Cytoplasmic immunoglobulin content in multiple myeloma

Journal of Clinical Investigation (Impact Factor: 13.22). 09/1985; 76(2):765-9. DOI: 10.1172/JCI112033
Source: PubMed


Bone marrow cells of 82 patients with multiple myeloma were subjected to flow cytometric analysis of DNA and cytoplasmic immunoglobulin (CIg) content using propidium iodide and direct immunofluorescence assays. Except for two patients with nonsecretory myeloma, there was conformity in the immunoglobulin type derived from immunoelectrophoresis and plasma cell CIg staining. One patient with nonsecretory myeloma exhibited monotypic CIg staining, while the second showed no reaction. In eight patients with IgG lambda myeloma, the same tumor cells contained both lambda and kappa light chains, suggesting the productive rearrangement of both light chain genes. 14 patients with previously unrecognized plasma cells of low RNA content, all of whom were resistant to chemotherapy, were identified by CIg staining. By revealing previously unrecognized plasma cells with low RNA content, CIg analysis identified more patients with treatment-refractory myeloma.

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Available from: Mark A Pershouse, Aug 13, 2014
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    • "FCM measurement of cytoplasmic immunoglobulin light chain can demonstrate light chain restriction patterns and can be used for supporting the diagnosis of MM [22]. However, FCM methods for the detection of cytoplasmic immunoglobulin light chain is somewhat labor-intensive and not reproducible [23, 24], and several alternative methods are available for measuring cytoplasmic light chain, including immunohistochemical staining, immunofixation electrophoresis, and serum free light chain assay. Thus, in our study, we did not use FCM to analyze cytoplasmic immunoglobulin light chain, and instead performed immunohistochemical staining of BM biopsy specimens for kappa and lambda light chains (data not shown) to further support the identification of neoplastic plasma cells. "
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    ABSTRACT: Flow cytometric immunophenotyping has been used to identify neoplastic plasma cell populations in patients with multiple myeloma (MM). Previous reports have described the use of several antigens, including CD38, CD138, CD56, CD117, CD52, CD19 and CD45, to distinguish distinct populations of plasma cells. The aim of this study was to evaluate a simplified immunophenotyping panel for MM analysis. A total of 70 patients were enrolled in the study, 62 of which were newly diagnosed with MM (untreated), whereas the remaining 8 were undergoing bone marrow assessment as part of follow-up after treatment (treated). Treated cases included 3 patients with relapse and 5 patients with persistence of MM. Multiparametric flow cytometric immunophenotyping was performed using monoclonal antibodies against CD56, CD19, CD138 (CD38), and CD45. In differential counts, plasma cells in bone marrow (BM) accounted for 3.6-93.2% of the total nucleated cell count. The positive expression rates of CD56, CD19, CD138, and CD45 in neoplastic myeloma cells were 83.9%, 0%, 98.4%, and 37.1%, respectively, among the 62 untreated cases, and 75.0%, 0%, 87.5%, and 37.5%, respectively, among the 8 treated cases. CD19 expression of neoplastic plasma cells was negative in both untreated and treated cases. The simplified immunophenotyping panel, CD56/CD19/CD138(CD38)/CD45, is useful for distinguishing neoplastic myeloma cells from reactive plasma cells in clinical practice. In addition, CD19 represents the most valuable antigen for identifying neoplastic myeloma cells in patients with MM.
    Full-text · Article · Dec 2012 · The Korean journal of hematology
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    • "These tests were performed before initiating protocol therapy, monthly until initiation of consolidation therapy and then every 3–6 months. Bone marrow aspirates and biopsies were examined morphologically and by flow cytometry to evaluate nuclear DNA content and cytoplasmic immunoglobulin prior to each of the four protocol phases and then at least annually as well as at relapse (Barlogie et al, 1985). Cytogenetic studies were also performed and cytogenetic abnormalities recorded among 20 Giemsa-banded metaphases (Sawyer et al, 1995). "
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    ABSTRACT: Total therapy 3 incorporated bortezomib into a melphalan-based tandem transplant regimen for 303 newly diagnosed patients with myeloma. Induction chemotherapy prior to and consolidation chemotherapy after transplants each consisted of two cycles of VTD-PACE (bortezomib, thalidomide, dexamethasone and 4-d continuous infusions of cis-platin, doxorubicin, cyclophosphamide, etoposide); 3-year maintenance comprised monthly cycles of VTD in the first and TD in the remaining years. The median age was 59 years (age >64 years, 28%). A minimum of 20 x 10(6) CD34 cells/kg was collected in 87% of patients; 83% completed both transplants, and only 5% suffered a treatment-related death. At 24 months, 83% had achieved near-complete remission, which was sustained in 88% at 2 years from its onset. With a median follow-up of 20 months, 2-year estimates of event-free and overall survival were 84% and 86% respectively. The 44 patients who experienced an event more often had a high-risk gene array profile, cytogenetic abnormalities and indicators of high lactate dehydrogenase, beta-2-microglobulin, creatinine and International Staging System stage. Toxicities of grade > 2 included thrombo-embolic events in 27% and peripheral neuropathy in 12%. Results of this phase-2 study demonstrated that bortezomib could be safely combined with multi-agent chemotherapy, effecting near-complete remission status and 2-year survival rates in more than 80% of patients.
    Full-text · Article · Jul 2007 · British Journal of Haematology
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    • "Recently, abnormalities of chromosome 13 (mainly complete and partial deletions of the long arm), found to be present in 16% of untreated patients, were recognized as the major adverse disease feature with high-dose therapy (HDT) (Tricot et al, 1995) and, subsequently, also with standard-dose therapy (SDT) (Seong et al, 1998). While proliferation-independent genetic measurements such as DNA flow cytometry (Barlogie et al, 1985) and, in recent years, interphase fluorescence hybridization (FISH) have revealed aneuploidy in virtually all patients with active MM (Drach et al, 1995; Tabernero et al, 1996; Zandecki et al, 1996), abnormal metaphases are obtained only in about one-third of newly diagnosed patients (Dewald et al, 1985; Gould et al, 1988; Sawyer et al, 1995). Cytogenetic abnormalities (CA) are typically complex in MM and represent a hallmark of this disease, involving many chromosomes that are altered both numerically and structurally (Rao et al, 1998; Sawyer et al, 1998a, 2001). "
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    ABSTRACT: Cytogenetic abnormalities (CA), especially of chromosome 13, have been used to identify a subgroup of previously untreated multiple myeloma (MM) patients with very poor prognosis despite high-dose therapy (HDT). We examined the prognostic implications of CA in 1000 MM patients receiving melphalan-based tandem autotransplants (median follow-up, 5 years). Negative consequences for both overall survival (OS) and event-free survival (EFS) in the presence of any CA were confirmed, especially when detected within 3 months of HDT. In the context of standard prognostic factors (SPF), 'MM-MDS' (MM karyotype that contains, in addition, CA typical of MDS) imparted a poor OS and EFS, after adjusting for any CA and all individual CA. One-year mortality was also high, especially for the MM-MDS subgroup with trisomy 8 within a MM signature karyotype (87%vs 34% in its absence, P < 0.001). No patient remained event free 5 years post transplant in the presence of these baseline high-risk CA. However, certain trisomies (e.g. chromosomes 7 and 9) and del 20 had favourable clinical consequences. The higher risk that is associated with CA compared with SPF justifies routine cytogenetic studies in all patients with MM at diagnosis and whenever additional treatment decisions are considered, such as in planning HDT either for initial response consolidation, at the time of primary unresponsiveness to induction therapy, or at relapse.
    Full-text · Article · Aug 2003 · British Journal of Haematology
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