1
|
Gjelberg HK, Helgeland L, Tsykunova G, Reikvam H. Bone marrow aspirate or biopsy for multiple myeloma: when percentages matter! Expert Rev Hematol 2024:1-4. [PMID: 39037042 DOI: 10.1080/17474086.2024.2383395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/18/2024] [Indexed: 07/23/2024]
Affiliation(s)
- Hilde K Gjelberg
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Lars Helgeland
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
- Department of Medical Science, University of Bergen, Bergen, Norway
| | - Galina Tsykunova
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Medicine, Hematology-Oncology and Research, Østfold Hospital Trust, Kalnes, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Håkon Reikvam
- Department of Medical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- K.G. Jebsen Center for Myeloid Blood Cancer, Department of Clinical Science, University of Bergen, Bergen, Norway
| |
Collapse
|
2
|
Gantana E, Mashigo N, Abdullah I, Musekwa E, Lohlun R, Nell EM, Chetty C, Ntobongwana M, Chapanduka Z. Evaluation of an innovative new method for quantitation of plasma cells on CD138 immunohistochemistry. J Clin Pathol 2023; 76:261-265. [PMID: 34625512 DOI: 10.1136/jclinpath-2021-207828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/22/2021] [Indexed: 11/03/2022]
Abstract
AIM To compare the frequently used CD138 immunohistochemistry-based method of plasma cell quantitation, to a proposed new method, using interobserver and intraobserver concordance parameters. METHODS Archival CD138 immunohistochemically stained slides made from paraffin-embedded bone marrow biopsies of 33 patients with a confirmed diagnosis of multiple myeloma were used. Light microscopic examination was performed using low magnification lenses (10×) for both the overview estimation method (method A) and the new method (method B), and high magnification lenses (50×), for method B only. For method B, reviewers selected three areas with low, intermediate and high plasma cell densities using 10× lenses. Using a well-defined technique, the 50× lens was then used to count plasma cells as a percentage of all nucleated cells. After blinded relabelling of all the slides, the nine reviewers repeated the plasma cell quantitation using both methods. The plasma cell counts were obtained, and the review times were recorded. RESULTS Overall intraobserver concordance was comparable for method A (concordance correlation coefficient (CCC)=0.840) and method B (CCC=0.733). Interobserver concordance for method A (intraclass correlation coefficient (ICC)=0.793 and 0.713) and method B (ICC=0.657 and 0.658) indicated high similarity between reviewers. Method A showed poor interobserver concordance (ICC=0.105) at low plasma cell densities. CONCLUSIONS The new method is comparable to the frequently used overview estimation method in terms of intraobserver and interobserver concordance, and cost. The new method has superior interobserver concordance at low plasma cell densities. The new method appears more amenable to digital scanning and analysis.
Collapse
Affiliation(s)
- Ethan Gantana
- Department of Haematology, National Health Laboratory Service, Tygerberg Hospital and Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Nomusa Mashigo
- Department of Haematology, National Health Laboratory Service, Tygerberg Hospital and Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Ibtisam Abdullah
- Department of Haematology, National Health Laboratory Service, Tygerberg Hospital and Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Ernest Musekwa
- Department of Haematology, National Health Laboratory Service, Tygerberg Hospital and Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Robert Lohlun
- Department of Haematology, National Health Laboratory Service, Tygerberg Hospital and Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Erica-Mari Nell
- Department of Haematology, National Health Laboratory Service, Tygerberg Hospital and Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Carissa Chetty
- Department of Haematology, National Health Laboratory Service, Tygerberg Hospital and Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Monalisa Ntobongwana
- Department of Haematology, National Health Laboratory Service, Tygerberg Hospital and Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Zivanai Chapanduka
- Department of Haematology, National Health Laboratory Service, Tygerberg Hospital and Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| |
Collapse
|
3
|
Caimi G, Presti RL, Mancuso S, Siragusa S, Carlisi M. Erythrocyte deformability profile evaluated by laser diffractometry in patients with multiple myeloma: Re-examination of our cases. Microvasc Res 2023; 146:104473. [PMID: 36587651 DOI: 10.1016/j.mvr.2022.104473] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Multiple myeloma is a complex pathology which represents about 10 % of all hematological neoplasms. It can often present changes in the hemorheological profile and, in relation to this last topic, our aim is to evaluate the hemorheological profile in a group of multiple myeloma patients, with reference to erythrocyte deformability. METHODS We have examined the profile of the erythrocyte deformability in multiple myeloma enrolling 29 patients; this profile, expressed as elongation index at several shear stress, has been obtained using the diffractometric method. RESULTS By comparing normal controls and MM patients, a significant decrease in erythrocyte deformability, especially at low shear stresses, but we did not observe any significant differences about this profile subdividing the whole group of MM patients according to the degree of bone marrow plasma cell infiltration, to the red blood cell distribution width and to the serum values of LDH. CONCLUSIONS In this paper we have taken in consideration all the hypothesis for a possible explanation of the behaviour of this a reduced erythrocyte deformability in multiple myeloma. Erythrocyte deformability interferes with the physiological release of oxygen to tissues, with several clinical implications.
