Is there a way to have a FISH test (for chromosomal abnormalities) done using a blood sample? Or can it only be done using a sample from a bone marrow biopsy?
My first bone marrow biopsy was done in April when I was diagnosed, but the doctor didn't do a FISH test. I was told I have to have another biopsy done, so I am waiting.
Just wanted to double check.
Thanks.
Forums
8 posts
• Page 1 of 1
-
Dean UK - Name: Dean
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: April 2016
- Age at diagnosis: 41
Re: Can a FISH test be done using a blood sample?
You can only do a FISH on a bone marrow biopsy sample.
You may want to double check if the pathology lab still has your original biopsy sample in storage. I needed to get my original sample reanalyzed a couple of months after the original biopsy / test, and was happy to find that the lab had stored what remained of my original sample.
You may want to double check if the pathology lab still has your original biopsy sample in storage. I needed to get my original sample reanalyzed a couple of months after the original biopsy / test, and was happy to find that the lab had stored what remained of my original sample.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Can a FISH test be done using a blood sample?
I think a FISH test can be done on peripheral blood. It's up to your doctor to order one.
However, in the context of myeloma, FISH examination of the peripheral blood does not seem to be done on a routine basis. I am not sure why, except to note that plasma cells tend to stay in the bone marrow, not the peripheral blood. And plasma cells are the bad guys in myeloma.
No need to go fishing when there is nothing to catch?
Joe
However, in the context of myeloma, FISH examination of the peripheral blood does not seem to be done on a routine basis. I am not sure why, except to note that plasma cells tend to stay in the bone marrow, not the peripheral blood. And plasma cells are the bad guys in myeloma.
No need to go fishing when there is nothing to catch?
Joe
-
Wobbles - Name: Joe
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: June 2016
- Age at diagnosis: 67
Re: Can a FISH test be done using a blood sample?
Hi Joe,
As I recall, quite a significant number of myeloma patients do not have any circulating plasma cells in their peripheral blood. And those that do have circulating plasma cells in their peripheral blood typically have very low plasma cell counts in comparison to what can be found in a bone marrow biopsy sample. So, it indeed wouldn't make a lot of sense to do a FISH test on peripheral blood for myeloma diagnostic and prognostic purposes.
As I recall, quite a significant number of myeloma patients do not have any circulating plasma cells in their peripheral blood. And those that do have circulating plasma cells in their peripheral blood typically have very low plasma cell counts in comparison to what can be found in a bone marrow biopsy sample. So, it indeed wouldn't make a lot of sense to do a FISH test on peripheral blood for myeloma diagnostic and prognostic purposes.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Can a FISH test be done using a blood sample?
Interesting question. I think that Multibilly is basically correct that, with current technology, it would be difficult to carry out FISH testing based on cells from a blood sample. I don't think it's impossible. It's just not easy.
What's important to keep in mind on this issue is that plasma cells are relatively rare in the blood. In healthy people, there are about 2 plasma cells per microlitre, or 2000 plasma cells per millilitre (see the first reference below). In comparison, there are 4500 to 11000 white blood cells per microlitre.
So a typical blood sample will not have many plasma cells in it. In addition, don't forget that when you do FISH testing on someone with myeloma, you want to use the monoclonal (myeloma) plasma cells for the testing – not just any plasma cells. It's the chromosomal abnormalities in the myeloma cells that matter when it comes, for example, to how the disease responds to treatment.
So the number of cells relevant for myeloma-related FISH testing will be even less than 2 per microlitre.
Also, even if you could develop sensitive enough technology to cost-effectively do FISH testing for multiple myeloma using blood samples, it's not clear the results would tell you what you want to know.
This is because the monoclonal plasma cells that make it out of the bone marrow and into the blood may not be the same as those in the bone marrow. A sample of myeloma cells from the blood may be biased – they may have fewer "adhesion molecules" than myeloma cells found in the bone marrow. And I believe there is research showing that myeloma cells with fewer adhesion molecules are more "dangerous" than typical myeloma cells. (The second paper I list below touches on how there can be differences between myeloma cells in the blood and those in the bone marrow.)
Cheers!
References:
1. Caraux, A, et al, "Circulating Human B And Plasma Cells. Age-Associated Changes In Counts And Detailed Characterization Of Circulating Normal CD138− And CD138+ Plasma Cells," Haematologica, June 2010 (full text of article)
2. Rawstron, A, et al, "Distribution of myeloma plasma cells in peripheral blood and bone marrow correlates with CD56 expression," British Journal of Haematology, January 1999 (full text of article)
What's important to keep in mind on this issue is that plasma cells are relatively rare in the blood. In healthy people, there are about 2 plasma cells per microlitre, or 2000 plasma cells per millilitre (see the first reference below). In comparison, there are 4500 to 11000 white blood cells per microlitre.
So a typical blood sample will not have many plasma cells in it. In addition, don't forget that when you do FISH testing on someone with myeloma, you want to use the monoclonal (myeloma) plasma cells for the testing – not just any plasma cells. It's the chromosomal abnormalities in the myeloma cells that matter when it comes, for example, to how the disease responds to treatment.
So the number of cells relevant for myeloma-related FISH testing will be even less than 2 per microlitre.
Also, even if you could develop sensitive enough technology to cost-effectively do FISH testing for multiple myeloma using blood samples, it's not clear the results would tell you what you want to know.
