Flow Cytometric Detection of Malignant Cells in Body Fluids

原发性渗出性淋巴瘤是一种侵袭性淋巴瘤，发生在HIV和HHV8的背景下，主要涉及体液。多中心卡斯特尔曼氏病是一种非克隆性增殖性疾病，发生在相同的临床环境中。在这些罕见疾病中，形态诊断是困难的。我们已经开发了临床流式细胞仪分析，可以帮助诊断原发性渗出性淋巴瘤和多中心卡斯特尔曼病，为使用NCI方案的患者提供关键的临床支持。仅凭形态学也很难证明血液系统恶性肿瘤累及脑脊液(CSF)。在一项单独的形态学与流式细胞术的形态学比较研究中，我们证明了在一系列已知的淋巴瘤或白血病患者中，流式细胞仪免疫荧光分型有助于确定肿瘤的诊断，以及使用形态标准初步诊断“不典型的”或“可疑的”脑脊液。流式细胞术单位评估了流式细胞术分析在高级别B细胞淋巴瘤患者分期和治疗中的作用。流式细胞仪鉴定出的肿瘤克隆仅占脑脊液淋巴细胞总数的0.02%。流式细胞仪检测到细胞学、化学和细胞计数失败的受累。流式细胞仪检测疾病是一个负面的预后因素，现在促使治疗干预。作为这项研究的结果，建议有中枢神经系统受累风险的侵袭性B细胞淋巴瘤患者接受通过流式细胞仪进行分期的脑脊液评估。流式细胞术单位参加了一次国际共识会议，以确定对脑脊液进行流式细胞术分析的最佳方法。

Primary effusion lymphoma is an aggressive lymphoma arising in the setting of HIV and HHV8 that primarily involves body fluids. Multicentric Castlemans disease is a non-clonal proliferative process that arises in the same clinical setting. Morphological diagnosis is difficult in these rare diseases. We have developed clinical flow cytometric assays that can aid in the diagnosis of primary effusion lymphoma and multicentric Castlemans disease, providing key clinical support to patients on NCI protocols. Involvement of the cerebrospinal fluid (CSF) by hematopoietic malignancies may also be difficult to document by morphology alone. In a study comparing morphology alone to morphology with flow cytometry, we demonstrated that flow cytometric immunophneotyping was useful in establishing a diagnosis of neoplasia in a series of patients with known lymphoma or leukemia and an initial diagnosis of "atypical" or "suspicious" CSF using morphologic criteria. The Flow Cytometry Unit evaluated the role of flow cytometric analysis in staging and management of patients with high grade B cell lymphomas. Flow cytometry identified neoplastic clones that constituted as little as 0.02% of total CSF lymphocytes. Flow cytometry detected involvement where cytology, chemistry and cell counts failed. Flow cytometric detection of disease was a negative prognostic factor and now prompts therapeutic intervention. As a result of the study it is recommended that patients at risk for CNS involvement by aggressive B cell lymphoma undergo staging CSF evaluation by flow cytometry. The Flow Cytometry Unit participated in an international consensus conference to determine optimal methodology for flow cytometric analysis of CSF.