Collapse
Affiliation(s)
- Gregorio Caimi
- Department of Health Promotion and Child Care, Internal Medicine and Medical Specialties, Università degli Studi di Palermo, Palermo, Italy.
| | - Rosalia Lo Presti
- Department of Psychology, Educational Science and Human Movement, Università degli Studi di Palermo, Palermo, Italy
| | - Salvatrice Mancuso
- Department of Health Promotion and Child Care, Internal Medicine and Medical Specialties, Università degli Studi di Palermo, Palermo, Italy
| | - Sergio Siragusa
- Department of Health Promotion and Child Care, Internal Medicine and Medical Specialties, Università degli Studi di Palermo, Palermo, Italy
| | - Melania Carlisi
- Department of Health Promotion and Child Care, Internal Medicine and Medical Specialties, Università degli Studi di Palermo, Palermo, Italy
| |
Collapse
|
4
|
Malise TTA, Nweke EE, Takundwa MM, Fru PF, Thimiri Govinda Raj DB. Treatment Strategies for Multiple Myeloma Treatment and the Role of High-Throughput Screening for Precision Cancer Therapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1436:167-185. [PMID: 37243923 DOI: 10.1007/5584_2023_775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In the past few years, development of approved drug candidates has improved the disease management of multiple myeloma (MM). However, due to drug resistance, some of the patients do not respond positively, while some of the patients acquire drug resistance, thereby these patients eventually relapse. Hence, there are no other therapeutic options for multiple myeloma patients. Therefore, this necessitates a precision-based approach to multiple myeloma therapy. The use of patient's samples to test drug sensitivity to increase efficacy and reduce treatment-related toxicities is the goal of functional precision medicine. Platforms such as high-throughput-based drug repurposing technology can be used to select effective single drug and drug combinations based on the efficacy and toxicity studies within a time frame of couple of weeks. In this article, we describe the clinical and cytogenetic features of MM. We highlight the various treatment strategies and elaborate on the role of high-throughput screening platforms in a precision-based approach towards clinical treatment.
Collapse
Affiliation(s)
| | - Ekene Emmanuel Nweke
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Mutsa M Takundwa
- Synthetic Nanobiotechnology and Biomachines, Synthetic Biology and Precision Medicine Centre, NextGeneration Health Cluster, Council for Scientific and Industrial Research, Pretoria, South Africa
| | - Pascaline Fonteh Fru
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Deepak B Thimiri Govinda Raj
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.
- Synthetic Nanobiotechnology and Biomachines, Synthetic Biology and Precision Medicine Centre, NextGeneration Health Cluster, Council for Scientific and Industrial Research, Pretoria, South Africa.
- Biotechnology Innovation Centre, Rhodes University, Grahamstown, South Africa.
- Faculty of Medicine, University of Pretoria, Pretoria, South Africa.
| |
Collapse
|
5
|
Fu F, Guenther A, Sakhdari A, McKee TD, Xia D. Deep Learning Accurately Quantifies Plasma Cell Percentages on CD138-Stained Bone Marrow Samples. J Pathol Inform 2022; 13:100011. [PMID: 35242448 PMCID: PMC8873946 DOI: 10.1016/j.jpi.2022.100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/03/2022] [Indexed: 11/08/2022] Open
Abstract
The diagnosis of plasma cell neoplasms requires accurate, and ideally precise, percentages. This plasma cell percentage is often determined by visual estimation of CD138-stained bone marrow biopsies and clot sections. While not necessarily inaccurate, estimates are by definition imprecise. For this study, we hypothesized that deep learning can be used to improve precision. We trained a semantic segmentation-based convolutional neural network (CNN) using annotations of CD138+ and CD138- cells provided by one pathologist on small image patches of bone marrow and validated the CNN on an independent test set of image patches using annotations from two pathologists and a non-deep learning commercial software. On validation, we found that the intraclass correlation coefficients for plasma cell percentages between the CNN and pathologist #1, a non-deep learning commercial software and pathologist #1, and pathologists #1 and #2 were 0.975, 0.892, and 0.994, respectively. The overall results show that CNN labels were almost as accurate as pathologist labels at a cell-by-cell level. Once satisfied with performance, we scaled-up the CNN to evaluate whole slide images (WSIs), and deployed the system as a workflow friendly web application to measure plasma cell percentages using snapshots taken from microscope cameras.
