International Journal of Hematology

, Volume 99, Issue 3, pp 296–304 | Cite as

Prognostic significance of flow cytometric residual disease, dysregulated neutrophils/monocytes, and hematogones in adult acute myeloid leukemia in first remission

  • Sung-Chao Chu
  • Tso-Fu Wang
  • Yu-Chieh Su
  • Ruey-Ho Kao
  • Yi-Feng Wu
  • Dian-Kun Li
  • Szu-Chin Li
  • Chi-Cheng Li
  • Denise A. Wells
  • Michael R. Loken
Original Article


Fifty-one consecutive non-M3 acute myeloid leukemia (AML) patients who had achieved morphologic complete remission (mCR) after induction chemotherapy were enrolled in the present study. Three characteristics of bone marrow (BM) composition analyzed by flow cytometry were combined to determine the prognostic impact. A standardized panel of reagents was used to detect residual disease of aberrant myeloid progenitor cells (RD), identify neutrophils/monocytes with dysregulated immunophenotype (dysregulated neutro/mono) and quantify the appearance of CD34+ B-progenitor-related cluster (hematogones) simultaneously in post-induction BM of adult AML patients. Patients who had detectable RD ≥0.2 % exhibited significantly lower median leukemia-free survival (LFS) than those who did not (13.5 vs. 48.0 months; P = 0.042). Dysregulated neutro/mono abnormalities assessed by this flow cytometric scoring system (FCSS ≥2) predicted shorter LFS (8.0 vs. 39.0 months; P = 0.008). While B-progenitor-related cluster size ≥5 % predicted improved outcome, with longer LFS (not reached vs. 13.5 months; P = 0.023) and better overall survival (not reached vs. 24.0 months; P = 0.027). The proposed RD/dysregulated neutro/mono/hematogones score showed a new risk groups with different LFS in the overall patients (P = 0.0006) as well as in the subgroup of intermediate cytogenetic risk (P = 0.001). The RD/dysregulated neutro/mono/hematogones score assessed by flow cytometry for adult AML in mCR may offer a rapid and practical risk assessment providing better refinement in risk-adapted management after induction chemotherapy.


Flow cytometry Residual disease Hematogones Acute myeloid leukemia 

Supplementary material

12185_2014_1525_MOESM1_ESM.doc (332 kb)
Supplementary material 1 (DOC 331 kb)


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Copyright information

© The Japanese Society of Hematology 2014

Authors and Affiliations

  • Sung-Chao Chu
    • 1
    • 2
    • 3
  • Tso-Fu Wang
    • 1
    • 3
  • Yu-Chieh Su
    • 3
    • 4
  • Ruey-Ho Kao
    • 1
    • 3
  • Yi-Feng Wu
    • 1
  • Dian-Kun Li
    • 3
    • 4
  • Szu-Chin Li
    • 4
  • Chi-Cheng Li
    • 5
  • Denise A. Wells
    • 6
  • Michael R. Loken
    • 6
  1. 1.Department of Hematology-OncologyBuddhist Tzu Chi General HospitalHualienTaiwan
  2. 2.Institute of Medical SciencesHualienTaiwan
  3. 3.Department of Medicine, College of MedicineTzu-Chi UniversityHualienTaiwan
  4. 4.Department of Hematology-OncologyBuddhist Tzu Chi General HospitalChiayiTaiwan
  5. 5.Tai Cheng Stem Cell Therapy CenterNational Taiwan University HospitalTaipeiTaiwan
  6. 6.Hematologics Inc.SeattleUSA

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