Myelodysplastic Syndromes with Bone Marrow Fibrosis: An Update
Akriti G. Jain 
, M.D., Ling Zhang , M.D., John M. Bennett , M.D., and Rami Komrokji , M.D.
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Review Article2022-05-01 Diagnostic Hematology
Abstract : Myelodysplastic syndrome (MDS) is a diverse hematological malignancy with a wide spectrum of presentations and implications. Treatment strategies for patients with MDS heavily rely on prognostic scoring systems, such as the revised international prognostic scoring system (IPSS-R). Bone marrow fibrosis (BMF) has been identified as an independent risk factor for poor survival in patients with MDS, irrespective of the IPSS-R risk category. However, BMF is not widely included in scoring systems and is not always considered by clinicians when making treatment decisions for patients. In this review, we discuss the available literature about the presentation and prognosis of patients with MDS and concurrent BMF. The prognostic impact of BMF should be factored in when deciding on transplant candidacy, especially for intermediate-risk patients.
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Review Article2022-09-01 Diagnostic Hematology
Unreliable Automated Complete Blood Count Results: Causes, Recognition, and Resolution
Gene Gulati, Ph.D., Guldeep Uppal, M.D., and Jerald Gong, M.D.
Ann Lab Med 2022; 42(5): 515-530Abstract : Automated hematology analyzers generate accurate complete blood counts (CBC) results on nearly all specimens. However, every laboratory encounters, at times, some specimens that yield no or inaccurate result(s) for one or more CBC parameters even when the analyzer is functioning properly and the manufacturer’s instructions are followed to the letter. Inaccurate results, which may adversely affect patient care, are clinically unreliable and require the attention of laboratory professionals. Laboratory professionals must recognize unreliable results, determine the possible cause(s), and be acquainted with the ways to obtain reliable results on such specimens. We present a concise overview of the known causes of unreliable automated CBC results, ways to recognize them, and means commonly utilized to obtain reliable results. Some examples of unreliable automated CBC results are also illustrated. Pertinent analyzer-specific information can be found in the manufacturers’ operating manuals.
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Brief Communication2021-09-01 Diagnostic Hematology
Granulocytic and Monocytic Myeloid-Derived Suppressor Cells are Functionally and Prognostically Different in Patients with Chronic Myeloid Leukemia
Ari Ahn
Ann Lab Med 2021; 41(5): 479-484, M.D., Chan-Jeoung Park , M.D., Ph.D., Min-sun Kim , M.D., Young-Uk Cho , M.D., Ph.D., Seongsoo Jang , M.D., Ph.D., Mi Hyun Bae , M.D., Ph.D., Jung-Hee Lee , M.D., Ph.D., Je-Hwan Lee , M.D., Ph.D., Kyung-Nam Koh , M.D., Ph.D., and Ho Joon Im , M.D., Ph.D.Abstract : Myeloid-derived suppressor cells (MDSCs) represent phenotypically heterogeneous populations that suppress tumor-specific T-cell responses. MDSCs are produced from myeloid precursors in emergent states and are increased in several hematologic malignancies. We evaluated the differences in the levels and prognostic significance of MDSCs according to the clinical status of chronic myeloid leukemia (CML). The percentages and numbers of granulocytic (g)MDSCs and monocytic (m)MDSCs in peripheral blood (PB) and bone marrow (BM) aspirates were determined by five-color flow cytometry (HLA-DR/CD11b/CD15/CD33/CD14). The median BM-gMDSC% and PB-gMDSC% of the CML group were lower than those of the complete hematologic response (CHR) and control groups (P
