Agus S. Kosasih, MD

Dharmais National Cancer Center Jakarta, Indonesia

Leukemia and lymphoma are account in the top 10th cancer in Indonesia. Generally, for diagnosis hematologic malignancies comprise of morphology, cytochemistry, cytogenetic, and biomolecular. Morphology study has been used widely in almost laboratory but has several limitations such as difficulty to differ type of cell and maturation degree and eventually diagnose the type of cancer. Cytochemistry, cytogenetic and biomolecular testing are not been used widely in laboratory. Flow cytometry is rapidly being used in many fields in hematological disorders, especially in malignancies. In hematological malignancies, it is commonly used in diagnosis, characterization, prognostication, monitoring of therapy and even selecting therapy target of acute leukemia and lymphoma.

Flow cytometry is a rapid, dynamic method of multiparameter, multicolour, single-cell analysis that may be combined with cell sorting. Immunophenotyping is a method that can be differentiate acute leukaemia into AML, ALL, or mixed phenotype of acute leukaemia; and can detect minimal residual disease (MRD) in ALL. This method uses panel of surface cell marker that specific to cell lineage. Flow cytometry can identify abnormal population by assessing increased or decreased antigen expression, asynchronous antigen expression, aberrant expression, and homogenous antigen expression.

In leukaemia setting, flow cytometry analysis should be systematically performed in all cases such as differentiate acute leukaemia (AML and ALL), blast transformation in CML, blast transformation of other myeloproliferative disorders and myeloid dysplasia, mixed lineage acute leukaemia (MPAL), and to detect minimal residual disease (MRD) in ALL. Flow cytometry in lymphoma is beneficial to differ non Hodgkin lymphoma (NHL) with benign reactive hyperplasia (BRH), classify of NHL (small and medium-large NHL), as surrogate marker of mutation status, and determine prognostic marker.

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