Current applications of multiparameter flow cytometry in plasma cell disorders

T Jelinek, R Bezdekova, M Zatopkova, L Burgos, M Simicek, T Sevcikova, B Paiva, R Hajek, T Jelinek, R Bezdekova, M Zatopkova, L Burgos, M Simicek, T Sevcikova, B Paiva, R Hajek

Abstract

Multiparameter flow cytometry (MFC) has become standard in the management of patients with plasma cell (PC) dyscrasias, and could be considered mandatory in specific areas of routine clinical practice. It plays a significant role during the differential diagnostic work-up because of its fast and conclusive readout of PC clonality, and simultaneously provides prognostic information in most monoclonal gammopathies. Recent advances in the treatment and outcomes of multiple myeloma led to the implementation of new response criteria, including minimal residual disease (MRD) status as one of the most relevant clinical endpoints with the potential to act as surrogate for survival. Recent technical progress led to the development of next-generation flow (NGF) cytometry that represents a validated, highly sensitive, cost-effective and widely available technique for standardized MRD evaluation, which also could be used for the detection of circulating tumor cells. Here we review current applications of MFC and NGF in most PC disorders including the less frequent solitary plasmocytoma, light-chain amyloidosis or Waldenström macroglobulinemia.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Time axis highlighting the most important discoveries concerning multiparameter flow cytometry and its use in plasma cell dyscrasias.
Figure 2
Figure 2
Example of MRD analysis in MM using next generation flow approach and Infinicyt software (Cytognos). (a) Bone marrow PC compartment represents 0.04% of total nucleated cells including 98.5% of normal PCs (blue) and 1.5% of aberrant PCs (red). These aberrant plasma cells represent 0.0004% of total nucleated cells translating in MRD positive result reaching the sensitivity of 10−6. The typical aberrant phenotype: CD45−/CD38dim/CD19−/CD56+/CD27−/CD81−/CD117+/cyKappa+. (b) NGF is optimal tool also for follow-up of patients with non-secretory multiple myeloma. Bone marrow PC compartment represents 0.16% of total nucleated cells including 50% of normal PCs (blue) and 50% of aberrant PCs (red). Aberrant PCs in this case have rare immunophenotype with CD38- and lack of cytoplasmic staining of kappa or lambda light chains: CD45+/CD38−/CD19−/CD56+/CD27−/CD81+/CD117−/cyKappa−/cyLambda−.
Figure 3
Figure 3
Next-generation flow approach used for identification of CTCs in MGUS, smoldering MM and active MM patients.

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