[tomhowardtx]

Percent plasma cells reported in biopsy results?

by tomhowardtx on Sun Aug 06, 2017 4:05 pm

We were told that we would be looking for the percent of plasma cells in the bone marrow. Could someone help me understand what the percent is based on these results?

CBC: WBC 8.5K/uL, RBC 3.61M/uL, Hgb 11.1g/dL, Hct 34.9%, MCV 96.7fL, MCH 30.7pg, MCHC 31.8g/dL, RDW 22.4%,Plts 198K/uL, MPV 10.8fL.

Auto diff(%): Segs+bands 69.8, Lymphs 15.1, Monos 11.5, Eos 3.2, Basos 0.4.

Interpretation
Monoclonal plasma cell population.

Abnormal bone marrow cells: 1.4% medium sized, plasma cells expressing CD38, CD45, CD117 and cytoplasmic Lambda light chain. Negative for CD19, CD33 and CD56.

Comment
This finding is compatible with a plasma cell neoplasm such as plasma cell myeloma, smoldering myeloma, or mono­clonal gammopathy of undetermined signifi­cance (MGUS). It should be noted, that this methodology may under­estimate the percentage of plasma cells present. Cyto­genetic analysis and FISH studies, along with serum and urine protein electrophoresis, free light chain analysis and immunofixation may be of use for further evaluation. Definitive diagnosis will require histo­morphologic and clinical correlation. The presence or absence of bony lesions, lymph­adenopathy and hepato­spleno­megaly are pertinent clinical considerations.

Results

Specimen Type: Bone Marrow

Other cells:

0.6% Myeloblasts
0.2% Hematogones
1.6% Polyclonal B-cells, Kappa/Lambda ratio=1.2:1
12.1% Small T-cells, CD4:CD8 ratio=2.5:1
1.2% Natural Killer (NK) cells
3.8% Mature Monocytes
2.3% Immature monocytes
74.0% Neutrophils
3.9% Eosinophils
0.2% Basophils
<0.1% Mast cells
Erythroid cells, CD45 [-] cells & debris comprise the remaining events

Viability: 100% Cellularity: 9.4 x10^6 cells / mL, 6.5 mL total specimen

Markers analyzed:
CD2, CD3, CD4, CD5, CD7, CD8, CD10, CD11b, CD13, CD14, CD15, CD16, CD19, CD20, CD33, CD34, CD38, CD45, CD56, CD64, CD117, CD123, HLA-DR, Kappa, Lambda, CyKappa, CyLambda

Morphology: The morphologic features have been correlated with the flow cytometric findings.

[Multibilly]

Re: Percent plasma cells reported in biopsy results?

by Multibilly on Sun Aug 06, 2017 9:35 pm

Hi Tomhowardtx:

Welcome to the forum.

1.4% is your is your clonal plasma cell percentage. 1.4% is a low number, which is good news and would likely put you in the MGUS category, depending on what your other lab results reveal.

I assume you have had all the other tests that were recommended in this report, namely the "cyto­genetic analysis and FISH studies, along with serum and urine protein electrophoresis, free light chain analysis and immunofixation" tests, as well as a comprehensive metabolic panel and CBC lab test and either a full-body xray, MRI or PET/CT scan?

[Ron Harvot]

Re: Percent plasma cells reported in biopsy results?

by Ron Harvot on Mon Aug 07, 2017 10:33 am

In addition to what Multibilly has stated, the new standard for diagnosis of active multiple myeloma is as follows:

Updated Definition of Multiple Myeloma

The revised IMWG criteria will allow, in addition to the classic CRAB features, the following three markers as “myeloma defining events” (MDEs).

- Sixty percent or greater clonal plasma cells on bone marrow examination
- Serum involved / uninvolved free light chain ratio of 100 or greater, provided the absolute level of the involved free light chain is at least 100 mg/L (a patient’s “involved” free light chain – either kappa or lambda – is the one that is above the normal reference range; the uninvolved light chain is the one that typically is in, or below, the normal range)
- More than one focal lesion on MRI that is at least 5 millimeters or greater in size.

Even if you do not have full active multiple myeloma you may have smoldering myeloma or MGUS which would put you on a wait and watch protocol. Treatment, generally is not recom­mended until the a full diagnosis of multiple myeloma. This can be confusing but many people that have MGUS never progress to multiple myeloma. Most smoldering myeloma patients eventually progress to full multiple myeloma but it may take years.