My name is Marina Delic and I am from Bosnia and Herzegovina where there are currently four flow cytometers and only four individuals currently performing immunophenotyping in hematopathology. I am the Supervisor of Flow Cytometry at the Clinical Center University of Sarajevo's Institute of Clinical Immunology where I have been performing flow cytometry now for six years. Most of the samples we receive are used to help with the diagnosis of leukemia and lymphoma. This last year we processed around 1000 samples in my lab.
In Bosnia and Herzegovina there are no Associations or experts who use this challenging technology or can assist us in designing panels or even the interpretation of patient cytometry data. Most of my flow cytometry knowledge has come by trial and error, reading the literature and correlating our cases with morphology. Looking around, I began to realize that at least locally I was considered the Flow Cytometry expert. Knowing that I needed help, I decided to turn to the International Clinical Cytometry Society and signed up on their mailing list for information about conferences and events. And that is where my flow cytometry education adventure started! I saw the information about the course and the meeting to be held in Bonita Springs, Florida and received information about the Clinical Cytometry Educational Network's (CCEN) Visitor Training Program. I applied immediately.
The CCEN Visitor Training Program is a competitive educational opportunity sponsored by the ICCS and ESCCA through a grant from the Wallace H. Coulter Foundation. The intended goal is to provide flow cytometrists from developing countries hands on exposure to specific flow cytometric topics based on their interest. Training is conducted in a clinical laboratory under the mentorship of an established faculty member for two weeks, though it is hoped that the mentor and mentee's relationship will continue long after the training. The ultimate goal of the Visitor Training Program is to foster best practices in clinical flow cytometry in developing countries in order to improve both research and patient care globally.
My training program was designed in consultation with the CCEN Visitor Training Program Committee. It was to include a week attending the ICCS Clinical Cytometry Course and Meeting held this past year in Bonita Springs, Florida and two weeks with Dr. Paul Wallace at Roswell Park Cancer Institute's Clinical Flow Laboratory. The ICCS Clinical Cytometry Course was very useful in all aspects of practicing flow cytometry not only in hematopathology, but also in immunophenotyping of immunodeficiencies. I had the pleasure and honor to meet people from CCEN and ICCS as well as numerous pathologists from across America. The ICCS Course was taught at a high level, with excellent lecturers whose contact e-mails I have been given in order ask question and share cases. I enjoyed the course and interactions so much, not even the warm sun of the Sunshine State (it was 10oC at home) could drag me from my air-conditioned room at Hyatt hotel and the quality science. But watching the sunset on the Gulf of Mexico and dolphins, which were playing around the boat that was taking us to the cruise was not to be missed and only further spiced up the beautiful experience that flow cytometry provided me. Next year there is a Course and Meeting in Arizona, and I am looking for ways to attend both again.
After this good and the quality introduction in flow cytometry I went to Roswell Park Cancer Institute in Buffalo NY to join my mentor Dr. Paul Wallace, where I stayed for the next two weeks. We followed a curriculum mutually agreed upon with the ICCS and CCEN. My training consisted of time spent in lectures/discussions with Dr. Wallace and hands on training with his staff learning both the theory and practice about the following:
- Roswell Park's staining, acquisition, analysis and reporting methods
- Antibody and cocktail quality control
- Instrument Setup and quality control
- Sample staining best practices and theory
- Fluorochromes and compensation
- Interpretation of leukemia, lymphoma, and MRD panels plus CD34, CD4/CD8, PNH and chimerism reports
- Normal hematopoiesis and populations falling within the blast cell gate
- Case report reviews of AML, ALL, B and T cell lymphomas, and multiple myeloma
- MRD testing for B-ALL, multiple myeloma and AML
- ImageStream clinical applications
Dr. Paul Wallace was a great mentor, who made a very reasonable plan for my stay where in a relatively short period we covered everything what would be necessary and useful for my future work in this diagnostic field. Every day in the morning I visited the lab with friendly staff that selflessly shared advice and helped me in all aspects of sample preparation and QC. By the end of the training period I felt I had perfectly mastered these tasks thanks to their thorough and dedicated work. In the afternoons, I reviewed with Dr. Wallace a series of lectures covering topics in immunophenotyping and hematopathology, then in the evenings we interpreted together that days patient reports. I also had the opportunity to attend the graduate level flow course being offered at Roswell Park where we learned how to do DNA cell cycle analysis and performed an experiment for the ICCS Quality and Standards committee looking at the effects of different lysing reagents on forward and side scatter.
Thanks to the kindness of Dr. Paul and Ms. Betsy Wallace I had the opportunity to visit beautiful places around Buffalo including Niagara Falls and Letchworth State Park. We also enjoyed Tchaikovsky performed by the Buffalo Philharmonic Orchestra on one beautiful Saturday evening.
After returning to my home country, I developed a plan together with my mentor and the CCEN committee members, which included specific goals for my laboratory as well as developing a network of flow cytometrists in my area, sharing the knowledge gained from this program.
This was all one excellent experience that I would immediately repeat if I had the opportunity and with all my heart I recommend the CCEN Visitor Training Program to all scientists in the flow cytometry field and personally thank Dr. Paul Wallace for this great educational opportunity.