribution of different subpopulations of CSF leukocytes and the clinico-biologic characteristics of CSF+ versus CSF-, patients, in an attempt to define new algorithms useful for predicting CNS disease.


RESULTS
Overall, 27 (22%) of 123 patients showed infiltration by FCM, while CC was positive in only seven patients (6%), with three other cases being suspicious (2%). CC+/FCM+ samples typically had more than 20% neoplastic B cells and/or >or= one neoplastic B cell/microL, while FCM+/CC- samples showed lower levels (P < .0001) of infiltration. Interestingly, in Burkitt lymphoma, presence of CNS disease by FCM could be predicted with a high specificity when increased serum beta2-microglobulin and neurological symptoms coexisted, while peripheral blood involvement was the only independent parameter associated with CNS disease in diffuse large B-cell lymphoma, with low predictive value.


CONCLUSIONS
FCM significantly improves the sensitivity of CC for the identification of leptomeningeal disease in aggressive B-NHL at higher risk of CNS disease, particularly in paucicellular samples.
Quijano
Sandra
S
Servicio General de Citometría, Department of Medicine and Centro de Investigación del Cáncer (CIC; USAL/CSIC), Universidad de Salamanca, Salamanca, Spain.
López
Antonio
A
Manuel Sancho
Juan
J
Panizo
Carlos
C
Debén
Guillermo
G
Castilla
Cristina
C
Antonio García-Vela
José
J
Salar
Antonio
A
Alonso-Vence
Natalia
N
González-Barca
Eva
E
Peñalver
Francisco Javier
FJ
Plaza-Villa
Josefa
J
Morado
Marta
M
García-Marco
José
J
Arias
Jesús
J
Briones
Javier
J
Ferrer
Secundino
S
Capote
Javier
J
Nicolás
Concepción
C
Orfao
Alberto
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001402:B-Lymphocytes / Q000473:pathology; D005260:Female; D005434:Flow Cytometry / Q000379:methods*; D006801:Humans; D007962:Leukocytes / Q000473:pathology; D016393:Lymphoma, B-Cell / Q000134:cerebrospinal fluid* / Q000473:pathology; D008297:Male; D008577:Meningeal Neoplasms / Q000134:cerebrospinal fluid* / Q000473:pathology; D008875:Middle Aged; D012680:Sensitivity and Specificity; D055815:Young Adult