Collapse
Affiliation(s)
- Fred Fu
- STTARR Innovation Centre, University Health Network, Toronto, ON, Canada
| | - Angela Guenther
- Division of Hematopathology and Transfusion Medicine, University Health Network, Toronto, ON, Canada.,Scarborough Health Network, Toronto, ON, Canada
| | - Ali Sakhdari
- Division of Hematopathology and Transfusion Medicine, University Health Network, Toronto, ON, Canada
| | - Trevor D McKee
- STTARR Innovation Centre, University Health Network, Toronto, ON, Canada.,HistoWiz Inc., Brooklyn, NY, USA
| | - Daniel Xia
- Division of Hematopathology and Transfusion Medicine, University Health Network, Toronto, ON, Canada
| |
Collapse
|
6
|
Gebreslassie KS, Bassa FC, Chapanduka ZC, Warwick JM. The relationship between bone marrow involvement on 18F-FDG PET/CT and bone marrow biopsy in patients with multiple myeloma and other plasma cell neoplasms. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2022. [DOI: 10.4102/sajo.v6i0.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Bone marrow biopsy (BMB) plays a crucial role in the diagnosis and assessment of treatment response in patients with multiple myeloma (MM). 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been shown to be a complimentary measure of marrow involvement in patients with Hodgkin and diffuse large B cell lymphomas. However, only limited information is available on its relationship with BMB in MM.Aim: To assess the association between bone marrow involvement on 18F-FDG PET/CT, and BMB in patients with MM and other plasma cell neoplasms.Setting: Cape Town, South Africa.Methods: Hundred and three patients undergoing 18F-FDG PET/CT and BMB were included. Plasma cell infiltration (PCI) on BMB was compared for three visual patterns of 18F-FDG bone marrow uptake (irregular, diffuse less than or equal to the liver and diffuse greater than liver).Results: Eighty-four patients had diffuse bone marrow uptake. Of these, 25/84 had uptake greater than liver, all having PCI ≥ 60% and a median value of 85%. Of the 84 patients, the 59 patients with uptake less than or equal to liver had PCI 10% in 57.6% (34/59), and ≥ 10% in 42.4% (25/59) with a median value of 8%. Nineteen patients had irregular bone marrow uptake. Of these, 4/19 (21.1%) had PCI of 10% and 15/19 (78.9%) had PCI ≥ 10%, with the median value of 23%. The median percentage of PCI across the three described patterns of FDG uptake was significantly different (p = 0.0001).Conclusion: 18F-fluorodeoxyglucose positron emission tomography/computed tomography might avoid the need of repeat BMB in most of the patients with diffuse and irregular patterns of 18F-FDG uptake.
Collapse
|
7
|
Visram A, Soof C, Rajkumar SV, Kumar SK, Bujarski S, Spektor TM, Kyle RA, Berenson JR, Dispenzieri A. Serum BCMA levels predict outcomes in MGUS and smoldering myeloma patients. Blood Cancer J 2021; 11:120. [PMID: 34168119 PMCID: PMC8225625 DOI: 10.1038/s41408-021-00505-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 11/09/2022] Open
Abstract
Soluble BCMA (sBCMA) levels are elevated in monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). However, the association between sBCMA levels and prognosis in MGUS and SMM has not been studied. We retrospectively analyzed sBCMA levels in stored samples from 99 MGUS and 184 SMM patients. Baseline sBCMA levels were significantly higher in MGUS and SMM patients progressing to MM during clinical follow up. When stratified according to the median baseline sBCMA level for each cohort, higher levels were associated with a shorter PFS for MGUS (HR 3.44 comparing sBCMA ≥77 vs <77 ng/mL [95% CI 2.07-5.73, p < 0.001] and SMM (HR 2.0 comparing sBCMA ≥128 vs <128 ng/mL, 95% 1.45-2.76, p < 0.001) patients. The effect of sBCMA on PFS was similar even after adjusting for the baseline MGUS or SMM risk stratification. We evaluated paired serum samples and found that sBCMA increased significantly in MGUS and SMM patients who eventually progressed to MM, whereas among MGUS non-progressors the sBCMA level remained stable. While our results require independent validation, they suggest that sBCMA may be a useful biomarker to identify MGUS and SMM patients at increased risk of progression to MM independent of the established risk models.
Collapse
Affiliation(s)
- A Visram
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - C Soof
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, California, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S Bujarski
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, California, USA
| | - T M Spektor
- OncoTracker, West Hollywood, CA, California, USA
| | - R A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J R Berenson
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, California, USA.,OncoTracker, West Hollywood, CA, California, USA.,Oncotherapeutics, West Hollywood, CA, California, USA.,Berenson Cancer Center, West Hollywood, CA, California, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
8
|
Baranova K, Tran C, Plantinga P, Sangle N. Evaluation of an open-source machine-learning tool to quantify bone marrow plasma cells. J Clin Pathol 2021; 74:462-468. [PMID: 33952591 DOI: 10.1136/jclinpath-2021-207524] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 01/09/2023]
Abstract
AIMS The objective of this study was to develop and validate an open-source digital pathology tool, QuPath, to automatically quantify CD138-positive bone marrow plasma cells (BMPCs). METHODS We analysed CD138-scanned slides in QuPath. In the initial training phase, manual positive and negative cell counts were performed in representative areas of 10 bone marrow biopsies. Values from the manual counts were used to fine-tune parameters to detect BMPCs, using the positive cell detection and neural network (NN) classifier functions. In the testing phase, whole-slide images in an additional 40 cases were analysed. Output from the NN classifier was compared with two pathologist's estimates of BMPC percentage. RESULTS The training set included manual counts ranging from 2403 to 17 287 cells per slide, with a median BMPC percentage of 13% (range: 3.1%-80.7%). In the testing phase, the quantification of plasma cells by image analysis correlated well with manual counting, particularly when restricted to BMPC percentages of <30% (Pearson's r=0.96, p<0.001). Concordance between the NN classifier and the pathologist whole-slide estimates was similarly good, with an intraclass correlation of 0.83 and a weighted kappa for the NN classifier of 0.80 with the first rater and 0.90 with the second rater. This was similar to the weighted kappa between the two human raters (0.81). CONCLUSIONS This represents a validated digital pathology tool to assist in automatically and reliably counting BMPC percentage on CD138-stained slides with an acceptable error rate.
