Blood cancer constitutes a variety of hematologic malignancies involving white blood cells (WBCs), red blood cells (RBCs) and platelets. With advances in genetic and molecular technologies and the ability to characterize various types of immunological markers, our understanding of blood cancers and ability to diagnose and treat them have undergone tremendous progress.
What causes blood cancers?
Most blood cancers involve disruptions of the hematopoietic and immune systems. During the transformation of normal cells into cancerous cells (oncogenic process), both the common myeloid and common lymphoid progenitor populations arising from hematopoietic stem cells (HSCs) undergo uncontrolled proliferation. Based on the population affected, different types of blood cancers have been identified.
The three major types of blood cancers
Leukemia arises due to an overproduction of WBCs. Based on the starting cell in the bone marrow, leukemia can be lymphocytic or myeloid. Lymphocytic leukemia arises from lymphocyte progenitors whereas non-lymphocytic or myeloid leukemia arises from progenitors of erythrocytes, granulocytes, monocytes or platelets. Based on lineage, maturation stage and speed of disease progression, leukemia is categorized into two types: acute1 or chronic. The prevalence of the disease varies based on age, stage and the type of leukemia (myeloid vs lymphoid).
Lymphoma arises due to the malignant transformation of lymphocytes. Most lymphomas originate from B cells with only 10–15% being of T and NK cell origin.3 More than 70 types of lymphomas have been described and are grouped in two main categories: Hodgkin and non-Hodgkin lymphoma.
Hodgkin lymphoma (HL) is mostly of B cell origin. It preferentially develops in young adults between 20 and 34 years old. Hodgkin Reed-Sternberg (HRS) cells are a hallmark of Hodgkin lymphoma. They are giant multinucleated abnormal cells constituting the clonal tumor pool of Hodgkin lymphoma. CD30 is the hallmark of HL and HRS cell surface markers.4, 5
Non-Hodgkin Lymphoma (NHL)
Non-Hodgkin lymphoma (NHL) is the most common form of lymphoma.6 Surface markers such as CD20, CD30 and CD19 are expressed in NHL that are derived from B lymphocytes.7 Flow cytometry–based immunophenotypic analysis of NHL relies on the detection of specific lineage markers of B and T cells.
Myeloma is the result of transformation of plasma cells either due to changes in the bone marrow microenvironment or genetic alterations in plasma cells. Because the tumors develop in multiple locations in the bone marrow and periphery, the disease is also called multiple myeloma.
Flow cytometry–based assays for blood cancers
Blood cancer differential diagnosis can be obtained by detecting signature profiles of altered immune cells associated with different types of blood cancers. Flow cytometry immunophenotyping is usually the next diagnostic step after a complete blood count (CBC) and blood smear morphological examination. A WBC differential indicates abnormalities in peripheral blood cell counts, including increased or decreased number of lymphocytes, morphological abnormalities, or the presence of myeloid or immature blood cells. Flow cytometry allows many liquid biopsies (blood, CSF) and tissue homogenates (e.g., bone marrow, lymph nodes) to be screened in a timely manner to concurrently evaluate an array of phenotypic and functional markers.
BD Biosciences offers a large portfolio of single-color antibody CE-IVD reagents that span across a range of specificities and dyes that can help in the characterization of hematologic neoplasia. Multicolor analysis using relevant combinations of reagents is highly recommended8.
Furthermore, BD provides the BD OneFlow™ Solution, comprising a comprehensive set of reagents2, setup beads, protocols and assay templates, to help standardize leukemia and lymphoma immunophenotyping.This can improve laboratory efficiency and enable reliability and accuracy of results.9,10
- Malouf C, Ottersbach K. Molecular processes involved in B cell acute lymphoblastic leukaemia. Cell Mol Life Sci. 2018;75(3):417-446. doi:10.1007/s00018-017-2620-z
- van Dongen JJ, Lhermitte L, Böttcher S, et al. EuroFlow antibody panels for standardized n-dimensional flow cytometric immunophenotyping of normal, reactive and malignant leukocytes. Leukaemia. 2012;26(9):1908-1975. doi:10.1038/leu.2012.120
- Jiang M, Bennani MN, Feldman AL. Lymphoma classification update: T-cell lymphomas, Hodgkin lymphomas and histiocytic/dendritic cell neoplasms. Expert Rev Hematol. 2017;10(3):239-249. doi: 10.1080/17474086.2017.1281122
- Küppers R, Hansmann ML. The Hodgkin and Reed/Sternberg cell. Int J Biochem Cell Biol. 2005;37(3):511-517. doi:10.1016/j.biocel.2003.10.025
- Kanzler H, Küppers R, Helmes S, et al. Hodgkin and Reed-Sternberg-like cells in B-cell chronic lymphocytic leukaemia represent the outgrowth of single germinal-center B-cell-derived clones: potential precursors of Hodgkin and Reed-Sternberg cells in Hodgkin's disease. Blood. 2000;95(3):1023-1031
- Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127(20):2375-2390. doi:10.1182/blood-2016-01-643569
- Sarkozy C, Baseggio L, Feugier P, et al. Peripheral blood involvement in patients with follicular lymphoma: a rare disease manifestation associated with poor prognosis. Br J Haematol. 2014;164(5):659-667. doi:10.1111/bjh.12675
- Stelzer GT, Marti G, Hurley A, McCoy P Jr, Lovett EJ, Schwartz A. US-Canadian Consensus recommendations on the immunophenotypic analysis of hematologic neoplasia by flow cytometry: standardization and validation of laboratory procedures. Cytometry. 1997;30:214-230.
- van der Velden VHJ, Flores-Montero J, Perez-Andres M, et al. Optimization and testing of dried antibody tube: The EuroFlow LST and PIDOT tubes as examples. J Immunol Methods. 2019;475:112287. doi: 10.1016/j.jim.2017.03.011
- Moloney E, Watson H, Barge D, et al. Efficiency and health economic evaluations of BD OneFlow™ Flow Cytometry Reagents for diagnosing chronic lymphoid leukemia. Cytometry B Clin Cytom. 2019;96(6):514-520. doi: 10.1002/cyto.b.21779
BD Single-Color Antibody reagents, as intended on this page, and BD OneFlow™ Reagents are in vitro diagnostic medical devices bearing a CE mark.