title: Implementation of erythroid lineage analysis by flow cytometry in diagnostic models for myelodysplastic syndromes.
abstract: Flow cytometric analysis is a recommended tool in the diagnosis of myelodysplastic syndromes. Current flow cytometric approaches evaluate the (im)mature myelo-/monocytic lineage with a median sensitivity and specificity of ~71% and ~93%, respectively. We hypothesized that the addition of erythroid lineage analysis could increase the sensitivity of flow cytometry. Hereto, we validated the analysis of erythroid lineage parameters recommended by the International/European LeukemiaNet Working Group for Flow Cytometry in Myelodysplastic Syndromes, and incorporated this evaluation in currently applied flow cytometric models. One hundred and sixty-seven bone marrow aspirates were analyzed; 106 patients with myelodysplastic syndromes, and 61 cytopenic controls. There was a strong correlation between presence of erythroid aberrancies assessed by flow cytometry and the diagnosis of myelodysplastic syndromes when validating the previously described erythroid evaluation. Furthermore, addition of erythroid aberrancies to two different flow cytometric models led to an increased sensitivity in detecting myelodysplastic syndromes: from 74% to 86% for the addition to the diagnostic score designed by Ogata and colleagues, and from 69% to 80% for the addition to the integrated flow cytometric score for myelodysplastic syndromes, designed by our group. In both models the specificity was unaffected. The high sensitivity and specificity of flow cytometry in the detection of myelodysplastic syndromes illustrates the important value of flow cytometry in a standardized diagnostic approach. The trial is registered at www.trialregister.nl as NTR1825; EudraCT n.: 2008-002195-10.
authors.affiliation: Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands.
authors.forename: Eline M P
authors.initials: EM
authors.lastname: Cremers
authors.affiliation: Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands.
authors.forename: Theresia M
authors.initials: TM
authors.lastname: Westers
authors.affiliation: Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands.
authors.forename: Canan
authors.initials: C
authors.lastname: Alhan
authors.affiliation: Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands.
authors.forename: Claudia
authors.initials: C
authors.lastname: Cali
authors.affiliation: HOVON Data Center, Erasmus MC Cancer Institute, Clinical Trial Center, Rotterdam, The Netherlands.
authors.forename: Heleen A
authors.initials: HA
authors.lastname: Visser-Wisselaar
authors.affiliation: HOVON Data Center, Erasmus MC Cancer Institute, Clinical Trial Center, Rotterdam, The Netherlands.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Chitu
authors.affiliation: Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Vincent H J
authors.initials: VH
authors.lastname: van der Velden
authors.affiliation: Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Jeroen G
authors.initials: JG
authors.lastname: Te Marvelde
authors.affiliation: Department of Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Saskia K
authors.initials: SK
authors.lastname: Klein
authors.affiliation: Department of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Petra
authors.initials: P
authors.lastname: Muus
authors.affiliation: Department of Hematology, University Medical Center Groningen, The Netherlands.
authors.forename: Edo
authors.initials: E
authors.lastname: Vellenga
authors.affiliation: Department of Hematology Erasmus MC Cancer Institute Rotterdam, The Netherlands.
authors.forename: Georgina E
authors.initials: GE
authors.lastname: de Greef
authors.affiliation: Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Marie-Cecile C J C
authors.initials: MC
authors.lastname: Legdeur
authors.affiliation: Department of Internal Medicine, Haga Ziekenhuis, The Hague, The Netherlands.
authors.forename: Pierre W
authors.initials: PW
authors.lastname: Wijermans
authors.affiliation: Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Marian J P L
authors.initials: MJ
authors.lastname: Stevens-Kroef
authors.affiliation: Laboratory of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Pedro da
authors.initials: PD
authors.lastname: Silva-Coelho
authors.affiliation: Laboratory of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Joop H
authors.initials: JH
authors.lastname: Jansen
authors.affiliation: Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands.
authors.forename: Gert J
authors.initials: GJ
authors.lastname: Ossenkoppele
authors.affiliation: Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands a.vandeloosdrecht@vumc.nl.
authors.forename: Arjan A
authors.initials: AA
authors.lastname: van de Loosdrecht
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D016022:Case-Control Studies; D019070:Cell Lineage; D041905:Erythroid Cells / Q000378:metabolism*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D016130:Immunophenotyping; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000175:diagnosis* / Q000378:metabolism*
chemical_list: D015415:Biomarkers