Collapse
Affiliation(s)
- Katherina Baranova
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher Tran
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Paul Plantinga
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Nikhil Sangle
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada.,Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| |
Collapse
|
9
|
Malherbe JAJ, Fuller KA, Mirzai B, Augustson BM, Erber WN. Automated digital enumeration of plasma cells in bone marrow trephine biopsies of multiple myeloma. J Clin Pathol 2020; 75:50-57. [PMID: 33234694 DOI: 10.1136/jclinpath-2020-207066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/17/2020] [Accepted: 11/02/2020] [Indexed: 11/03/2022]
Abstract
AIMS Determination of the number of plasma cells in bone marrow biopsies is required for the diagnosis and ongoing evaluation of plasma cell neoplasms. We developed an automated digital enumeration platform to assess plasma cells identified by antigen expression in whole bone marrow sections in multiple myeloma, and compared it with manual assessments. METHODS Bone marrow trephine biopsy specimens from 91 patients with multiple myeloma at diagnosis, remission and relapse were stained for CD138 and multiple myeloma oncogene 1 (MUM1). Manual assessment and digital quantification were performed for plasma cells in the entire trephine section. Concordance rates between manual and digital methods were evaluated for each antigen by intraclass correlation analyses (ICC) with associated Spearman's correlations. RESULTS The digital platform counted 16 484-1 118 868 cells and the per cent CD138 and MUM1-positive plasma cells ranged from 0.05% to 93.5%. Overall concordance between digital and manual methods was 0.63 for CD138 and 0.89 for MUM1. Concordance was highest with diffuse plasma cell infiltrates (MUM1: ICC=0.90) and lowest when in microaggregates (CD138: ICC=0.13). Manual counts exceeded digital quantifications for both antigens (CD138: mean=26.4%; MUM1: mean=9.7%). Diagnostic or relapse threshold counts, as determined by CD138 manual assessments, were not reached with digital counting for 16 cases (18%). CONCLUSIONS Automated digital enumeration of the entire, immunohistochemically stained bone marrow biopsy section can accurately determine plasma cell burden, irrespective of pattern and extent of disease (as low as 0.05%). This increases precision over manual visual assessments which tend to overestimate plasma burden, especially for CD138, and when plasma cells are in clusters.
Collapse
Affiliation(s)
- Jacques A J Malherbe
- School of Biomedical Sciences, Faculty of Health & Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Kathryn A Fuller
- School of Biomedical Sciences, Faculty of Health & Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Bob Mirzai
- School of Biomedical Sciences, Faculty of Health & Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia.,PathWest Laboratory Medicine WA, Nedlands, Western Australia, Australia
| | - Bradley M Augustson
- PathWest Laboratory Medicine WA, Nedlands, Western Australia, Australia.,Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Wendy N Erber
- School of Biomedical Sciences, Faculty of Health & Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia .,PathWest Laboratory Medicine WA, Nedlands, Western Australia, Australia
| |
Collapse
|
10
|
Biological properties of bone marrow plasma cells influence their recovery in aspirate specimens: impact on classification of plasma cell disorders and potential bias to evaluation of treatment response. Ann Hematol 2020; 99:2599-2609. [PMID: 32935190 PMCID: PMC7536141 DOI: 10.1007/s00277-020-04249-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 09/01/2020] [Indexed: 01/22/2023]
Abstract
Methods to estimate bone marrow plasma cells (BMPC) basically include histopathology, cytomorphology, and flow cytometry. The present study compares the outcomes of these methods with special focus on the impact of BMPC-specific characteristics on their recovery by either method. Laboratory reports of diagnostic samples from 238 consecutive patients with suspected or known plasma cell disease were retrospectively analyzed. The median (IQR) proportion of BMPC was 30.0% (15.0–70.0%) by histological review (hBMPC), 7.0% (2.0–16.0%) by smear review (sBMPC), and 3.0% (0.8–10.0%) by flow cytometry (fBMPC). The disparity of results between core biopsy and aspirate smear was enhanced in case of poor quality of the smear, increased BM fiber content, higher grade cell atypia, expression of CD56 (all P < 0.0001), the number of cytogenetic aberrations (P = 0.0002), and abnormalities of the MYC gene (P = 0.0002). Conversely, expression of CD19 and a non-clonal plasma cell phenotype were associated with a lower difference between hBMPC and sBMPC (both P < 0.0001). The disparity between the percentages of sBMPC and fBMPC was associated with the quality of the smear (P = 0.0007) and expression of CD56 (P < 0.0001). Our results suggest that the recovery of BMPC in aspirate specimens not only is a matter of sampling quality but also depends on biological cell properties. Aspiration failure due to malignant type features of BMPC may lead to misclassification of plasma cell disorders and represent a bias for the detection of minimal residual disease after therapy.
