My recent bone marrow results reflect a percentage of plasma cells in four different sections:
Comment:
Neoplastic plasma cell infiltrate comprises approximately 10-20% of marrow cellularity.
Bone Marrow Differential:
8% Plasma Cells
Bone Marrow Core Biopsy:
Other: Increased plasma cell infiltrate seen on routine histology, accounting for approximately 10% of marrow cellularity on the core biopsy.
Bone Marrow Aspirate Clot:
CD138: Highlights about 10-20% plasma cells (core biopsy and clot section).
Which one is used in determining the appropriate diagnosis? My oncologist (breast cancer) says she used the 8% referenced in the differential and defined me as MGUS, but clearly progressing. However, she readily stated that she was not an expert with multiple myeloma and has referred me to a specialist.
Based on percentage of plasma cells only, am I smoldering?
Thanks.
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Re: What is the correct plasma cell percentage to use?
SlimMoe,
I am not a doc and not 100% certain, but I believe the 10-20% figure is the correct one to use. I say this because I believe the CD138 staining count of the marrow core is considered to be the most accurate method of determining plasma cell percentages and I believe it is also the standard that the IMWG recommends.
I also say this based on my own BMB report. The staining section of my BMB report states "CD138 positive cells represent 11% of the total cellularity" and this 11% figure represents the bone marrow plasma % that my doctors used for my diagnosis of smoldering multiple myeloma.
It's good you are seeing a multiple myeloma specialist to get his/her take on all this. If you also want recommendations of specific multiple myeloma doctors or institutions to seek out, just let us know what city you are in and folks can make some recommendations.
I am not a doc and not 100% certain, but I believe the 10-20% figure is the correct one to use. I say this because I believe the CD138 staining count of the marrow core is considered to be the most accurate method of determining plasma cell percentages and I believe it is also the standard that the IMWG recommends.
I also say this based on my own BMB report. The staining section of my BMB report states "CD138 positive cells represent 11% of the total cellularity" and this 11% figure represents the bone marrow plasma % that my doctors used for my diagnosis of smoldering multiple myeloma.
It's good you are seeing a multiple myeloma specialist to get his/her take on all this. If you also want recommendations of specific multiple myeloma doctors or institutions to seek out, just let us know what city you are in and folks can make some recommendations.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: What is the correct plasma cell percentage to use?
Just to add a bit to what's already been said here, the IMWG focuses on the "clonal" plasma cell percentage in its criteria, at least those that were published last year. It's the monoclonal (mutated, myeloma) plasma cells in the bone marrow that matter in terms of the percentage, not regular, healthy plasma cells.
Keep in mind, though, that in someone who is healthy (i.e., does not have multiple myeloma), plasma cells make up less than 5% of the bone marrow, according to what I've read here and elsewhere. In someone who has myeloma, the percentage of normal plasma cells may be even lower than in a normal person, due to the disease's suppression of healthy blood cell production.
As I mentioned, the IMWG criteria focus on the "Clonal bone marrow plasma cell percentage", and go on to say that
The thing that is relevant in the additional clarification is that, if you have two estimates of the clonal plasma cell percentage – one from the aspirate, and one from the core – you're supposed to use the higher of the two.
So I would agree with Multibilly that the 10-20 percent figure is the one that, according to the IMWG diagnostic criteria, should be used in this case.
With these sorts of borderline cases, though, the doctor's judgment is important, particularly if the doctor is a myeloma specialist who has access to the patient's full history of test results.
Good luck!
Keep in mind, though, that in someone who is healthy (i.e., does not have multiple myeloma), plasma cells make up less than 5% of the bone marrow, according to what I've read here and elsewhere. In someone who has myeloma, the percentage of normal plasma cells may be even lower than in a normal person, due to the disease's suppression of healthy blood cell production.
As I mentioned, the IMWG criteria focus on the "Clonal bone marrow plasma cell percentage", and go on to say that
Clonality should be established by showing κ/λ-light-chain restriction on flow cytometry, immunohistochemistry, or immunofluorescence. Bone marrow plasma cell percentage should preferably be estimated from a core biopsy specimen; in case of a disparity between the aspirate and core biopsy, the highest value should be used.
The thing that is relevant in the additional clarification is that, if you have two estimates of the clonal plasma cell percentage – one from the aspirate, and one from the core – you're supposed to use the higher of the two.
So I would agree with Multibilly that the 10-20 percent figure is the one that, according to the IMWG diagnostic criteria, should be used in this case.
With these sorts of borderline cases, though, the doctor's judgment is important, particularly if the doctor is a myeloma specialist who has access to the patient's full history of test results.
Good luck!
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JimNY
Re: What is the correct plasma cell percentage to use?
Thanks you two. I've got an appointment with the specialist next Friday, but I'm the type that wants all the pieces at once, throw them into a spreadsheet and shazam, an answer.
This waiting game is for the birds. Thanks again
This waiting game is for the birds. Thanks again
Re: What is the correct plasma cell percentage to use?
I have the same issue. My latest report says:
1-2. Bone marrow, left posterior iliac crest, biopsy and aspirate smears:
- Plasma cell neoplasm,
20-25% involvement by CD138 immunohistochemistry
15% involvement by aspirate differential
1.1% involvement by 10-color flow cytometry
- Cellular marrow with trilineage maturing hematopoiesis.
So should I consider my plasma involvement 15% or 20-25%?
Thanks.
1-2. Bone marrow, left posterior iliac crest, biopsy and aspirate smears:
- Plasma cell neoplasm,
20-25% involvement by CD138 immunohistochemistry
15% involvement by aspirate differential
1.1% involvement by 10-color flow cytometry
- Cellular marrow with trilineage maturing hematopoiesis.
So should I consider my plasma involvement 15% or 20-25%?
Thanks.
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jlasiter - Name: jlmtc
Re: What is the correct plasma cell percentage to use?
I've had 3 unilateral bone marrow biopsies as well as a single bilateral biopsy (for a total of 5 sets of reports since 2013), and I wish I had an easy answer for this one. 
It would be ideal if there was a standard result format that could be used to define the amount of clonal plasma cells when reading bone marrow biopsy reports, i.e., of all of the formats / values that may be found on a single report, if there was just one result that could be singled out as "the result" so that figure could be used when answering the question "what was the percent of clonal bone marrow plasma cells found".
It would be ideal if there was a standard result format that could be used to define the amount of clonal plasma cells when reading bone marrow biopsy reports, i.e., of all of the formats / values that may be found on a single report, if there was just one result that could be singled out as "the result" so that figure could be used when answering the question "what was the percent of clonal bone marrow plasma cells found".
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pinball - Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2010 MGUS, 2014 Smoldering
- Age at diagnosis: 39
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