Walking the Hemato-path

They say, “if it bleeds, it leads.” In this case, that means anything hematopathology! And where better to find cutting-edge research than at the 2022 American Society of Hematology Meeting and Exposition? We’ve curated some of the best in leading stories in hemepath – all across this vital field.

Good for the environment
 

Mass cytometry imaging of more than 300 primary diffuse large B-cell lymphoma (DLBCL) tumors has led researchers to map more of the condition’s tumor biology and microenvironment. The DLBCL cellular landscape is now known to include two sets of 34 protein markers, as well as 57 markers identifying major cell lineages (CD3, CD20, PDPN, CD68), immune function (IDO, PD1, granzyme B,) and tumor phenotypes (IRF4, BCL6, p53) (1).

If you’re LaPI and you know it…
 

Not all clinics and centers can assess the large number of known prognostic variables for DLBCL. The Laboratory Prognostic Index (LaPI), first announced at the 2021 ASH Annual Meeting, has shown that it can predict DLBCL outcomes by analyzing three blood parameters that are frequently assessed in most labs: lactate dehydrogenase, hemoglobin, and beta-2 microglobulin. The LaPI score is capable of the same prognostic quality as other methods and can even identify patients with severe prognoses to guide targeted treatment (2).

Not on a WHIM
 

Warts, hypogammaglobulinemia, infections, and myelokathexis (WHIM) syndrome is an immunodeficiency usually caused by CXCR4 mutations. Because WHIM presents with a wide range of clinical symptoms, it can be difficult to diagnose. Recently, CXCR4 sequencing has been used to confirm diagnosis in patients suspected of WHIM syndrome – but pathologists and patients still want an accessible, noninvasive biomarker. To this end, a team has identified a unique CD19+CD10+CD38+IgM–IgD–CD21–CD27– B-cell in WHIM patients that could be a potential candidate (3).

’Allo there
 

For many acute myeloid leukemia and myelodysplastic syndrome patients, allogeneic blood or bone marrow transplantation (alloBMT) is the only available form of therapy. But a new cfDNA-based MRD assessment shows promise as a minimally invasive prognostic test in patients undergoing alloBMT. Researchers found that cfDNA evidence of MRD 90 days after alloBMT was linked to worse relapse-free and overall survival. This relationship could help to guide health providers on treatment protocols after alloBMT (4).

Quick as a gazelle
 

A team has presented a point-of-care diagnostic test – the first of its kind – for the hemoglobin disorder β-thalassemia. The test is able to detect and count multiple hemoglobin types including HbA2, HbA, HbF, and HbS, ultimately helping care providers spot β-thalassemia quickly and easily. With a cost below US$2 and a result time under eight minutes, the assay is a viable candidate for accurate and affordable testing in β-thalassemia (5).

Spotting signs
 

Intravascular large B cell lymphoma (IVBCL) is a rare subtype of DLBCL often only diagnosed postmortem. Researchers have now hypothesized that the presence of complex karyotype in bone marrow may be an indicator of IVBCL – which they then found to be true in 20 percent of investigated cases. Though its presence does not directly affect prognosis, monitoring of complex karyotype may help patients undergoing repeated biopsies (6).

Bone marrow biomarkers
 

A team that isolated extracellular vesicle (EV) miRNA from the bone marrow of AML patients has found that the substance may have potential as a biomarker for risk and prognosis. Researchers identified a total of 965 EV-derived miRNAS from tested samples and compared their expression levels with those of AML risk groups. Within the downregulated miRNA sequences, hsa-mir-181b and hsa-mir-143 were correlated with unfavorable risk and worse overall survival. For upregulated miRNAs, hsa-mir-188 and hsa-mir-501 were correlated with unfavorable risk, but not associated with survival (7).

^{Image Credit : Atlas of Pulmonary Pathology: Flickr}