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Multiple Myeloma |
1 The HMDS, Leeds Teaching Hospitals NHS Trust, Leeds, UK
2 General Cytometry Service, Department of Medicine and Cancer Research Center (IBMCC), University of Salamanca/CSIC and Department of Haematology, University Hospital of Salamanca, Salamanca, Spain
3 Department of Haematology, Ankara University, Ankara, Turkey
4 Department of Clinical Haematology, University Hospital Kralovske Vinohrady, Prague and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
5 Department of Internal Oncology, Erasmus MC, Daniel den Hoed Cancer Center, Rotterdam, the Netherlands
6 Emergency University Hospital, Department of Hematology, "Carol Davila" University of Medicine, Bucharest, Romania
7 Dept. of Cell Biology Section Immunology University Medical Center Groningen, Groningen, The Netherlands
8 Universtitäsklinikum Heidelberg, Medizinische Klinik V, Sektion Multiples Myelom, Multiple Myeloma Research Laboratory, Heidelberg, Germany
9 Dept. of Hematology, University Hospital, Brno, Czech Republic
10 University Medical Centre Hamburg - Eppendorf Clinic for Stem Cell Transplantation, Hamburg, Germany
11 Section of Haemato-Oncology, Institute of Cancer Research, Sutton, Surrey, UK
12 Department of Haematology, Rigshospitalet University of Copenhagen, Denmark
13 Flow Cytometry Lab., Divisione di Ematologia dell'Università di Torino, Italy
14 Inserm U601 and Laboratoire d'Hématologie, CHU de Nantes, France
15 University Rome La Sapienza, Dept. of Cellular Biotechnology and Hematology, Rome, Italy
16 Flow Cytometry Lab, Department of Pathology, the Maria Skodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
17 Department of Haematology, Aalborg Hospital Science and Innovation Center, Aarhus University Hospital, Aalborg, and Department for Molecular Biology, Aarhus University, Aarhus, Denmark
18 Wilhelminen-Krebsforschungsinstitut 1st Department of Medicine Wilhelminenspital Wien, Vienna, Austria
19 Vrije Universiteit Brussel, Brussels, Belgium
20 University of Southampton, Southampton, UK
21 Dept of Hematology, Erasmus MC, Rotterdam, the Netherlands
22 Department of Haematology, the Research Laboratory, Aalborg Hospital Science & Innovation Center, Aarhus University Hospital, Aalborg, Denmark and
23 The European Myeloma Network (www.myeloma-europe.org) Secretariat, Aalborg Hospital Science and Innovation Center, Aarhus University Hospital, Aalborg, Denmark
Correspondence: Hans E. Johnsen, MD, DMSC, Professor in Hematology, Department of Hematology, the Research Laboratory, Aalborg Hospital Science and Innovation Center, Sdr. Skovvej 15, 9000 Aalborg, Denmark. E-mail: haej{at}rn.dk
The European Myeloma Network (EMN) organized two flow cytometry workshops. The first aimed to identify specific indications for flow cytometry in patients with monoclonal gammopathies, and consensus technical approaches through a questionnaire-based review of current practice in participating laboratories. The second aimed to resolve outstanding technical issues and develop a consensus approach to analysis of plasma cells. The primary clinical applications identified were: differential diagnosis of neoplastic plasma cell disorders from reactive plasmacytosis; identifying risk of progression in patients with MGUS and detecting minimal residual disease. A range of technical recommendations were identified, including: 1) CD38, CD138 and CD45 should all be included in at least one tube for plasma cell identification and enumeration. The primary gate should be based on CD38 vs. CD138 expression; 2) after treatment, clonality assessment is only likely to be informative when combined with immunophenotype to detect abnormal cells. Flow cytometry is suitable for demonstrating a stringent complete remission; 3) for detection of abnormal plasma cells, a minimal panel should include CD19 and CD56. A preferred panel would also include CD20, CD117, CD28 and CD27; 4) discrepancies between the percentage of plasma cells detected by flow cytometry and morphology are primarily related to sample quality and it is, therefore, important to determine that marrow elements are present in follow-up samples, particularly normal plasma cells in MRD negative cases.
Key words: flow cytometry, myeloma, monoclonal gammopathies of undetermined significance.
Related Article
Haematologica 2008 93: 423-430.
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