This is because the monoclonal plasma cells that make it out of the bone marrow and into the blood may not be the same as those in the bone marrow. A sample of myeloma cells from the blood may be biased – they may have fewer "adhesion molecules" than myeloma cells found in the bone marrow. And I believe there is research showing that myeloma cells with fewer adhesion molecules are more "dangerous" than typical myeloma cells. (The second paper I list below touches on how there can be differences between myeloma cells in the blood and those in the bone marrow.)
Cheers!
References:
1. Caraux, A, et al, "Circulating Human B And Plasma Cells. Age-Associated Changes In Counts And Detailed Characterization Of Circulating Normal CD138− And CD138+ Plasma Cells," Haematologica, June 2010 (full text of article)
2. Rawstron, A, et al, "Distribution of myeloma plasma cells in peripheral blood and bone marrow correlates with CD56 expression," British Journal of Haematology, January 1999 (full text of article)
Re: Can a FISH test be done using a blood sample?
Nice follow up Ian. You may also want to see this article if the subject of circulating plasma cells is of interest to you.
Nowakowski, GS, et al, "Circulating plasma cells detected by flow cytometry as a predictor of survival in 302 patients with newly diagnosed multiple myeloma," Blood, Oct 2005 (full text of article)
Excerpt:
We detected circulating plasma cells (PCs) by flow cytometry in 302 patients with newly diagnosed multiple myeloma (multiple myeloma) by gating on CD38+CD45- cells. The number of circulating PCs per 50 000 mononuclear cells was reported. In 80 (27%) patients, no circulating PC were seen; 106 (35%) patients had 1 to 10 and 115 (38%) patients had more than 10 circulating PCs. Median overall survival for the 302 patients was 47 months. Patients with 10 or fewer circulating PCs had a median survival of 58.7 months, whereas patients with more than 10 circulating PCs had a median survival of 37.3 months (P = .001). On multivariate analysis, the prognostic value of circulating PCs was independent of β2-microglobulin, albumin, and C-reactive protein. There was only a weak correlation between tumor mass and circulating PCs, suggesting that the appearance of circulating PCs may be a reflection of tumor biology. We conclude that the number of circulating PCs measured by flow cytometry in patients with newly diagnosed multiple myeloma is an independent predictor of survival.
Nowakowski, GS, et al, "Circulating plasma cells detected by flow cytometry as a predictor of survival in 302 patients with newly diagnosed multiple myeloma," Blood, Oct 2005 (full text of article)
Excerpt:
We detected circulating plasma cells (PCs) by flow cytometry in 302 patients with newly diagnosed multiple myeloma (multiple myeloma) by gating on CD38+CD45- cells. The number of circulating PCs per 50 000 mononuclear cells was reported. In 80 (27%) patients, no circulating PC were seen; 106 (35%) patients had 1 to 10 and 115 (38%) patients had more than 10 circulating PCs. Median overall survival for the 302 patients was 47 months. Patients with 10 or fewer circulating PCs had a median survival of 58.7 months, whereas patients with more than 10 circulating PCs had a median survival of 37.3 months (P = .001). On multivariate analysis, the prognostic value of circulating PCs was independent of β2-microglobulin, albumin, and C-reactive protein. There was only a weak correlation between tumor mass and circulating PCs, suggesting that the appearance of circulating PCs may be a reflection of tumor biology. We conclude that the number of circulating PCs measured by flow cytometry in patients with newly diagnosed multiple myeloma is an independent predictor of survival.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Can a FISH test be done using a blood sample?
Thanks, Multibilly. As I was preparing my earlier post, I came across a couple studies like the one you mentioned. However, when I skimmed them, I could not tell if they gave the concentration of plasma cells in the blood in a standardised way (such as per millilitre or per microlitre). That's why I did not quote from any of them.
As you probably know, there is a study similar to the one you mentioned, but related to smoldering myeloma. It found a correlation between the concentration of plasma cells in a smoldering patient's blood and the patient's risk of progressing to symptomatic disease:
Bianchi, G, et al, "High levels of peripheral blood circulating plasma cells as a specific risk factor for progression of smoldering multiple myeloma," Leukemia, Aug 2012 (abstract)
Cheers!
Moderator's Note: The Beacon has a news article with a summary of the study Ian mentions:
"Smoldering Myeloma Patients With High Percentage Of Plasma Cells In The Blood Are At Increased Risk Of Early Progression," The Myeloma Beacon, Oct 3, 2012
As you probably know, there is a study similar to the one you mentioned, but related to smoldering myeloma. It found a correlation between the concentration of plasma cells in a smoldering patient's blood and the patient's risk of progressing to symptomatic disease:
Bianchi, G, et al, "High levels of peripheral blood circulating plasma cells as a specific risk factor for progression of smoldering multiple myeloma," Leukemia, Aug 2012 (abstract)
Cheers!
Moderator's Note: The Beacon has a news article with a summary of the study Ian mentions:
"Smoldering Myeloma Patients With High Percentage Of Plasma Cells In The Blood Are At Increased Risk Of Early Progression," The Myeloma Beacon, Oct 3, 2012
Re: Can a FISH test be done using a blood sample?
Thank you everyone for all your advice.
-
Dean UK - Name: Dean
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: April 2016
- Age at diagnosis: 41
8 posts
• Page 1 of 1