High-sensitivity multicolour flow cytometry (MFC)-based B-lymphoblastic leukaemia (B-ALL) measurable residual disease (BMRD) assay is increasingly being used in clinical practice. Herein, we describe six consistently present low-level populations immunophenotypically mimicking abnormal B-ALL blasts in 441 BMRD samples from 301 children. These included CD19 CD123 plasmacytoid dendritic cells differentiating from lymphoid precursors, CD10 transitional B cells with CD10 /CD38dim-to-negative/CD20bright/CD45bright phenotype, CD19 natural killer (NK) cells, CD73bright/CD10 mesenchymal stromal/stem cells, CD73bright/CD34 endothelial cells, and a CD34 CD38dim-to-negative/CD10 /CD20bright/CD45bright subset of mature B cells. We provide the proportions, comprehensive immunophenotype, and practical clues for proper identification of these low-level populations. Knowledge regarding the presence and immunophenotype of these mimics is essential for accurate interpretation in high-sensitivity MFC-BMRD analysis.
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