Hematogones with light chain restriction: A potential diagnostic pitfall when using flow cytometry analysis to assess bone marrow specimens

Siba El Hussein, Wei Wang, Sa A. Wang, Hong Fang, Sofia Garces, Mehrnoosh Tashakori, Kirill A. Lyapichev, Lianqun Qiu, Xiaoqiong Wang, Sanam Loghavi, L. Jeffrey Medeiros, Pramoda Challagundla, Jeffrey L. Jorgensen

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Light-chain restricted hematogones (LCR HGs) detected by flow cytometry analysis can mimic bone marrow involvement by B-cell lymphoma. This phenomenon can present a diagnostic pitfall and negatively impact patient management, as misinterpretation may upgrade disease stage. In this study, we characterized the immunophenotype of LCR HGs with an aim to differentiate them from B-cell lymphoma. We analyzed 24 patients with LCR HGs, 12 (50 %) were kappa light chain restricted and 12 (50 %) were lambda light chain restricted. LCR HGs account for 51 % (range, 1.5%–99%) of B cells, and 0.5 % (range, 0.1%–3.7%) of total cells. In 15 patients in whom multiple specimens were analyzed, 10 (67 %) showed persistent LCR HGs in more than 1 specimen, and the duration of the light chain restriction ranged from 4 months to 2 years. Among 24 patients, 4 (16.6 %) cases were concurrently involved by B-cell lymphoma/myeloma in addition to LCR HGs. With the exception of light chain restriction, LCR HGs showed a similar immunophenotype as normal HGs and had a distinct location on the CD45/Side Scatter (SSC) plot. They were also consistently positive for CD10, CD19, CD38 (bright), CD43, and CD200. CD20 expression showed a spectrum from dim/negative to positive.

Original languageEnglish (US)
Article number106704
JournalLeukemia Research
Volume111
DOIs
StatePublished - Dec 2021

Keywords

  • Daratumumab
  • Flow cytometry analysis
  • Hematogones
  • Light chain restricted hematogones
  • Lymphoma
  • Myeloma

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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