Immunophenotypic expression and immunomodulation in minimal residual disease analysis of pediatric B acute lymphoblastic leukemia by high sensitive flow cytometry

Abstract

The major challenge in minimal residual disease (MRD) detection is the antigen modulation in post treated samples restraining the use of diagnostic immunophenotypic (IP) signature of leukemic blasts for MRD detection. The IP expression of 10 antigens in 167 children diagnosed as B-acute lymphoblastic leukemia (B-ALL) in comparison to hematogones and the extent of immunomodulation in 60 post treated MRD positive cases were studied. Upregulation was the predictable shift noted in antigens like CD73, CD86, CD19, CD20 and CD45 which was statistically significant for all except CD45. Downregulation was the predictable shift noted in antigens like CD10, CD38, CD58 and CD34 and was statistically significant in all. CD123 showed no significant trend. This immunomodulation in B-ALL results in aberrant expression of antigens during follow-up compared to the diagnostic phenotypic pattern. Hence it is necessary to be aware of the immunomodulations of antigens used in primary diagnosis to avoid being misled during MRD analysis.

Keywords:

• Precursor B-lineage
• acute lymphoblastic leukemia
• minimal residual disease
• immunophenotyping
• immunomodulation

Acknowledgments

Mrs. Arcot Radhakrishnan Abitha (Senior scientific assistant) is acknowledged for her efforts in FCM sample processing and sample acquisition. Dr. Rama R, Assistant professor and statistician helped with the statistics involved in the manuscript.

Disclosure statement

All authors have made significant contribution toward the manuscript, have agreed to the final version of the manuscript being submitted and don’t have any conflict of interest to declare. There was no specific funding received for this study.

Additional information

Funding

We acknowledge the support provided by the Indian Council of Medical Research (ICMR) and National Cancer Grid (NCG) towards the Indian childhood collaborative leukemia (ICiCLe) project.