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Original Article2021-05-01 Diagnostic Hematology
Immune Checkpoint Programmed Cell Death Protein-1 (PD-1) Expression on Bone Marrow T Cell Subsets in Patients With Plasma Cell Myeloma
Min Young Lee
Ann Lab Med 2021; 41(3): 259-267, M.D., Ph.D., Chan-Jeoung Park , M.D., Ph.D., Young-Uk Cho , M.D., Ph.D., Eunkyoung You , M.D., Ph.D., Seongsoo Jang , M.D., Ph.D., Eul Ju Seo , M.D., Ph.D., Jung-Hee Lee , M.D., Ph.D., Dok Hyun Yoon , M.D., Ph.D., and Cheolwon Suh , M.D., Ph.D.Abstract : Background: Plasma cell myeloma (PCM) is caused by immune dysregulation. We evaluated the expression of immune checkpoint programmed cell death protein-1 (PD-1) on T cell subsets in PCM patients according to disease course and cytogenetic abnormalities. This study aimed to find a target group suitable for therapeutic use of PD-1 blockade in PCM. Methods: A total of 188 bone marrow (BM) samples from 166 PCM patients and 32 controls were prospectively collected between May 2016 and May 2017. PD-1 expression on BM T cell subsets was measured using flow cytometry. Results: At diagnosis, the median PD-1 expression on CD4+ T cells was 24.6%, which did not significantly differ from that in controls. After stem cell transplantation, PD-1 expression on CD4+ T cells was higher than that at diagnosis (P
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Letter to the Editor2021-09-01 Diagnostic Hematology
Bone Marrow Findings in Patients With Ewing Sarcoma/Primitive Neuroectodermal Tumor
Kuenyoul Park
Ann Lab Med 2021; 41(5): 499-501, M.D., Hyeri Kim , M.D., Ph.D., Kyung-Nam Koh , M.D., Ph.D., Ho Joon Im , M.D., Ph.D., Young-Uk Cho , M.D., Ph.D., Seongsoo Jang , M.D., Ph.D., Eul-Ju Seo , M.D., Ph.D., Chan-Jeoung Park , M.D., Ph.D. -
Brief Communication2021-07-01 Diagnostic Hematology
Phospholipase C Beta 2 Protein Overexpression Is a Favorable Prognostic Indicator in Newly Diagnosed Normal Karyotype Acute Myeloid Leukemia
Mi Suk Park
Ann Lab Med 2021; 41(4): 409-413, Ph.D., Young Eun Lee , M.S., Hye Ran Kim , Ph.D., Jong Hee Shin , M.D., Ph.D., Hyun Wook Cho , Ph.D., Jun Hyung Lee , M.D., Ph.D., and Myung Geun Shin , M.D., Ph.D.Abstract : Phospholipase C beta 2 (PLC-β2) regulates various essential functions in cell signaling, differentiation, growth, and mobility. We investigated the clinical implications of PLC-β2 protein expression in newly diagnosed normal karyotype acute myeloid leukemia (NK-AML). The PLC-β2 expression status in bone marrow tissues obtained from 101 patients with NK-AML was determined using semiquantitative immunohistochemistry (IHC). IHC results were compared with those for known prognostic markers. Using a cutoff score for positivity of 7.0, the PLC-β2 overexpression group showed superior overall survival (OS) (72.6% vs. 26.5%; P=0.016) and low hazard ratio (HR) (0.453; P=0.019) compared with the PLC-β2 low-expression group. The PLC-β2 overexpression group showed no significant gain in event-free survival (50.6% vs. 43.0%, P=0.465) and HR (0.735; P=0.464). Among the known prognostic markers, only FLT3-ITD positivity was associated with a significantly low OS and high HR. In conclusion, PLC-β2 overexpression was associated with favorable OS in NK-AML patients. Our results suggest that PLC-β2 expression assessment using IHC allows prognosis prediction in NK-AML.