Collapse
|
11
|
Gilotra M, Gupta M, Singh S, Sen R. Comparison of bone marrow aspiration cytology with bone marrow trephine biopsy histopathology: An observational study. J Lab Physicians 2020; 9:182-189. [PMID: 28706388 PMCID: PMC5496296 DOI: 10.4103/jlp.jlp_117_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION: Bone marrow examination is a useful investigative tool for the diagnosis of many hematological and nonhematological disorders. Bone marrow aspiration (BMA) provides information about the numerical and cytological features of marrow cells, whereas bone marrow trephine biopsies (BMB) provide excellent appreciation of spatial relationships between cells and of overall bone marrow structure. We conducted this study with the objective of comparing the accuracy of BMA with BMB in the diagnosis of various hematological disorders. MATERIALS AND METHODS: Both BMA and BMB were performed on a total of 130 cases and a comparative evaluation was performed in 100 cases to see the complementary role of both the procedures. However, 30 cases were excluded due to inadequate BMA, BMB, or both. Immunohistochemistry (IHC) was employed whenever required. RESULTS: In our study of 100 cases, 87% of cases were confirmed on bone marrow biopsy and in remaining 13% of cases final diagnosis was achieved with the help of other ancillary investigations. These cases were excluded for calculation of concordance rate between BMA and BMB. The concordance and disconcordance rate between BMA and BMB was 72.4% and 27.6%, respectively. CONCLUSION: BMA cytology and trephine biopsy histopathology complement each other and the superiority of one method over the other depended on the underlying disorder. Furthermore, application of ancillary techniques such as flow cytometery and IHC proved to be an additional advantage in further typing of various diseases.
Collapse
Affiliation(s)
- Meenu Gilotra
- Department of Pathology, Pt. BDS, PGIMS, University of Health Sciences, Rohtak, Haryana, India
| | - Monika Gupta
- Department of Pathology, Pt. BDS, PGIMS, University of Health Sciences, Rohtak, Haryana, India
| | - Sunita Singh
- Department of Pathology, Pt. BDS, PGIMS, University of Health Sciences, Rohtak, Haryana, India
| | - Rajeev Sen
- Department of Pathology, Pt. BDS, PGIMS, University of Health Sciences, Rohtak, Haryana, India
| |
Collapse
|
12
|
Wang X, Scarfò I, Schmidts A, Toner M, Maus MV, Irimia D. Dynamic Profiling of Antitumor Activity of CAR T Cells Using Micropatterned Tumor Arrays. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2019; 6:1901829. [PMID: 31832320 PMCID: PMC6891905 DOI: 10.1002/advs.201901829] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/27/2019] [Indexed: 05/30/2023]
Abstract
Cancer immunotherapy based on the engineering of chimeric antigen receptors (CAR) on T cells has emerged as one of the most promising new therapies for patients with B-cell malignancies. Preclinical assessments of essential CAR T cell functions such as trafficking and cytotoxicity are critical for accelerating the development of highly effective therapeutic candidates. However, current tools for evaluating CAR-T functions lack sufficient precision. Here, a micropatterned tumor array (MiTA) is described that enables detailed and dynamic characterization of CAR T cell trafficking toward tumor-cell islands and subsequent killing of tumor cells. It is shown that CAR T cells often merge into large clusters that envelop and kill the tumor cells with high efficiency. Significant differences are also measured between CAR T cells from different donors and between various CAR T cell constructs. Overall, the assay allows for multifaceted, dynamic, high-content evaluation of CAR T trafficking, clustering, and killing and could eventually become a useful tool for immune-oncology research and preclinical assessments of cell-based immunotherapies.
