Circulating aberrant plasma cells allow risk stratification of patients with myeloma

Issue Highlights—May 2018 (94B3)

“…While this set of markers contains only a subset of suggested markers for detecting PCM, a survival analysis showed that a circulating PC level ≥0.02% was an independent predictor of shorter progression‐free and overall survival . This study confirms the work of others about the significance of circulating plasma cells but required fewer mAbs and tubes making it more cost effective.…”

Increased circulating plasma cells detected by flow cytometry predicts poor prognosis in patients with plasma cell myeloma

“…Cytoplasmic immunoglobulin stain was performed in the second tube to confirm clonality (14). Cytoplasmic immunoglobulin stain was performed in the second tube to confirm clonality (14).…”

“…Another group used a seven-color, two-tube method, where abnormal cPCs were initially gated with CD3811/CD1381 and quantified by immunophenotyping from five surface antigens in the first tube. Cytoplasmic immunoglobulin stain was performed in the second tube to confirm clonality (14). They reported replacing adverse cytogenetics as a poor prognostic factor in the IMWG 2014 and 2015 criteria with 'cPCs 0.0035%' as a marker with comparable 3-year progression and overall survival rates, while minimizing the intermediate group using this new risk stratification due to the high sensitivity of the FC assay.…”

“…Previous studies have used various antibody panels to detect cPCs that range from two colors (CD38 and CD45) (10,13) to seven colors (CD38, CD45, CD19, CD20, CD27, CD56, and CD138) (14). Our institution has applied a FC panel with five surface antigens (CD45, CD38, CD138, CD19, and CD56) which is a minimal panel recommended by the European Myeloma Network (3), for the diagnosis of PCM.…”

Therapy for Relapsed Multiple Myeloma

“…The presence of circulating clonal plasma cells also suggests active, and generally more aggressive, disease and has an effect on prognosis. 122,124,125 A summary of prognostic factors relevant to patients with relapsed multiple myeloma is provided in Table 3. On the basis of these studies, patients are stratified into low-, intermediate-, and high-risk disease, 20–22,114,123,126–132 similar to the newly diagnosed setting (Figure 1) but with the difference that patients who previously had standard- or intermediate-risk disease may subsequently be reclassified into the high-risk group because of the acquisition of additional mutational events as discussed above.…”