Impact of immunophenotyping on management of acute leukemias

Background and Objectives. The diagnosis of acute leukemias (AL) requires a multiparametric approach in order to apply risk-adapted therapeutic protoc ols and appreciate the potential outcome of any given patient. Blast cells immunophenotyping is a key test in this Issue, yet the Information provided by Immunophenotyping has become staggering, and it may be difficult to ide ntify relevant characteristics clearly. This manuscript provides a critical review of the literature regarding the importance of immunophenotyping in acute leukemia diagnosis and management. Data sources and Methods. The information given here is based on the experi ence of the authors, on their literature files and on additional material r etrieved through articles and reviews covered by the Institute far Scientif ic Information (ISI) and the Medline' database. Studies with proper definit ion of the patients and sufficient information regarding followup were cons idered. Results. Immunophenotyping allows an early confirmation of AL diagnosis and establishes lineage assignment. Adequate and comprehensive panels of monoc lonal antibodies also allow detection of aberrant immunophenotypic profiles of prognostic value or of use in detecting minimal residual disease. A num ber of unusual immunophenotypic features are also associated with prognosis . The development of new antibodies, new insights in the functional propert ies of differentiation antigens, and the quantimetric approach of immunophe notyping will keep this field changing. Moreover, as therapeutic protocols evolve, some earlier results need to be reconsidered. Interpretation and Conclusions. Immunophenotyping, together with cytologic, karyotypic and molecular approaches, retains a crucial place in the diagno sis and management of acute leukemias. It remains a rather specialized appr oach and should be interpreted in a multidisciplinary perspective, consider ing for each patient the Idiosyncrasies possibly relevant to prognosis. (C) 1999, Ferrata Storti Foundation.