{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T19:45:41Z","timestamp":1788983141282,"version":"build-2803163510"},"reference-count":70,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007065","name":"University of Salerno","doi-asserted-by":"publisher","award":["300397FRB24GIUDI"],"award-info":[{"award-number":["300397FRB24GIUDI"]}],"id":[{"id":"10.13039\/501100007065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007065","name":"University of Salerno","doi-asserted-by":"publisher","award":["300397FRB25GIUDI"],"award-info":[{"award-number":["300397FRB25GIUDI"]}],"id":[{"id":"10.13039\/501100007065","id-type":"DOI","asserted-by":"publisher"}]},{"award":["300397FRB24GIUDI"],"award-info":[{"award-number":["300397FRB24GIUDI"]}],"id":[{"id":"https:\/\/ror.org\/0192m2k53","id-type":"ROR","asserted-by":"publisher"}]},{"award":["300397FRB25GIUDI"],"award-info":[{"award-number":["300397FRB25GIUDI"]}],"id":[{"id":"https:\/\/ror.org\/0192m2k53","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003196","name":"European Union","doi-asserted-by":"publisher","award":["CUP Master G13C24000100001"],"award-info":[{"award-number":["CUP Master G13C24000100001"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003196","name":"European Union","doi-asserted-by":"publisher","award":["CUP I53C24000560001"],"award-info":[{"award-number":["CUP I53C24000560001"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]},{"award":["CUP Master G13C24000100001"],"award-info":[{"award-number":["CUP Master G13C24000100001"]}],"id":[{"id":"https:\/\/ror.org\/019w4f821","id-type":"ROR","asserted-by":"publisher"}]},{"award":["CUP I53C24000560001"],"award-info":[{"award-number":["CUP I53C24000560001"]}],"id":[{"id":"https:\/\/ror.org\/019w4f821","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background\/Objectives: Clonal evolution is mainly defined based on the appearance or expansion of clones harboring specific somatic mutations and\/or cytogenetic abnormalities, whereas few studies have investigated immunophenotypic heterogeneity assessed by flow cytometry and its relationship with disease progression. In this study, flow cytometry immunophenotyping of acute myeloid leukemia (AML) was carried out to identify phenotypic subclones based on antigen expression and to investigate clonal sweep. Methods: A total of 24 patients diagnosed with AML followed at the Hematology and Transplant Center of Salerno were included. Bone marrow or peripheral blood specimens were subjected to flow cytometry immunophenotyping and leukemic cell characterization. Phenotypic profiles were also compared to molecular alterations detected by next-generation sequencing. Results: We found that flow cytometry-defined clonal heterogeneity was more complex than molecular heterogeneity at diagnosis and disease relapse. Flow cytometry enabled the identification of small phenotypic subclones that were not detected by molecular profiling and that, in several cases, expanded over time, consistent with a phenotypic clonal sweep. The presence of small clones was associated with shorter progression-free survival and overall survival. Conclusions: Flow cytometric clonal heterogeneity, especially the presence of small clones (defined by antigen expression from 2 to 30%), may serve as an additional prognostic factor in AML. Immunophenotyping integrated with molecular data may improve risk stratification, enhance measurable residual disease assessment, and contribute to a more personalized disease monitoring strategy.<\/jats:p>","DOI":"10.3390\/jpm16040180","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T15:05:33Z","timestamp":1774451133000},"page":"180","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Immunophenotypic Heterogeneity and Clonal Sweep in Acute Myeloid Leukemia Revealed by Flow Cytometry: A Case Series Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Angela","family":"Bertolini","sequence":"first","affiliation":[{"name":"Hematology and Transplant Center, University Hospital \u201cSan Giovanni di Dio e Ruggi d\u2019Aragona\u201d, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marisa","family":"Gorrese","sequence":"additional","affiliation":[{"name":"Hematology and Transplant Center, University Hospital \u201cSan Giovanni di Dio e Ruggi d\u2019Aragona\u201d, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Luponio","sequence":"additional","affiliation":[{"name":"Hematology and Transplant Center, University Hospital \u201cSan Giovanni di Dio e Ruggi d\u2019Aragona\u201d, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6509-9789","authenticated-orcid":false,"given":"Francesca","family":"Picone","sequence":"additional","affiliation":[{"name":"Hematology and Transplant Center, University Hospital \u201cSan Giovanni di Dio e Ruggi d\u2019Aragona\u201d, 84131 Salerno, Italy"},{"name":"Department of Medicine and Surgery \u201cScuola Medica Salernitana\u201d, University of 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Maria","family":"Sessa","sequence":"additional","affiliation":[{"name":"Hematology and Transplant Center, University Hospital \u201cSan Giovanni di Dio e Ruggi d\u2019Aragona\u201d, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7267-8310","authenticated-orcid":false,"given":"Simona","family":"Caruso","sequence":"additional","affiliation":[{"name":"Hematology and Transplant Center, University Hospital \u201cSan Giovanni di Dio e Ruggi d\u2019Aragona\u201d, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"De Leucio","sequence":"additional","affiliation":[{"name":"Hematology and Transplant Center, University Hospital \u201cSan Giovanni di Dio e Ruggi d\u2019Aragona\u201d, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossella","family":"Marcucci","sequence":"additional","affiliation":[{"name":"Hematology and Transplant Center, University Hospital \u201cSan Giovanni di Dio e Ruggi d\u2019Aragona\u201d, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Maria","family":"Della Corte","sequence":"additional","affiliation":[{"name":"Hematology and Transplant Center, University Hospital \u201cSan Giovanni di Dio e Ruggi d\u2019Aragona\u201d, 84131 Salerno, Italy"},{"name":"Department of Medicine and Surgery \u201cScuola Medica Salernitana\u201d, University of Salerno, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasqualina","family":"Scala","sequence":"additional","affiliation":[{"name":"Hematology and Transplant Center, University Hospital \u201cSan Giovanni di Dio e Ruggi d\u2019Aragona\u201d, 84131 Salerno, Italy"},{"name":"Department of Medicine and Surgery \u201cScuola Medica Salernitana\u201d, University of Salerno, 84081 Baronissi, 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