Lab Med Online.  2019 Jul;9(3):126-132. 10.3343/lmo.2019.9.3.126.

Large Unstained Cell, Blast Suspect and Delta Neutrophil Index ll Analyzed with Automated Hematology Analyzer as Parameters for the Prediction of Acute Leukemia Relapse

• Hwang N
• Kim YK
• Suh JS

• KMID: 2450837
• DOI: http://doi.org/10.3343/lmo.2019.9.3.126

Abstract

BACKGROUND
Here we investigated the clinical utilities of blast suspect, large unstained cell (LUC), delta neutrophil index ll (DN ll), and delta neutrophil index l (DN l), analyzed in peripheral blood samples with automated hematology analyzers to predict the relapse of acute leukemia.
METHODS
We retrospectively reviewed the medical records of 112 patients, including 56 patients with acute leukemia relapse and 56 controls. Blast suspect, LUC, DN ll, and DN l were compared between the control and leukemia relapse groups.
RESULTS
Significant differences in blast suspect (P<0.001), LUC (P<0.001), DN ll (P<0.001), and DN l (P=0.002) were observed between the leukemia relapse and control groups. The areas under the curve (AUC) value was 0.927 for blast suspect (95% confidence interval [CI]: 0.8750.978, P<0.001), 0.868 for LUC (95% CI: 0.794-0.941, P<0.001), and 0.900 for DN ll (95% CI: 0.841-0.960, P<0.001). Logistic regression analysis for the prediction of leukemia relapse revealed odds ratio values of 1.52 (95% CI: 1.26-1.96, P=0.0002) for blast suspect, 1.66 (95% CI: 1.27-2.42, P=0.0019) for LUC, 1.16 (95% CI: 1.08-1.29, P=0.0014) for DN ll, and 1.05 (95% CI: 1.01-1.13, P=0.0845) for DN l.
CONCLUSIONS
Multiple parameters provided by automated blood cell analyzers may serve as powerful ancillary tools for the prediction and diagnosis of leukemia relapse.

Keyword

Acute leukemia; Automated hematology analyzer; Large unstained cell; Blast suspect; Delta neutrophil index

MeSH Terms

Blood Cells
Diagnosis
Hematology*
Humans
Leukemia*
Logistic Models
Medical Records
Neutrophils*
Odds Ratio
Recurrence*
Retrospective Studies

Figure

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  Fig. 1. Box plot of blast suspect (A), LUC (B), DN II (C), DN I (D) in control and leukemia relapse groups.

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  Fig. 2. Kaplan–Meier overall survival analysis of patients with leukemia relapse with blast suspect (A), LUC (B), DN II (C) and DN I (D). Dotted line represents patients with leukemia relapse in the third quartile (blast suspect >15.43%, LUC >11.65%, DN II >25.7%, DN I >4.25%) and solid line represents patients with leukemia relapse in the first to third quartile.

Reference

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