Flow cytometry for minimal residual disease testing in acute leukemia: opportunities and challenges

ABSTRACT

Introduction: Flow cytometric quantification of minimal residual disease (MRD) in acute leukemia (AL) represents an indispensable tool to guide modern therapeutic protocols toward a precision medicine approach, being a powerful predictor of the overall response to treatment. This review covers the most challenging aspects and developments of this method, aiming at supporting further its implementation in clinical practices.

Area covered: Flow cytometric MRD is based on the discrimination of leukemia cells from their physiological counterparts by the recognition of the leukemia-associated immunophenotypes. Technical and standardization advances along the last decades have been implemented allowing flow cytometric MRD to consolidate its role in modern therapeutic protocols for ALs. However, gaps in sensitivity and data interpretation are still present together with the need for further optimization of MRD-based clinical protocols. In this review, we critically analyze and discuss the most relevant and representative contributions in the field by accurate selection of the literature available in PubMed.

Expert commentary: Further research in flow cytometric MRD can bring this technology toward wider and consistent applications in multiple acute leukemia settings rendering this tool a future golden standard and providing clinicians with more reliable and accurate tools for clinical decisions.

KEYWORDS:

• Acute Leukemia
• flow cytometry
• minimal residual disease

Acknowledgments

The authors would like to acknowledge Mr. Oscar Maglia and Mrs Giada Matera for valuable technical support and for assistance in preparing the Figures (OM), and the Associazione Italiana Emato-Oncologia Pediatrica (AIEOP) centers for their continuous support.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Funding

This article was funded by Charities: Comitato Maria Letizia Verga; Fondazione Alessandro Maria Zancan (GrandeAle) ONLUS. Grants: Investigator Grant 2017 Associazione Italiana per la Ricerca sul Cancro (AIRC; project number 20564 to A.B.); AIRC Special Program Molecular Clinical Oncology-5 per mile 2018 (project number 21147 to A.B.)