Abstract
Objective B-lymphocyte progenitors, namely the hematogones (HGs), may pose problems in morphological
assessment of bone marrow, not only during the diagnostic workup but also while evaluating
bone marrow for remission status following chemotherapy. Here, we describe a series
of 12 cases of acute lymphoblastic leukemia (ALL) that included both B-ALL and T-ALL
cases, which were evaluated for remission status and revealed blast-like mononuclear
cells in bone marrow in the range of 6 to 26%, which on immunophenotypic analysis
turned out to be HGs.
Materials and Methods This is a case series of 12 ALL cases who were undergoing treatment at the Army Hospital
(Referral and Research), New Delhi. All these cases were under workup for post-induction
status (day 28) and to check for suspected ALL relapse. Bone marrow aspirate (BMA),
biopsy, and immunophenotyping were performed. Multicolored flow cytometry was performed
using CD10, CD20, CD22, CD34, CD19, and CD38 antibodies panel.
Results BMA assessment of 12 cases revealed a maximum of 26% blastoid cells and a minimum
of up to 6%, raising the suspicion of hematological relapse. However, on clinical
assessment, these patients were well preserved, with preserved peripheral counts.
Hence, marrow aspirates were subjected to flow cytometry using the CD markers panel,
as discussed above, which revealed HGs. These cases were followed by minimal residual
disease (MRD) analysis that revealed MRD-negative status, further confirming our findings.
Conclusion This case series highlights the importance of morphology and bone marrow immunophenotyping
in unveiling the diagnostic dilemma in post-induction ALL patients.
Keywords
bone marrow - flow cytometry - hematogones - immunophenotyping
