Aiding in the diagnosis and monitoring of chronic myelomonocytic leukemia
Immunophenotyping
MONOF
CMML
Monocytes
Monocytosis
Monocyte repartition
Whole blood
If cytogenetic tests are also desired an additional specimen should be submitted. It is important that the specimen be obtained, processed, and transported according to instructions for the other required test.
Specimens must be received within 72 hours of collection.
Container/Tube:
Preferred: Yellow top (ACD solution A or B)
Acceptable: Lavender top (EDTA)
Specimen Volume: 3 mL
1 mL
Gross hemolysis | Reject |
New York State specimens, <50% viability | Reject |
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Whole blood | Refrigerated | 72 hours |
Aiding in the diagnosis and monitoring of chronic myelomonocytic leukemia
Chronic myelomonocytic leukemia (CMML) is a myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN) overlap syndrome characterized by peripheral blood monocytosis (absolute monocyte count > or =1.0 x 10(9)/L, > or =10% of the total white blood cell count) persisting for 3 months or greater. It could be very challenging to distinguish CMML from a reactive monocytosis or from a MPN (such as primary myelofibrosis or polycythemia vera) with monocytosis. Monocytes can be classified into 3 subsets: classical MO1 (CD14+/CD16-), intermediate MO2 (CD14+/CD16+), and non-classical MO3 (CD14-/CD16+) monocytes, with MO1 constituting the major monocyte population (85%) in healthy individuals. Recent reports using multiparametric flow cytometry have demonstrated a characteristic increase in classical monocytes (> or =94%) in CMML patients, thus distinguishing them from other causes of reactive and clonal monocytosis with greater than 90% sensitivity and specificity.(1) This panel is designed to analyze the repartition of monocytes in these patients and to give a semi-quantitative value for the MO1 compartment. This value will aid in the differential diagnosis and monitoring of CMML.
% Monocytes of WBC: 1.0-6.6%
MO1 (classical monocytes): <94.0%
An interpretive report describing the classical monocytes (MO1) fraction as either increased or normal will be provided. See Cautions.
Clinical Sensitivity and Sensitivity:
Thirty-two patients with untreated chronic myelomonocytic leukemia (CMML) were tested. Twenty-five of these patients had a percent classical monocyte (%MO1) result of greater than or equal to 94%(abnormal result), which correlated to a sensitivity of 78%.
One hundred one patients with non-CMML hematologic malignancies were also tested. Ninety of these patients had a %MO1 result of less than 94% (normal result), which correlated to a specificity of 89%.
In addition, 30 healthy donors also had a %MO1 result of less than 94% (normal result).
1. Selimoglu-Buet D, Wagner-Ballon O, Saada V, et al: Characteristic repartition of monocyte subsets as a diagnostic signature of chronic myelomonocytic leukemia. Blood. 2015 Jun 4;125(23):3618-3626. doi: 10.1182/blood-2015-01-620781
2. Pophali PA, Marinelli LM, Ketterling RP, et al: High level MYC amplification in B-cell lymphomas: is it a marker of aggressive disease? Blood Cancer J. 2020 Jan 13;10(1):5. doi: 10.1038/s41408-019-0271-z
3. Patnaik MM, Timm MM, Vallapureddy R, et al: Flow cytometry based monocyte subset analysis accurately distinguishes chronic myelomonocytic leukemia from myeloproliferative neoplasms with associated monocytosis. Blood Cancer J. 2017 Jul 21;7(7):e584. doi: 10.1038/bcj.2017.66
Flow cytometric immunophenotyping of peripheral blood is performed to evaluate the percentage of monocytes in the classical (MO1), intermediate (MO2), and non-classical (MO3) compartments. Only the MO1 compartment will be reported. MONOF Panel: CD3, CD7, CD14, CD16, CD24, CD33, CD45, and CD56.(Patnaik MM, Timm MM, Vallapureddy R, et al: Flow cytometry based monocyte subset analysis accurately distinguishes chronic myelomonocytic leukemia from myeloproliferative neoplasms with associated monocytosis. Blood Cancer J. 2017 Jul;7[7]:e584. doi: 10.1038/bcj.2017.66)
Monday through Friday
This test was developed using an analyte specific reagent. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.
88184-Flow cytometry; first cell surface, cytoplasmic or nuclear marker
88185 x 7-Flow cytometry; additional cell surface, cytoplasmic or nuclear marker (each)
88187-Flow Cytometry Interpretation, 2 to 8 Markers
Test Id | Test Order Name | Order LOINC Value |
---|---|---|
MONOF | Monocyte Repartition by CD14/CD16,B | 101146-9 |
Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
---|---|---|
610019 | % Monocytes of WBC | 101147-7 |
610020 | MO1 (Classical Monocytes) | 101148-5 |
610023 | Final Diagnosis | In Process |