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Standardization of flow cytometry in myelodysplastic syndromes: a report from an international consortium and the European LeukemiaNet Working Group

Abstract

Flow cytometry (FC) is increasingly recognized as an important tool in the diagnosis and prognosis of myelodysplastic syndromes (MDS). However, validation of current assays and agreement upon the techniques are prerequisites for its widespread acceptance and application in clinical practice. Therefore, a working group was initiated (Amsterdam, 2008) to discuss and propose standards for FC in MDS. In 2009 and 2010, representatives from 23, mainly European, institutes participated in the second and third European LeukemiaNet (ELN) MDS workshops. In the present report, minimal requirements to analyze dysplasia are refined. The proposed core markers should enable a categorization of FC results in cytopenic patients as ‘normal’, ‘suggestive of’, or ‘diagnostic of’ MDS. An FC report should include a description of validated FC abnormalities such as aberrant marker expression on myeloid progenitors and, furthermore, dysgranulopoiesis and/or dysmonocytopoiesis, if at least two abnormalities are evidenced. The working group is dedicated to initiate further studies to establish robust diagnostic and prognostic FC panels in MDS. An ultimate goal is to refine and improve diagnosis and prognostic scoring systems. Finally, the working group stresses that FC should be part of an integrated diagnosis rather than a separate technique.

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Acknowledgements

We express our gratitude to Wolfgang Kern (MLL, Munich, Germany) and Robin Ireland (King's College Hospital, London, UK) for their excellent organization and facilitation of the ELN Working Group meetings in 2009 and 2010, respectively. Furthermore, we acknowledge financial support from the European LeukemiaNet (ELN WP8), the ‘Elimination of Leukaemia Fund’ (UK), Leukaemia and Lymphoma Research (UK), Alexion (UK), Amgen Oncology (UK, Beckman Coulter (Krefeld, Germany), Becton Dickinson (UK), and Celgene (Germany and UK), and Cooperative Research Thematic Network on Cancer (RD06/0020/0035) from the Ministerio de Ciencia e Innovación (Madrid, Spain).

Author Contributions

All persons listed as co-authors contributed to pre-conference and post-conference discussions (June 2009 until November 2010), and actively participated in the Standardization Conferences (Munich, Germany, 30–31 October 2009; London, UK, 5–6 November 2010). All co-authors contributed equally by discussing criteria, standards, algorithms and recommendations at the Working Conference. In addition, all persons listed as co-authors provided essential input by drafting parts of the manuscript and by approving the final version of the document.

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Westers, T., Ireland, R., Kern, W. et al. Standardization of flow cytometry in myelodysplastic syndromes: a report from an international consortium and the European LeukemiaNet Working Group. Leukemia 26, 1730–1741 (2012). https://doi.org/10.1038/leu.2012.30

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