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Central nervous system (CNS) involvement worsens the prognosis of hematologic neoplasms since cerebrospinal fluid (CSF) represents a sanctuary for malignant cells. Thus, it is evident that without the use of FCM we would have missed 17% and 40% of patients with CNS involvement at diagnosis and relapse respectively. Two patients (40%), who were not screened at diagnosis for CNS disease, resulted at relapse CC SP - sp /FCM SP + sp (15 and 40 events) (Table 1). [Extracted from the article]

Introduction: Multiparametric flow cytometry immunophenotype (MFCI) plays a crucial role in the diagnosis of acute leukemia (AL). Through the comprehensive assessment of surface and intracellular antigens expressed by blasts, MFCI permits to distinguish myeloid or B/T lymphoid AL, or AL of ambiguous lineages. By means of MFCI, the blasts can be characterized in bone marrow, peripheral blood, and body fluids, such as cerebrospinal fluid. Area covered: This review discusses how MFCI is currently applied in the diagnostic evaluation of AL; it also focuses on 'peculiar' issues such as the role of MFCI for the diagnosis of central nervous system leukemic involvement. Expert commentary: Despite the improved knowledge about the biology of AL, MFCI remains a fundamental tool to make a prompt and accurate diagnosis. MFCI also provides prognostic information for some antigens are associated with specific cytogenetic/genetic abnormalities and, recently, it became a powerful tool to evaluate the quality and depth of response (the so called 'measurable residual disease'). Its role as an efficient detector of residual disease paved the way to the investigation of tissues other than bone marrow and peripheral blood, demonstrating that even small amounts of AL appear to have a prognostic impact and may require personalized intervention. [ABSTRACT FROM AUTHOR]