Collapse
Affiliation(s)
- Xiao Wang
- BioMEMS Resource CenterDepartment of SurgeryMassachusetts General HospitalBostonMA02114USA
- Shiners Hospitals for ChildrenBostonMA02114USA
- Harvard Medical SchoolBostonMA02115USA
| | - Irene Scarfò
- Harvard Medical SchoolBostonMA02115USA
- Cellular Immunotherapy ProgramMassachusetts General Hospital Cancer CenterCharlestownMA02129USA
| | - Andrea Schmidts
- Harvard Medical SchoolBostonMA02115USA
- Cellular Immunotherapy ProgramMassachusetts General Hospital Cancer CenterCharlestownMA02129USA
| | - Mehmet Toner
- BioMEMS Resource CenterDepartment of SurgeryMassachusetts General HospitalBostonMA02114USA
- Shiners Hospitals for ChildrenBostonMA02114USA
- Harvard Medical SchoolBostonMA02115USA
| | - Marcela V. Maus
- Harvard Medical SchoolBostonMA02115USA
- Cellular Immunotherapy ProgramMassachusetts General Hospital Cancer CenterCharlestownMA02129USA
- Broad Institute of Harvard and MITCambridgeMA02142USA
| | - Daniel Irimia
- BioMEMS Resource CenterDepartment of SurgeryMassachusetts General HospitalBostonMA02114USA
- Shiners Hospitals for ChildrenBostonMA02114USA
- Harvard Medical SchoolBostonMA02115USA
| |
Collapse
|
13
|
Chai KY, Boyke Berahmana AA, Morison IM. Haematologists usually over-estimate the percentage of CD138+ plasma cells in marrow biopsies. Pathology 2019; 51:647-648. [DOI: 10.1016/j.pathol.2019.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
|
14
|
Survival rate of multiple myeloma patients in Indonesia: A retrospective study in multiple myeloma at a single institution. Ann Med Surg (Lond) 2019; 41:11-15. [PMID: 31011418 PMCID: PMC6460220 DOI: 10.1016/j.amsu.2019.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/11/2019] [Accepted: 03/31/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction To evaluate the response and the correlation between survival and prognostic factors in 32 patients with multiple myeloma. Method We recruited 32 patients (18 men and 14 women) with mean age 59 years old who were diagnosed with multiple myeloma that were treated with surgery (n = 21) and without surgery (n = 11). 9 patients underwent hemiarthroplasty, 14 patients underwent open reduction and internal fixation and 4 patients underwent spinal decompression and posterior pedicular instrumentation from January 2012 to December 2017. In this group, there were 6 patients who underwent more than one surgeries. Patients were classified using the International Staging System (ISS) for multiple myeloma by evaluated albumin and β2-microglobulin level. Results The mean follow up period for 32 patients was 30.2 months (range, 3–65 months) with 7 patients in ISS stage I, 22 patients in ISS stage II and 3 patients in ISS stage III. The median survival duration was 28 months (95% CI). We documented the median survival for ISS stage II disease was 29 months, stage III disease 6 months and stage I disease 16 months with the median age of ISS stage I, II, and III disease was 65, 59, 60 years respectively. Survival correlation with ISS stage (p = 0.009), the hemoglobin level (p = 0.772), and the calcium level (p = 0.926). Conclusions The survival rate was lower in patients with higher ISS stage for this disease. Survival rate seems to be better among younger patients than in older ones even with lower ISS stage of this disease. Multiple myeloma remains an incurable disease that the survival rate was lower in patients with higher ISS stage. Regarding the prognostic impact of age, survival seems to be better among patients younger than in older patients. In this study, calcium and hemoglobin level is not correlated with the prognosis of patients with multiple myeloma.
Collapse
|
15
|
Dass J, Arava S, Mishra PC, Dinda AK, Pati HP. Role of CD138, CD56, and light chain immunohistochemistry in suspected and diagnosed plasma cell myeloma: A prospective study. South Asian J Cancer 2019; 8:60-64. [PMID: 30766858 PMCID: PMC6348785 DOI: 10.4103/sajc.sajc_64_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction: Plasma cells (PCs) have conventionally been counted on the bone marrow aspirate, and small focal involvement may be missed even on bone marrow biopsy sections. Material and Methods: We aimed to study the role of CD138, CD56, anti-κ, and anti-λ immunohistochemistry (IHC) to separate PC myeloma from reactive plasmacytosis and to study the utility of these in cases suspected as myelomas and lacking >10% PCs on bone marrow aspirate. The study comprised 35 diagnosed myelomas, 20 reactive plasmacytosis, and 19 M-band positive suspected myelomas. CD138 IHC was performed on all cases along with CD56, anti-κ, and anti-λ IHC. PCs were counted on CD138-immunostained sections by manual count and by image analysis. In addition, CD56 expression was correlated with clinical features in diagnosed myeloma group. Results: In all cases, both manual counts and image analysis, PC counts were significantly higher on the CD138 stained sections than bone marrow aspirates. It was seen that the manual PC counts and image analysis counts were equivalent in diagnosed myeloma cases. CD56 expression was seen in ~62.85% diagnosed myeloma cases while it was negative in cases of reactive plasmacytosis. CD56 expression was significantly higher in patients with lytic lesions (78.26% vs. 21.74%). CD138, anti-κ, and anti-λ IHC also helped classify 11/19 (57.8%) cases correctly. Conclusion: The use of CD138 along with the light chain and CD56 IHC adds a high diagnostic value in myeloma patients and suspected myeloma cases. The PCs can be counted manually on the CD138-immunostained sections and correlate well with the counts obtained by image analysis.
