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Flow Cytometry of CD5-Positive Hairy Cell Leukemia

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Abstract

Background and Objective

Hairy cell leukemia (HCL) is a chronic lymphoproliferative disorder for which diagnosis is typically straightforward, based on bone marrow morphology and flow cytometry (FC) or immunohistochemistry. Nevertheless, variants present atypical expressions of cell surface markers, as is the case of CD5, for which the differential diagnosis can be more difficult. The aim of the current paper was to describe diagnosis of HCL with atypical CD5 expression, with an emphasis on FC.

Methods

The detailed diagnostic methodology for HCL with atypical CD5 expression is presented, including differential diagnosis from other lymphoproliferative diseases with similar pathologic features, by FC analysis of the bone marrow aspirate.

Results

Diagnosis of HCL by means of FC started by gating all events based on side scatter (SSC) versus CD45 and B lymphocytes were selected from the lymphocytes gate as CD45/CD19 positive. The gated cells were positive for CD25, CD11c, CD20, and CD103, while CD10 proved to be dim to negative. Moreover, cells positive for CD3, CD4, and CD8, the three pan-T markers, as well as CD19, showed a bright expression of CD5. The atypical CD5 expression is usually correlated with a negative prognosis and thus chemotherapy with cladribine should be initiated.

Conclusion

HCL is an indolent chronic lymphoproliferative disorder and diagnosis is usually straightforward. However, atypical expression of CD5 renders its differential diagnosis more difficult, but FC is a useful tool that allows an optimal classification of the disease and allows initiation of timely satisfactory therapy.

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Author notes

  1. Diana Cenariu and Ioana Rus contributed equally to the article and are both considered first authors.

Authors and Affiliations

  1. Medfuture Research Center for Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Louis Pasteur Street, Cluj-Napoca, Romania

    Diana Cenariu, Adrian-Bogdan Tigu, Bobe Petrushev & Ciprian Tomuleasa

  2. Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania

    Ioana Rus, Delia Dima, Cristina Selicean & Mihnea Zdrenghea

  3. Stem Cell Research Unit, Biomedical Center, School of Health Sciences, University of Iceland, Reykjavík, Iceland

    Jon Thor Bergthorsson

  4. Department of Pathology, National Health Laboratory Services, Port Elizabeth, South Africa

    Ravnit Grewal

  5. Department of Clinical Sciences, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca, Romania

    Mihai Cenariu

  6. Laboratory for Computational and Systems Immunology, University of Oslo, Oslo, Norway

    Victor Greiff

  7. Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA

    Jonathan Fromm

  8. Haematology Laboratory, University Hospital of Saint-Etienne, Saint-Etienne, France

    Carmen-Mariana Aanei

  9. INSERM U1059-SAINBIOSE, Université de Lyon, Saint-Etienne, France

    Carmen-Mariana Aanei

Authors
  1. Diana Cenariu
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  14. Ciprian Tomuleasa
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Corresponding author

Correspondence to Ciprian Tomuleasa.

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Funding

Diana Cenariu, Mihai Cenariu, Jon Thor Bergthorsson, and Victor Greiff are financed by an international collaborative grant of the European Economic Space between Romania, Iceland, and Norway 2014–2021 (Grant no 21-COP-0034). Diana Cenariu also received funding from a grant of the National Research Ministry of Romania - PN-III-P4-ID-PCE-2020-1118.

Conflict of interest

Diana Cenariu, Ioana Rus, Jon Thor Bergthorsson, Ravnit Grewal, Mihai Cenariu, Victor Greiff, Bogdan Tigu, Delia Dima, Mihnea Zdrenghea, Cristina Selicean, Bobe Petrushev, Jonathan Fromm, Carmen-Mariana Aanei, and Ciprian Tomuleasa declare that they have no conflicts of interest.

Availability of data and material

Data supporting the results reported in the article can be found at Medfuture Research Center for Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.

Ethics approval

The study was approved by the Ethics committee of the Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Consent to participate

Informed written consent was obtained from the patient included in the study.

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Not applicable.

Code availability

Not applicable.

Author contributions

Diana Cenariu, Bogdan Tigu, Cristina Selicean, Mihnea Zdrenghea, Bobe Petrushev, and Mihai Cenariu prepared the samples and performed the flow cytometry analysis; Ioana Rus, Delia Dima, and Ciprian Tomuleasa performed clinical examination of the patient, collected the bone marrow sample, and established the final diagnosis and treatment. Jon Thor Bergthorsson, Victor Greiff, Ravnit Grewal, and Jonathan Fromm provided valuable input on bone marrow analysis methodology, evaluated the results and participated in the preparation of the Discussion section, Diana Cenariu, Ioana Rus, and Mihai Cenariu drafted the manuscript; Carmen-Mariana Aanei and Ciprian Tomuleasa reviewed the whole manuscript and established its final form.

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Cenariu, D., Rus, I., Bergthorsson, J.T. et al. Flow Cytometry of CD5-Positive Hairy Cell Leukemia. Mol Diagn Ther 27, 593–599 (2023). https://doi.org/10.1007/s40291-023-00658-x

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  • DOI: https://doi.org/10.1007/s40291-023-00658-x

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