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Assessment of myeloid and monocytic dysplasia by flow cytometry in de novo AML helps define an AML with myelodysplasia-related changes category
  1. Olga K Weinberg1,
  2. Robert P Hasserjian2,
  3. Betty Li3,
  4. Olga Pozdnyakova3
  1. 1Department of Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
  2. 2Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Olga K Weinberg, Department of Pathology, Boston Children's Hospital, 300 Longwood Ave, Bader 126, Boston, MA 02115, USA; Olga.Weinberg{at}


Aims In recent years, multiparameter flow cytometry has been increasingly recognised as an important tool in diagnosis of myelodysplastic syndrome and acute myeloid leukaemia (AML). Assessment of myeloid and monocytic ‘immunophenotypic’ dysplasia by flow cytometry in de novo AML has not been evaluated.

Methods 97 cases of de novo AML cases were identified and reviewed by three hematopathologists. ‘Immunophenotypic’ dysplasia was assessed on blasts, monocytes and granulocytes by mean fluorescence intensity.

Results Using the 2008 WHO classification criteria, there were 53 AML-not otherwise specified (NOS) (55%) and 28 AML with myelodysplasia-related changes (AML-MRC) (29%), while 16 cases were ambiguous as to AML-MRC status due to limited maturing cells for morphologic but adequate events number for immunophenotypic evaluation (AML-not evaluable, 16%). Compared with AML-NOS, granulocytic cells in AML-MRC had higher CD33 expression but lower CD45, CD11b and CD15. Monocytes in AML-MRC had lower expression of CD14, CD56 and CD45. Morphologic dysplasia was associated with significantly lower granulocytic forward scatter, side scatter and CD10 but higher CD33 expression.

Conclusions Our results suggest that the workup of AML cases should include flow cytometric assessment of granulocytes and monocytes. This analysis can aid a morphologic impression of multilineage dysplasia in distinguishing AML-MRC from AML-NOS, especially in cases with limited maturing myeloid cells.


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  • Handling editor Mary Frances McMullin

  • Contributors All authors contributed to this work. OKW and OP designed the study, analysed the data and wrote the manuscript. RPH and BL analysed the data and helped to write the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.