I totally agree with Dr. Singleton. In a world of cost containment and selection of appropriate testing, we should be very selective in the use of technologies which are an "diagnostic overkill". We have only few diagnostic issues for MM. A bone marrow biopsy/aspirate and serum electrophoresis /IFE are routine tools used for the diagnosis. Despite the potential focality of the disease in the marrow, it is not often that we are unable to make such a diagnosis. In our practice here at Einstein, we refrain from approving a flow study to diagnose MM in patients. Ierachmiel Daskal M.D. PhD. FCAP, FASCP Chairman Department of Pathology and Laboratory Medicine (215) 456-6126 Pager: 2-3559 daskali@einstein.edu >>> "Timothy Singleton, M.D." <tsingleton@smtpgw.beaumont.edu> 12/03/01 05:29PM >>> I have mixed feelings about performing flow cytometry for monoclonal gammopathies. These patients all have monoclonal plasma cells. Phenotyping just documents whether the clone is detectable by flow cytometry and whether there might be a phenotypic aberrancy that correlates with malignancy. Flow cytometry might not be necessary for diagnosis. >From a patient care perspective multiple myeloma is incurable, except possibly for newer modalities, such as allogeneic bone marrow transplant. Some clinical textbooks just recommend following the patients and waiting for clinical signs of disease progression (anemia, lytic bone lesions, etc.) to decide when to initiate treatment. Tim Singleton, MD Royal Oak, MI >>> "Andrea Illingworth" <dcdsflow@mint.net> 11/30/01 04:03PM >>> Dear group, What are your thoughts on the use of CD40 to differentiate normal plasma cells from myeloma cells? Currently we are using the CD45/CD56/CD38 combination but we are looking into either adding CD138 and/or CD40. Would you recommend one over the other or recommend adding both antibodies? Thank you for your input! Andrea Illingworth Dahl-Chase Flow Cytometry Bangor, Maine 04401 Andrea_Illingworth@dahlchase.com
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