Collapse
Affiliation(s)
- Jasmita Dass
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Sudheer Arava
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Amit Kumar Dinda
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Hara Prasad Pati
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
16
|
Discrepancies between the percentage of plasma cells in bone marrow aspiration and BM biopsy: Impact on the revised IMWG diagnostic criteria of multiple myeloma. Blood Cancer J 2017; 7:e530. [PMID: 28211888 PMCID: PMC5386332 DOI: 10.1038/bcj.2017.14] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
17
|
Sönmez M, Özbaş HM, Ermantaş N, Çobanoğlu Ü. Aggressive multiple myeloma with unusual morphology. Turk J Haematol 2014; 31:437-8. [PMID: 25541671 PMCID: PMC4454069 DOI: 10.4274/tjh.2013.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Mehmet Sönmez
- Karadeniz Technical University Faculty of Medicine, Department of Hematology, Trabzon, Turkey. E-mail:
| | | | | | | |
Collapse
|
18
|
Second-Generation Tyrosine Kinase Inhibitors (Tki) as Salvage Therapy for Resistant or Intolerant Patients to Prior TKIs. Mediterr J Hematol Infect Dis 2014; 6:e2014003. [PMID: 24455112 PMCID: PMC3894843 DOI: 10.4084/mjhid.2014.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/26/2013] [Accepted: 11/11/2013] [Indexed: 11/08/2022] Open
Abstract
With the advent of target therapies, imatinib became the mainstay for treatment of chronic myeloid leukemia. However, despite the brilliant results obtained with this drug, more than 30% of patients discontinue therapy in long-term due to several reasons, including failure and/or intolerance. Second-generation tyrosine kinase inhibitors (TKIs) are more potent drugs and have expanded inhibition against a broad spectrum of mutations resistant to imatinib. Both nilotinib and dasatinib have demonstrated in vitro and in vivo clinical activity against different types of mutations and various forms of resistance. However, patients with T315I mutation do not obtain an advantage from these drugs and a third generation inhibitor ponatinib, a pan-BCR drug, was tested with significant results. In this review, we report the results of second-and third-generation TKIs tested as second or third line therapy in patients resistant and/or intolerant to previous inhibitors.
Collapse
|
19
|
Comparative evaluation of bone marrow aspirate with trephine biopsy in hematological disorders and determination of optimum trephine length in lymphoma infiltration. Mediterr J Hematol Infect Dis 2014; 6:e2014002. [PMID: 24455111 PMCID: PMC3894839 DOI: 10.4084/mjhid.2014.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/22/2013] [Indexed: 01/05/2023] Open
Abstract
Introduction Bone marrow examination is an indispensable diagnostic tool to evaluate neoplastic and non neoplastic hematological diseases. Aims To compare bone marrow aspirate with trephine biopsy in hematological disorders. To determine the optimum trephine preprocessing length in lymphoma infiltration. Methods Diagnostic comparison was done between simultaneous bone marrow aspirates and trephine biopsies in 449 patients. Biopsies were fixed in formalin, decalcified in 5.5% EDTA and routinely processed. Concordance rates and validity parameters for aspirate were calculated. Three deeper sections of trephine biopsy, cut at 0.1–0.2 mm intervals, were assessed for lymphoma involvement. Proportion of biopsies showing marrow infiltration by lymphoma cells was plotted against trephine length and correlation was assessed. Results Aspirate had a high sensitivity for acute leukemia (89.4%) and multiple myeloma (88.5%), moderate for NHL (67.6%) and nonhematopoietic metastases (58.3%) and low for aplastic anemia (38.5%) and Hodgkin lymphoma (5%). Aspirate has no role in granulomatous myelitis and myelofibrosis. Lymphoma positivity increased with trephine length, with maximum positivity (68.9%) seen in 17–20 mm group and no further gain beyond 20 mm. (lymphoma positivity ≤16mm=40.3% and ≥17mm=66.1%, p=0.0011). Conclusion Aspirate has a high specificity; its sensitivity depends upon the type of disease. Apart from few conditions, in which aspirate alone is sufficient, biopsy is mandatory in most. Preprocessing trephine length of 17–20 mm examined at multiple deeper levels was found optimal for assessing lymphoma positivity.
