Assessment of acute myeloid leukemia molecular measurable residual disease testing in an interlaboratory study.

The European LeukaemiaNet (ELN) measurable residual disease (MRD) working group has published consensus guidelines to standardize molecular genetic MRD testing of the t(8;21)(q22;q22.1) RUNX1::RUNX1T1, inv(16)(p13.1q22) CBFB::MYH11, t(15;17)(q24.1;q21.2) PML::RARA, and NPM1 type A markers. A study featuring 29 international laboratories was performed to assess interlaboratory variation in testing and the subsequent interpretation of results, both crucial to patient safety. Most participants in this study were able to detect, accurately quantify, and correctly interpret MRD testing results, with a level of proficiency expected from a clinical trial or standard-of-care setting. However, a few testing and interpretive errors were identified that, in a patient setting, would have led to misclassification of patient outcomes and inappropriate treatment pathways being followed. Of note, a high proportion of participants reported false-positive results in the NPM1 marker-negative sample. False-positive results may have clinical consequences, committing patients to unneeded additional chemotherapy and/or transplant with the attendant risk of morbidity and mortality, which therefore highlights the need for ongoing external quality assessment/proficiency testing in this area. Most errors identified in the study were related to the interpretation of results. It was noted that the ELN guidance lacks clarity for certain clinical scenarios and highlights the requirement for urgent revision of the guidelines to elucidate these issues and related educational efforts around the revisions to ensure effective dissemination.

Cytogenetic analysis of human blastocysts.

UNLABELLED: The human blastocyst is key to understanding the aetiology of constitutional chromosome abnormalities in our species. OBJECTIVES: To investigate the range and incidence of chromosome abnormalities in a large series of human blastocysts, using classic cytogenetic techniques. METHODS: Using thymidine, cell division is synchronized in spare five-to-eight-day-old human blastocysts generated by IVF. A simple acetic acid disaggregation step produces discrete metaphases for G-band analysis. Subsequent FISH analysis of both metaphase and interphase nuclei allows further exploration of an abnormality detected by G-banding, including the investigation of any mosaicism. RESULTS: A total of 438 blastocysts have been prepared. Where analysis was possible, 3% appeared polyploid (mainly tetraploid), 29% were diploid : tetraploid mosaics and 68% were uniformly diploid. Abnormalities observed include triploidy, trisomy 16, trisomy 2, trisomy for unidentifiable D-group chromosome, mosaic trisomy 3, and mosaic trisomy 3 and trisomy 7. CONCLUSION: Comparison of results with existing data from both first trimester pregnancies and cleavage stage embryos suggests significant loss of haploid and monosomic embryos, as well as loss of some trisomies, prior to the blastocyst stage. It appears that the general range and incidence of most main groups of constitutional abnormalities observed in the first trimester (including mosaic forms) are in place by the blastocyst stage.