使用多參數流式細胞螢光套組診斷被套細胞淋巴瘤與慢性淋巴細胞性白血病

Using a Powerful Multiparameter Flow Cytometry Panel for Diagnostic Evaluation of Mantle Cell Lymphoma and Chronic Lymphocytic Leukemia

背景：慢性淋巴細胞白血病（CLL）與被套細胞淋巴瘤（MCL）皆屬於B細胞淋巴瘤，但後者更具侵略性且預後差，治療所使用之標靶藥物也互異，因此需精準快速地針對兩者進行鑑別診斷。方法：收集28例以流式細胞技術進行多色免疫抗原檢驗之資料，結合病理診斷進行統計分析。結果：本實驗室以淋巴瘤抗體套組搭配CD200抗體，流式細胞術分析後的數據，依淋巴瘤細胞表面抗原特性，進行邏輯性圈選和確認；我們一共探討28筆案例，其中10例免疫組織化學染色法呈現cyclin D1陽性且病理診斷為MCL之檢體，CD200抗原表現均為陰性；18例免疫組織化學染色法呈現cyclin D1陰性且病理診斷為CLL之檢體，CD200抗原表現均為陽性，故我們探討的28筆案例與病理檢驗結果一致性達100％，並可在5小時內得到結果。結論：未來結合CD200於創新冷凍乾燥客製化多色淋巴瘤抗體檢驗套組，簡化操作步驟，提升報告產出率，而且檢體採樣比傳統病理學更低侵略性，也不易受切片取樣部位影響，藉此協助醫師快速進行鑑別診斷。

Background: Chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL) are both B-cell lymphomas, but MCL is clinically more aggressive and associated with a worse prognosis. The treatment planning and novel targeted agents for these two diseases are also different. Therefore, it is necessary to differentiate between the two promptly and accurately. Method: We collected immunophenotyping data of 28 cases of CLL and MCL by multiparameter flow cytometry. We performed statistical analysis in correlation with pathological diagnosis. Result: In our lab, we combined the lymphoma panel with the newly incorporated CD200 surface marker into our flow cytometry workflow. Based on the characteristics of cell surface antigens in lymphoma, we analyzed the data by logical gatingstrategy. Among 28 caseswe analyzed, there were 10 cases whose pathological sections were stained positive cyclin D1 by immunohistochemistry, pathological diagnoses were MCL and CD200 expressions were negative by flow cytometry. In the other 18 cases, those cyclin D1 were negative, pathological diagnoses were CLL and CD200 expressions were positive. It shows thatthe concordance rate is 100% between pathological examination and CD200 expression. Furthermore, the flow cytometry is a faster procedure and can produce test results within 5 hours. Conclusion: We will integrate CD200 into our innovative customized lyophilized multiparameter lymphoma panel, simplify the operation steps, and enhance the report output rate. Furthermore, the sampling process is less invasive than the traditional pathological examination, and less affected by the biopsy location. And therefore, we can help physicians make the distinguishing diagnosis of CLL versus MCL more instantaneously.