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Original Article2022-07-01 Diagnostic Hematology
Digital Morphology Analyzer Sysmex DI-60 vs. Manual Counting for White Blood Cell Differentials in Leukopenic Samples: A Comparative Assessment of Risk and Turnaround Time
Minjeong Nam
Ann Lab Med 2022; 42(4): 398-405 , M.D., Ph.D., Sumi Yoon , M.D., Mina Hur , M.D., Ph.D., Gun Hyuk Lee , M.D., Hanah Kim , M.D., Ph.D., Mikyoung Park , M.D., Ph.D., and Hyeong Nyeon Kim , M.D.Abstract : Background: Digital morphology (DM) analyzers are increasingly being used for white blood cell (WBC) differentials. We assessed the laboratory efficiency of the Sysmex DI-60 system (DI-60; Sysmex, Kobe, Japan) in comparison with manual counting in leukopenic samples. Methods: In total, 40 peripheral blood smear samples were divided into normal, mild leukopenia, moderate leukopenia, and severe leukopenia groups based on WBC count. In each group, the risk and turnaround time (TAT) were compared between DI-60 and manual counting. Risk was determined by failure mode and effect analysis using the risk priority number (RPN) score, and TAT was recorded for the analytical phase. Results: Overall, DI-60 showed a five-fold lower risk (70 vs. 350 RPN) and longer TAT than manual counting. In severe leukopenic samples, DI-60 showed a shorter TAT/slide and a remarkably lower cell count/slide than manual counting. In all samples, the TAT/cell for DI-60 was substantially longer than that for manual counting (DI-60 vs. manual: total, 1.8 vs. 1.0 sec; normal, 1.5 vs. 0.7 sec; mild leukopenia, 1.9 vs. 0.9 sec; moderate leukopenia, 1.8 vs. 1.0 sec; severe leukopenia, 28.8 vs. 19.0 sec). Conclusions: This is the first comparative assessment of risk and TAT between DI-60 and manual counting in leukopenic samples. DI-60 decreases the laboratory risk and improves patient safety, but requires more time to count fewer cells, especially in severe leukopenic samples. DM analyzers should be applied selectively depending on the WBC count to optimize laboratory efficiency.
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Letter to the Editor2022-03-01 Diagnostic Hematology
Concomitant Diagnosis of Primary Bone Marrow B-Cell Non-Hodgkin Lymphoma and Essential Thrombocythemia: A Case Report
Hongkyung Kim
Ann Lab Med 2022; 42(2): 282-285, M.D., Hye Min Kim , M.D., Jin Ju Kim , M.D., Saeam Shin , M.D., Doh Yu Hwang , M.D., Seung-Tae Lee , M.D., and Jong Rak Choi , M.D. -
Original Article2022-09-01 Diagnostic Hematology
Clinical Utility of Next-Generation Flow-Based Minimal Residual Disease Assessment in Patients with Multiple Myeloma
Hyun-Young Kim
Ann Lab Med 2022; 42(5): 558-565, M.D., In Young Yoo , M.D., Dae Jin Lim , M.T., Hee-Jin Kim , M.D., Sun-Hee Kim , M.D., Sang Eun Yoon , M.D., Seok Jin Kim , M.D., Duck Cho , M.D., and Kihyun Kim , M.D.Abstract : Background: Minimal residual disease (MRD) is an important prognostic factor for evaluating a deeper treatment response in patients with multiple myeloma (MM). We evaluated the clinical utility of next-generation flow (NGF)-based MRD assessment in a heterogeneous MM patient population. Methods: Patients with suspected morphological remission after or during MM treatment were prospectively enrolled. In total, 108 bone marrow samples from 90 patients were analyzed using NGF-based MRD assessment according to the EuroFlow protocol, and progression-free survival (PFS) was evaluated according to the International Myeloma Working Group response status, cytogenetic risk, and MRD status. Results: The overall MRD-positive rate was 31.5% (34/108 samples), and MRD-positive patients showed a lower PFS than MRD-negative patients (P=0.005). MRD-positive patients showed inferior PFS than MRD-negative in patients with stringent complete remission (sCR)/complete remission (P=0.014) and high-risk cytogenetic abnormalities (P=0.016). MRD was assessed twice in 18 patients with a median interval of 12 months. Sustained MRD negativity was only observed in patients with sustained sCR, and their PFS was superior to that of patients who were not MRD-negative (P=0.035). Conclusions: Clinical application of NGF-based MRD assessment can provide valuable information for predicting disease progression in patients with MM in remission, including those with high-risk cytogenetic abnormalities.
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Letter to the Editor2022-03-01 Diagnostic Hematology
Clinical Performance of Monocyte Distribution Width for Early Detection of Sepsis in Emergency Department Patients: A Prospective Study
Shinae Yu
Ann Lab Med 2022; 42(2): 286-289, M.D., Sae Am Song , M.D., Ph.D., Kyung Ran Jun , M.D., Ph.D., Ha Young Park , M.D., and Jeong Nyeo Lee , M.D., Ph.D.
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