Re: MGUS & Myeloma

From: Ierachmiel Daskal (DASKALI@einstein.edu)
Date: Mon Oct 08 2001 - 13:55:29 EST


Please consult the paper of Bergsagel et al  ( Blood 85:436-447 (1995)) for a complete
review of the CD19 status in MM, pre and post Rx.  Your question does not identify if
this refers to the peripheral blood of BM. The presence of CD19  in plasma cells should
not be the diagnostic corner stone for MM. As a matter of fact patient with MM have
2-8 times more circulating CD19 positive cells than normal individuals. Of course the
prerequisite is that these are monotypic ( restricted to one of the light chains), as
well as CD19/CD38 or CD138 which is more specific. MM cells are also positive for CD56
and CD58 which are absent from normal plasma cells. Knowles in his latest edition of
"Neoplastic Hematopathology "actually claims that malignant Plasma cells are negative
for ...CD19 (!)
With respect to MGUS the basic criteria is  a total serum gamma globulin concentration
less than 3.5gm/dl no BJ proteins and no other clinical presentation.
 Hope this is more helpful than confusing.


Ierachmiel Daskal M.D. PhD. FCAP, FASCP
Chairman
Department of Pathology and Laboratory Medicine
(215) 456-6126
Pager: 2-3559
daskali@einstein.edu


>>> "Wal & Sue Sharp" <walnsue@cableinet.co.uk> 10/06/01 08:16AM >>>

Eyup me owd Flowers (Yorkshire slang),

I'd like to try and get a consensus on two related topics -

1) Is CD19 positivity in plasma cells definitive of Myeloma or can you get
reactive plasma cells showing the same ?

2) Does the list believe that even a small number of these cells in bone
marrow justifies the diagnosis of Myeloma when clinical evidence (or rather,
lack of it) would normally support MGUS ?

I have my own thoughts on the matter but I thought it would be interesting
to get wider opinions.

Wal Sharp
Yorkshire
UK



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