Collapse
|
20
|
Seili-Bekafigo I, Valković T, Babarović E, Duletić-Načinović A, Jonjić N. Myeloma cell morphology and morphometry in correlation with clinical stages and survival. Diagn Cytopathol 2013; 41:947-54. [DOI: 10.1002/dc.22986] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 02/01/2013] [Accepted: 02/14/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Irena Seili-Bekafigo
- Department of Cytology; Clinical Hospital Center Rijeka; Internal Medicine Clinic; Krešimirova 42; 51000; Rijeka; Croatia
| | - Toni Valković
- Department of Hematology; Clinical Hospital Center Rijeka; Internal Medicine Clinic; Krešimirova 42; 51000; Rijeka; Croatia
| | - Emina Babarović
- Department of Pathology; School of Medicine; University of Rijeka; Braće Branchetta 20; 51000; Rijeka; Croatia
| | - Antica Duletić-Načinović
- Department of Hematology; Clinical Hospital Center Rijeka; Internal Medicine Clinic; Krešimirova 42; 51000; Rijeka; Croatia
| | - Nives Jonjić
- Department of Pathology; School of Medicine; University of Rijeka; Braće Branchetta 20; 51000; Rijeka; Croatia
| |
Collapse
|
21
|
Extensive bone marrow infiltration and abnormal free light chain ratio identifies patients with asymptomatic myeloma at high risk for progression to symptomatic disease. Leukemia 2012. [DOI: 10.1038/leu.2012.309] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
22
|
Shi L, Liu S, Wang D, Wong HL, Huang WH, Wang YXJ, Griffith JF, Leung PC, Ahuja AT. Computerized quantification of bone tissue and marrow in stained microscopic images. Cytometry A 2012; 81:916-21. [PMID: 22899564 DOI: 10.1002/cyto.a.22157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 07/18/2012] [Accepted: 07/20/2012] [Indexed: 01/02/2023]
Abstract
Stained histological images assist physicians to identify different types of tissues or cells and their architectures. They can be applied on the diagnosis of various diseases and the assessment of treatment effects. Osteoporosis is an aging disease that reduces the density of bones and increases the risk of bone fracture. Literatures indicate that osteoporosis is associated with the ratio of trabecular bone tissues and bone marrow cells, and bones in osteoporosis patients consist of a significantly higher marrow fat content. Interactive segmentation of bone tissue and different types of bone marrow cells in high-resolution histological images, however, is a very tedious and labor-intensive process. The aim of this study is to develop an automatic algorithm to quantify the areas of different tissues such as the trabecular bones and yellow and red marrow cells. This image segmentation method consists of a series of mathematical morphological operation steps based on both the color and morphology features of tissues and was implemented in Matlab. The results obtained from the proposed method have been verified by comparing with those obtained interactively from an experienced histotechnician (Pearson correlation coefficient > 0.94, P < 0.001). The result suggests that the proposed algorithm can effectively assist physicians to quantify stained bone histological images.
Collapse
Affiliation(s)
- Lin Shi
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Babarović E, Valković T, Štifter S, Budisavljević I, Seili-Bekafigo I, Duletić-Načinović A, Lučin K, Jonjić N. Assessment of bone marrow fibrosis and angiogenesis in monitoring patients with multiple myeloma. Am J Clin Pathol 2012; 137:870-8. [PMID: 22586045 DOI: 10.1309/ajcpt5y2jriuucub] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The aim of our study was to emphasize the importance of accurate and standardized techniques for detailed monitoring of the microenvironment in multiple myeloma (MM). Bone marrow fibrosis, angiogenesis, and plasma cell infiltrates in bone marrow biopsy (BMB) samples at the time of diagnosis and on completion of therapy were analyzed for 42 patients with newly diagnosed MM. Computerized image analysis was used for all slides stained with anti-CD138 and anti-CD34. The patients with fibrosis in pretreatment BMB samples had significantly higher microvessel density (MVD) and plasma cell infiltrates. In posttreatment BMB samples, nonresponders had a significantly higher frequency and grade of fibrosis and higher values of MVD, total vascular area, and plasma cell percentage. The overall survival of nonresponders and patients with increased marrow fibrosis in posttreatment BMB samples was significantly shorter. The obtained results confirm that complex morphologic examination of the bone marrow microenvironment during the monitoring of MM can provide better prognostic significance.
Collapse
|
24
|
Shetty S, Siady M, Mallempati KC, Wilson A, Poarch J, Chandler B, Gray J, Salama ME. Utility of a column-free cell sorting system for separation of plasma cells in multiple myeloma FISH testing in clinical laboratories. Int J Hematol 2012; 95:274-81. [PMID: 22328174 DOI: 10.1007/s12185-012-1021-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 01/22/2012] [Accepted: 01/24/2012] [Indexed: 12/15/2022]
Abstract
Targeted FISH analysis is an essential component of the management of plasma cell myeloma for identification of cytogenetic abnormalities. The purpose of this study was to evaluate the column-free method, RoboSep® (RS), for sorting CD138-expressing cells in bone marrow aspirates. Comparative analysis of column-based and RS methodologies was carried out on 54 paired bone marrow aspirate validation samples from patients undergoing work-up for plasma cell dyscrasia. Abnormalities detected by FISH analysis using an IGH@/CCND1 probe set were seen in 54% with RS, and 44% with column-based. We found a statistically significant difference between the yield of abnormalities detected in paired positive cases (p = 0.0001). An additional 183 consecutive post-validation samples sorted by RS showed recurrent genetic abnormalities in 85/120 (71%) of successfully sorted samples with ≥ 1% plasma cells but in none of 63 samples in which FISH analysis was completed on samples that could not be sorted due to insufficient plasma cells upon cell sorting. The column-free method successfully sorted PC, when present in ≥ 1% of cells, for detection of abnormalities by FISH. Furthermore, our data suggest that FISH analysis should not be performed on samples with an inadequate yield at the cell selection step.
Collapse
Affiliation(s)
- Shashirekha Shetty
- Cleveland Clinic, 9500 Euclid Avenue, Mail Code LL2-2, Cleveland, OH 44195, USA.
| | | | | | | | | | | | | | | |
Collapse
|