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

  • 1Department of Clinical Pathology, School of Medicine, Kyungpook National University, Daegu, Korea.


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.
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.
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.
Multiple parameters provided by automated blood cell analyzers may serve as powerful ancillary tools for the prediction and diagnosis of leukemia relapse.


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