Background In plasma cell neoplasms, the percentage of plasma cells in bone marrow (PPCBM) is important for diagnosis and assessment of the treatment. This quantification is performed using bone marrow multiparameter flow cytometry (FC), aspirate smears (BMA) and biopsy. Differences among the percentage of infiltration detected by these techniques have been reported, which can be related to a heterogeneous pattern of infiltration of multiple myeloma (MM) or sample quality. However, a simultaneous evaluation of these three techniques has not been reported nor their ability to detect bone marrow involvement with high or low infiltration, associated with different stages of this disease. Purpose The aim of this study was to compare the results of PPCBM obtained by FC, BMA, and biopsy with CD138 immunohistochemistry (BMB) in different stages of the disease with high and low infiltration, and the ability of these techniques to correctly classify the disease. Methods Pathological studies of patients referred to Hospital Fundación Santa Fe, Colombia were reviewed between January 2015 and June 2018. The selection of patients was based on both, a diagnosis of plasma cell neoplasms, classified according to the International Myeloma Working Group criteria and the simultaneous use of FC by FACSCanto II flow cytometer (Infinicyt 2.0 software program), wright-stained aspirate smears and biopsy with CD138 immunohistochemistry in the detection. Descriptive analysis was performed and PPCBM was expressed as the mean± standard error of the mean (SEM). The Kruskal-Wallis test was used to compare the mean of PPCBM among the three methods. Lineal regression and Spearman´s coefficient were used to correlate the variables. Statistical association was considered significant for p values <0.05. Results A total of 130 patients with plasma cells neoplasms were included in this study, 57 with newly diagnosed MM (N), 58 following therapy MM (F) and 15 MGUS patients. In the N patients, the mean of infiltration was 12.3% ±1.8, 30.3% ±3.4 and 52.2% ±3.74 detected by FC, BMA and BMB, respectively. The PPCBM detected by this three analysis were significantly different (p<0.001). In F patients, the mean of infiltration was 0.37% ±0.05, 1.88 % ±0.16 and 2.61% ±0.21 while in MGUS-patients was 0.49% ±0.09, 2.067 % ±0.37 and 2.4% ±0.28 detected by FC, BMA and BMB, respectively. For F and MGUS patients, significant statistic differences between BMB and BMA versus FC (p<0.01) were observed, but not between BMB and BMA (Figure 1). In the comparative analysis of the three methods in all patients, the highest infiltration was always detected by BMB, followed by BMA and finally by FC (p<0.01) (Figure 2). Linear regression established that for each 1% of infiltration detected by FC or BMA, the BMB identified 2.11% and 1.4% of infiltration, respectively (Figure 2). However, each univariate model only explained 55% and 67% of the observed results. Notably, there was a high correlation among these three techniques (Spearman´s coefficient > 0.8). Finally, given that there are important PPCBM such as ≥10 that allows establishing the diagnosis of MM or ≥60%, considered an MM definitive event, we found that 21% and 52% of cases assessed by BMA and FC had PPCBM <10%, but all of them were reclassified as MM with BMB. None case had PCBM <10% using BMB. Finally, among all cases diagnosed as MM, there were identified 26 by FC and 35 cases by BMA with a PCBM percentage between 10 and 59%, of which 84% and 54% respectively had ≥60% of involvement detected by BMB Conclusion In the comparison of the PCBM was observed a high linear correlation between MFC, BMA, and BMB, although we found a differential behavior of these methods, depending on the level of tumor infiltration. High percentages of infiltration, such as newly diagnosed MM patients, the BMB detected significantly more PPCBM than the others two methods (1.7 to 4-fold compared to BMA and FC). This supports the systematic incorporation of BMB into the analysis of patients with suspected MM for allowing a proper classification of disease. With low percentages of infiltration, such as MGUS and following therapy patients, the difference of PPCBM between BMA and BMB was not significant. Although, FC detected the lowest percentage of infiltration, it known its high specificity to discriminate tumor and normal plasma cells, being in one of the most important analysis to monitor minimal residual. Disclosures No relevant conflicts of interest to declare.
El síndrome de vasoconstricción cerebral reversible se produce por la constricción variable, segmentaria y multifocal, de las arterias cerebrales y, generalmente, es de curso benigno. Se describe el caso de una mujer de 49 años que consultó por cefalea, síntomas visuales y convulsiones; tres días después, presentaba áreas de vasoconstricción en, por lo menos, dos territorios vasculares y dos segmentos de las mismas arterias. Fue internada en la unidad de cuidados intensivos para controlarle la presión arterialy recibir tratamiento médico. Tuvo una evolución tórpida y, en el séptimo día de hospitalización, desarrolló edema cerebral maligno, tras lo cual ocurrió la muerte cerebral. Se inició entonces el plan de donación de órganos y, posteriormente, se practicó una autopsia guiada del cerebro. El estudio de patología descartó vasculitis y reveló áreas de hemorragia en la convexidad cerebral.Se discuten los aspectos más relevantes de los casos con evolución fulminante informados en la literatura científica. El síndrome de vasoconstricción cerebral reversible se asocia con resultados fatales cuando los pacientes tienen una deficiencia neurológica focal, la neuroimagen inicial muestra alteraciones y hay un deterioro clínico rápido. Es importante conocer los factores asociados con un mal pronóstico, y establecer estrategias tempranas de intervención y prevención.
Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headaches and constriction of cerebral arteries related with stroke. Hypothesis: To describe the patients characteristics, radiological findings and clinical course of adults patients with fatal RCVS. Methods: A systematic literature search using MEDLINE and EMBASE was performed up to March 6, 2017. Studies reporting RVCS in adult patients with fatal outcomes were included. Results: Of 368 initially identified studies, 121 full text articles were reviewed, of which 6 publications describing 10 subjects were entered. The vast majority of the reports came from the U.S except for one report form Denmark that included a male patient. Almost all the cases occurred during pregnancy or post-partum. Only 40% subjects had a history of migraine. The clinical presentation involved headache although only 20% presented with thunderclap headache and 14.3% had seizures. A CT was performed in 71.4% of the patients and the rest had an MRI. Imaging results were diverse with trend towards PRESS and ICH. The main course of treatment included steroids in 70% of the subjects and only 30% received nimodipine. Time to death ranged from 7 to 24 days with a median of 11 days. Conclusion: Most of the time RCVS has a benign course, however we described fatal cases from the literature mostly related with post-partum angiopathy. We found a trend in the onset with PRESS, ICH and diffuse cerebral edema with less subjects using nimodipine as main treatment. We described some markers for worse prognosis. Table 1 Description of studies Fig. 1
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.