Multiparameter immunophenotyping by flow cytometry as a diagnostic tool in multiple myeloma and monoclonal gammopathy of undetermined significance
di
G. Carulli, V. Ottaviano, E. Cannizzo, S. Giuntini, C. Manetti, E. M. Ciancia, A. Azzarà
Background. Immunophenotyping by multiparameter flow cytometry
(MFC) provides relevant information about prognosis and
minimal residual disease detection in multiple myeloma (MM) and
might be used to distinguish MM from monoclonal gammopathies of
undetermined significance (MGUS). Materials and Methods. We evaluated a possible usage of MFC to
predict the differential diagnosis between MM and MGUS.
One hundred consecutive patients were studied at diagnosis and
underwent conventional diagnostic procedures. We carried out a
double-blind study. Immunophenotyping was performed on samples
from myeloaspirates before establishing diagnosis, while the final
clinical diagnosis was established independently from MFC results.
A five- or six-color method was carried out by means of monoclonal
antibody combinations able to identify abnormal plasma cells (CD19-)
and the most relevant immunophenotypic aberrations (loss of CD27;
overexpression of CD117, CD56, CD28; asynchronous expression of
CD20). MFC was applied following the indications of the European
Myeloma Network. When abnormal plasma cells were ≤ 3% of the
global plasma cell population, MM was predicted; when abnormal
plasma cells were ≥ 3.1%, MGUS was predicted. Results. MFC results predicted 63 cases of MM and 37 cases
of MGUS. At the end of our study, 61 cases of MM and 39 cases of
MGUS were diagnosed. Therefore, 4% of patients were misdiagnosed
by MFC parameters alone, with sensitivity and specificity of 0.983
and 0.92, respectively. Conclusions. Only a small proportion of patients with MM and
MGUS were misdiagnosed by MFC alone and a possible systematic
application of MFC in all patient with MM and MGUS at diagnosis
might be proposed. Novel additional criteria could be necessary to
improve the diagnostic impact of MFC in monoclonal gammopathies.
Clin Ter 2012; 163(5):387-392
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