Indian Pediatrics

, Volume 55, Issue 1, pp 55–62 | Cite as

Flow Cytometry in Pediatric Malignancies

  • Anil Handoo
  • Tina Dadu
Open Access
Rational Diagnostics


The utility of flow cytometry as a useful diagnostic modality for the assessment of hematopoietic neoplasms has been established beyond doubt. In fact, it is now an integral part of the diagnosis and classification of various diseases like leukemias and lymphomas along with molecular studies and cytogenetics. Prognostication and disease monitoring by flow cytometry is also being recognized increasingly as one of the important fortes. This is evident by the number of articles in the published in literature on the minimal residual disease detection by flow cytometry especially in the last decade or so. To add to this, ever growing list of utilities in hematopoietic malignancies, many nonhematopoietic neoplasms can also be analyzed by flow cytometry. The examples include fluid specimens from serous cavity effusions and samples from solid tissues like lymph nodes, reticulo-endothelial tissue, central nervous system tissue, etc. Flow cytometry technique provides a unique blend of rapidity, high sensitivity and specificity compared to cyto-morphology and conventional immunohistochemical staining. It is also remarkable for simultaneous analysis of more than one marker on the cells. Evaluation of limited samples such as cerebrospinal fluid or fine needle aspiration samples makes Flow cytometry a valuable tool. DNA ploidy analysis and assessment of pediatric non-hematopoietic neoplasms by Flow cytometry has envisaged the utility vista of this technique. This review is aimed at providing an insight into the applications of flow cytometry in pediatric malignancies.


Diagnosis Immunophenotyping Lymphoma Leukemia 


  1. 1.
    Arora RS, Eden TOB, Kapoor G. Epidemiology of childhood cancer in India. Indian J Cancer. 2009;46:264–73.CrossRefPubMedGoogle Scholar
  2. 2.
    Ferreira-Facio CS, Milito C, Botafogo V, Fontana M, Thiago LS, Oliveria E, et al. Contribution of multiparameter flow cytometry immunophenotyping to the diagnostic screening and classification of pediatric cancer. PLoS ONE. 2013;8: e55534.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Pillai V, Dorfman DM. Flow cytometry of non-hematopoietic neoplasms. Acta Cytologica. 2016;60:336–43.CrossRefPubMedGoogle Scholar
  4. 4.
    Li J, Wertheim G, Paessler M, Pillai V. Flow Cytometry in pediatric hematopoietic malignancies. Clin Lab Med. 2017;37:879–93.CrossRefPubMedGoogle Scholar
  5. 5.
    Arnoulet C, Béné MC, Durrieu F, Feuillard J, Fossat C, Husson B, et al. Four-and five-color flow cytometry analysis of leukocyte differentiation pathways in normal bone marrow: A reference document based on a systematic approach by the GTLLF and GEIL. Cytometry Part B: Clin Cytometry. 2010;78B:3–10.Google Scholar
  6. 6.
    Mckenna RW, Asplund SL, Kroft SH. Immunophenotypic analysis of hematogones (B-lymphocyte precursors) and neoplastic lymphoblasts by 4-color flow cytometry. Leuk Lymphoma. 2004;45:277–85.CrossRefPubMedGoogle Scholar
  7. 7.
    Handoo A, Dadu T, Rangan A, Bachchas V, Sartor M, Choudhary DR, et al. CD45-side scatter dot plot in malignant hematological flow cytometry–scanner view for prediction of immunophenotypic diagnosis/lineage assignment and an optimizing tool for cost effective flow cytometry. Int J Lab Hemat. 2012;34:50 (Abstract).Google Scholar
  8. 8.
    Wang XM. Advances and issues in flow cytometric detection of immunophenotypic changes and genomic rearrangements in acute pediatric leukemia. Transl Pediatr. 2014;3:149–55.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Jain N, Lamb AV, O’Brien S, Ravandi F, Konopleva M, Jabbour E, et al. Early T-cell precursor acute lymphoblastic leukemia/lymphoma (ETP-ALL/LBL) in adolescents and adults: a high-risk subtype. Blood. 2016;127:1863–9.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Craig FE, Foon KA. Flow cytometric immunophenotyping for hematologic neoplasms. Blood. 2008;111:3941–67.CrossRefPubMedGoogle Scholar
  11. 11.
    Borowitz MJ, Bene MC, Harris NL, Porwit A, Matutes E. Acute leukemias of ambiguous lineage. In: Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J Vardiman JW, editors. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. 4th ed. Lyon, France: IARC Press; 2008. p. 150–155.Google Scholar
  12. 12.
    Campana D, Coustan-Smith E. Detection of minimal residual disease in acute leukemia by flow cytometry. Cytometry. 1999;38:139–52.CrossRefPubMedGoogle Scholar
  13. 13.
    Coustan-Smith E, Ribeiro RC, Stow P, Zhou Y, Pui CH, Rivera GK, et al. A simplified flow cytometric assay identifies children with acute lymphoblastic leukemia who have a superior clinical outcome. Blood. 2006;108:97–102.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Chatterjee T, Somasundaram V. Flow cytometric detection of minimal residual disease in B-Lineage acute lymphoblastic leukemia by using “MRD lite” panel. Med J Armed Forces India. 2017;73:54–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Braylan RC. Impact of flow cytometry on diagnosis and characterization of lymphomas, chronic lymphoproliferative disorders and plasma cell neoplasias. Cytometry A. 2004;58:57–61.CrossRefPubMedGoogle Scholar
  16. 16.
    Consensus Document for Management of Pediatric Lymphomas and Solid Tumors–Prepared as an outcome of the ICMR-sub-committee on paediatric lymphomas and solid tumors. ICMR 2017:29. Available at URL: final%20pdf. pdf. Accessed October 09, 2017.Google Scholar
  17. 17.
    Miles RR, Arnold S, Cairo MS. Risk factors and treatment of childhood and adolescent Burkitt lymphoma/leukaemia. Br J Haematol. 2012;156:730–43.CrossRefPubMedGoogle Scholar
  18. 18.
    Darzynkiewicz Z, Halicka HD, Zhao H. Analysis of cellular DNA content by flow and laser scanning cytometry. Adv Exp Med Biol. 2010;676:137–47.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Pillai V, Dorfman DM. Flow cytometry of nonhematopoietic neoplasms. Acta Cytologica. 2016;60:336–43.CrossRefPubMedGoogle Scholar

Copyright information

© Indian Academy of Pediatrics 2018

Authors and Affiliations

  1. 1.Centre for Exellence — Flow Cytometry — Department of HepatologyDr BL Kapur Memorial HospitalNew DelhiIndia
  2. 2.Laboratory ServicesBLK Super Speciality HospitalNew DelhiIndia

Personalised recommendations