A-224 Flow Cytometry in Hematopoietic Malignancies: Current Applications, Advances, and Minimal Residual Disease Monitoring in Clinical Laboratory Practice

Abstract

This review evaluates current clinical applications, limitations, and implementation challenges of flow cytometry for hematopoietic disorders in clinical laboratories. Flow cytometry is an essential tool for detecting and monitoring various diseases, such as minimal residual disease (MRD). With substantial technological advances, spectral flow cytometry has greatly increased the sensitivity and reliability of disease monitoring. However, clinical laboratories continue to face significant obstacles for on-site adoption. A practice-focused study was conducted to evaluate current clinical laboratory use of flow cytometry for hematopoietic malignancies and MRD monitoring. Evidence from peer-reviewed publications and professional guidance published between 2015 and 2025 was analyzed to assess laboratory workflow, testing complexity, sources of analytical variability, and barriers to on-site implementation. Advances in multiparametric and spectral flow cytometry were evaluated in relation to feasibility, standardization requirements, quality assurance considerations, and their impact on routine clinical laboratory practice. Laboratory practice evaluation indicates that multiparametric and spectral flow cytometry improve sensitivity and flexibility for disease classification and MRD monitoring. Despite these advances, implementation across clinical laboratories remains inconsistent. Variability in results is driven by preanalytical, analytical, and post-analytical differences, limited workforce expertise, high costs, and regulatory complexity. These factors continue to restrict routine on-site adoption despite demonstrated clinical value. Flow cytometry is becoming an increasingly important tool for hematopoietic malignancies and MRD diagnosis and monitoring. Clinical laboratory shortcomings must be addressed and prioritized. A more rigorous quality assurance program, the design of more straightforward and diagnostic-focused antibody panels, and continued standardization research are necessary to achieve successful implementation in clinical settings and promote high-quality patient care.