Re: MGUS & Myeloma

From: Timothy Singleton, M.D. (tsingleton@smtpgw.beaumont.edu)
Date: Wed Oct 10 2001 - 07:24:09 EST


In MGUS, plasma cells appear polytypic for cytoplasmic kappa and lambda light chain by
immunophenotype, with rare exception.  There is a monoclonal plasma cell population,
which is responsible for the monoclonal gammopathy, but the polyclonal plasma cells
predominate.  MGUS with monoclonal plasma cells warrants close follow-up.  Plasma cells
appear monoclonal in smoldering myeloma, multiple myeloma, primary amyloidosis and
plasmacytoid lymphomas.

Tim Singleton, MD
William Beaumont Hospital
Royal Oak, MI

>>> Anja Porwit <Anja.Porwit@ks.se> 10/09/01 03:06AM >>>


Hello Wal,
Within European Working Group on Clinical cell Analysis we have performed
phenotyping of plasma cells on approx 100 myeloma, MGUS and normal BM
collected in 6 laboratories.
In normal BM plasma cells showed "dim" CD 19 expression. In myeloma and
MGUS in 90% of cases the CD19 expression was negative or much lower than in
normal/reactive plasma cells. The best differentiation between normal and
pathological plasma cells was obtained by CD56 expression which was
negative in normal plasma cells but positive in approx. 80% of myeloma/MGUS
cases.
When it comes to differentiation between MGUS and myeloma our experience
supports the previous findings of Dr Orfao's group (Am J Pathol. 1998
Jun;152(6):1655-65) showing that in MGUS the normal plasma cells are also
present while in myeloma there is a total dominance of the pathological
plasma cell population.
Kind regards
Anna

At 13:16 2001-10-06 +0100, you wrote:
>
>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
>
>
>
Anna Porwit
Hematopathology Lab.
Department of Pathology, Radiumhemmet
Karolinska Hospital, 171 76 Stockholm, Sweden
Anja.Porwit@ks.se
tel.:+46-851774518
fax.:+46-851775843



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