Acute Leukemia is the most common hematologic malignancy in children and adolescents. A key methodology in the diagnostic evaluation of this malignancy is immunophenotyping based on Multiparameter Flow Cytometry (FCM). However, this approach is manual, and thus time-consuming and subjective. To alleviate this situation, we propose in this paper the FCM-Former, a machine learning, self-attention based FCM-diagnostic tool, automating the immunophenotyping assessment in Childhood Acute Leukemia. The FCM-Former is trained in a supervised manner, by directly using flow cytometric data. Our FCM-Former achieves an accuracy of 96.5% assigning lineage to each sample among 960 cases of either acute B-cell, T-cell lymphoblastic, and acute myeloid leukemia (B-ALL, T-ALL, AML). To the best of our knowledge, the FCM-Former is the first work that automates the immunophenotyping assessment with FCM data in diagnosing pediatric Acute Leukemia.

Explainability for Deep Learning Models is especially important for clinical applications, where decisions of automated systems have far-reaching consequences. While various post-hoc explainable methods, such as attention visualization and saliency maps, already exist for common data modalities, including natural language and images, little work has been done to adapt them to the modality of Flow CytoMetry (FCM) data. In this work, we evaluate the usage of a transformer architecture called ReluFormer that ease attention visualization as well as we propose a gradient- and an attention-based visualization technique tailored for FCM. We qualitatively evaluate the visualization techniques for cell classification and polygon regression on pediatric Acute Lymphoblastic Leukemia (ALL) FCM samples. The results outline the model's decision process and demonstrate how to utilize the proposed techniques to inspect the trained model. The gradient-based visualization not only identifies cells that are most significant for a particular prediction but also indicates the directions in the FCM feature space in which changes have the most impact on the prediction. The attention visualization provides insights on the transformer's decision process when handling FCM data. We show that different attention heads specialize by attending to different biologically meaningful sub-populations in the data, even though the model retrieved solely supervised binary classification signals during training.