Acute leukemia: Diagnosis improved by flow cytometry in addition to morphology

Aims: Immunophenotyping using flow cytometry (FCM) has become an essential component of acute leukemia (AL) diagnosis. This study evaluated the judicious application of FCM as an adjunct to well-informed morpho-cytochemical assessment in patients with acute leukemia. Methods: 100 untreated patients with AL were studied using morpho-cytochemistry and immunophenotyping through FCM. Results: There were 29 patients with acute myeloid leukemia (AML), 47 with B-acute lymphoblastic leukemia (ALL), 20 with T-acute lymphoblastic leukemia (ALL) and four with biphenotypic acute leukemia (BAL). Morpho-cytochemistry without FCM could provide definite diagnosis only in the AML cases. It failed to provide definite diagnosis in ALL patients. Over half (55%) of ALL patients were given the noncommittal label, AL. The remaining 45% patients were labeled a more definite, probable ALL. Conclusion: FCM thus had a role to play in ALL patients to confirm a definite and a probable diagnosis, to define therapeutically and prognostically groups such as B and T lineage ALL and to distinguish AML - M0 from ALL. FCM helps in diagnosing AML cases as well, but is a less essential mode of investigation in this group purely from the perspective of the therapy regime. But its role in defining different subgroups in AML is its major use. While morpho-cytochemistry provides a first-line investigation of great therapeutic value, and more so in AML, it needs to be supplemented by flow cytometry, particularly in ALL.