Computational flow cytometry immunophenotyping at diagnosis is unable to predict relapse in childhood B-cell Acute Lymphoblastic Leukemia

B-cell Acute Lymphoblastic Leukemia is the most prevalent form of childhood cancer, with approximately 15% of patients undergoing relapse after initial treatment. Further advancements depend on novel therapies and more precise risk stratification criteria. In the context of computational flow cytometry and machine learning, this paper aims to explore the potential prognostic value of flow cytometry data at diagnosis, a relatively unexplored direction for relapse prediction in this disease. To this end, we collected a dataset of 252 patients from three hospitals and implemented a comprehensive pipeline for multicenter data integration, feature extraction, and patient classification, comparing the results with existing algorithms from the literature. The analysis revealed no significant differences in immunophenotypic patterns between relapse and non-relapse patients and suggests the need for alternative approaches to handle flow cytometry data in relapse prediction. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was partially supported by project PDC2022-133520-I00 funded by Ministerio de Ciencia e Innovacióoacuten/ Agencia Estatal de investigacióoacuten (doi:10.13039/501100011033) and European Union NextGenerationEU/PRTR; by project PID2022-140451OA-I00 funded by Ministerio de Ciencia e Innovacióoacuten/Agencia Estatal de investigacióoacuten (doi:10.13039/501100011033) and ERDF A way of making Europe; and by University of Castilla-La Mancha / ERDF, A way of making Europe (Applied Research Projects) under grant 2022-GRIN-34405. The support of Fundacióoacuten Espaóntildeola para la Ciencia y la Tecnologóiacutea (FECYT project PR214), Asociacióoacuten Pablo Ugarte (APU, Spain) and Junta de Andalucóiacutea (Spain) group FQM-201 is also acknowledged. This work was also subsidized in its early stages by a grant for the research and biomedical innovation in the health sciences within the framework of the Integrated Territorial Initiative (ITI) for the province of Cóaacutediz (grant number ITI-0038-2019). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of Hospital Universitario de Jerez de la Frontera gave ethical approval for this work. IRB of Hospital Infantil Universitario Niño Jesús gave ethical approval for this work. IRB of Hospital Universitario Virgen del Rocío gave ethical approval for this work. IRB of Hospital Clínico Universitario Virgen de la Arrixaca gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The source code and functions used in this article can be consulted at . This repository also includes the preprocessed and merged files of the 188 patients selected for the main analysis. The full database of anonymized FC files is available at .