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bcl-2 Expression by Multicolor Flow Cytometric Analysis Assists in the Diagnosis of Follicular Lymphoma in Lymph Node and Bone Marrow

James R. Cook MD, PhD, Fiona E. Craig MD, Steven H. Swerdlow MD
DOI: http://dx.doi.org/10.1309/820R476KY9G03L9A 145-151 First published online: 1 January 2003


The expression of bcl-2, CD10, and CD20 was examined by multicolor flow cytometry in 78 samples including lymph node or other tissue biopsy specimens containing follicular lymphoma (FL; n = 17), reactive hyperplasia (RH; n = 28), or other malignant lymphomas (n = 20), as well as bone marrow aspirates (n = 13). The presence of CD10+ cells with high bcl-2 expression predicted the presence of FL rather than RH with a positive predictive value of 100% and negative predictive value of 96%. CD10+ cells with high bcl-2 expression also were found in a subset of diffuse large B-cell lymphomas and were otherwise rare in other types of malignant lymphoma. In contrast with immunohistochemical studies, a reduced but apparently measurable level of bcl-2 was present in benign follicular center cells. Hematogones showed lower bcl-2 levels than did FL cells in the bone marrow, and neutrophils were bcl-2–. Measurement of bcl-2 expression levels by multiparameter flow cytometry offers a rapid, quantitative assessment that may assist in the diagnosis of FL in lymph nodes or bone marrow, even when other CD10+ cells or admixed normal B cells are present.

Key Words:
  • Follicular lymphoma
  • bcl-2
  • Flow cytometry