title: Multiparameter flow cytometry in the diagnosis and management of acute leukemia.
abstract: BACKGROUND
  Timely and accurate diagnosis of hematologic malignancies is crucial to appropriate clinical management. Acute leukemias are a diverse group of malignancies with a range of clinical presentations, prognoses, and preferred treatment protocols. Historical classification systems relied predominantly on morphologic and cytochemical features, but currently, immunophenotypic, cytogenetic, and molecular data are incorporated to define clinically relevant diagnostic categories. Multiparameter flow cytometry provides rapid and detailed determination of antigen expression profiles in acute leukemias which, in conjunction with morphologic assessment, often suggests a definitive diagnosis or a narrow differential. Many recurrent molecular or cytogenetic aberrations are associated with distinct immunophenotypic features, and therefore flow cytometry is an important tool to direct further testing. In addition, detection of specific antigens may have prognostic or therapeutic implications even within a single acute leukemia subtype. After initial diagnosis, a leukemia's immunophenotypic fingerprint provides a useful reference to monitor response to therapy, minimal residual disease, and recurrence.
  
  
  OBJECTIVE
  To provide an overview of the application of flow cytometric immunophenotyping to the diagnosis and management of acute leukemias, including salient features of those entities described in the 2008 World Health Organization classification.
  
  
  METHODS
  Published articles pertaining to flow cytometry, acute leukemia classification, and experiences of a reference flow cytometry laboratory.
  
  
  CONCLUSIONS
  Immunophenotypic evaluation is essential to accurate diagnosis and classification of acute leukemia. Multiparameter flow cytometry provides a rapid and effective means to collect this information, as well as providing prognostic information and a modality for minimal residual disease evaluation.
authors.affiliation: Department of Pathology, Southwestern Medical School, 5323 Harry Hines Blvd., Dallas, TX 75390-9073, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Peters
authors.forename: M Qasim
authors.initials: MQ
authors.lastname: Ansari
mesh_terms: D000208:Acute Disease; D019468:Disease Management; D005434:Flow Cytometry; D006801:Humans; D016130:Immunophenotyping; D007938:Leukemia / Q000145:classification / Q000175:diagnosis* / Q000235:genetics; D015470:Leukemia, Myeloid, Acute / Q000145:classification / Q000175:diagnosis / Q000235:genetics; D018365:Neoplasm, Residual / Q000175:diagnosis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000235:genetics