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Multiparameter flow cytometry for the identification of the Waldenström's clone in IgM-MGUS and Waldenström's Macroglobulinemia: new criteria for differential diagnosis and risk stratification.

Abstract: Although multiparameter flow cytometry (MFC) has demonstrated clinical relevance in monoclonal gammopathy of undetermined significance (MGUS)/myeloma, immunophenotypic studies on the full spectrum of Waldenström?s Macroglobulinemia (WM) remain scanty. Herein, a comprehensive MFC analysis on bone marrow samples from 244 newly diagnosed patients with an immunoglobulin M (IgM) monoclonal protein was performed, including 67 IgM-MGUS, 77 smoldering and 100 symptomatic WM. Our results show a progressive increase on the number and light-chain-isotype-positive B-cells from IgM-MGUS to smoldering and symptomatic WM (P<.001), with only 1% of IgM-MGUS patients showing >10% B cells or 100% light-chain-isotype-positive B-cells (P<.001). Complete light-chain restriction of the B-cell compartment was an independent prognostic factor for time-to progression in smoldering WM (median 26 months; HR: 19.8, P=0.001) and overall survival in symptomatic WM (median 44 months; HR: 2.6, P=0.004). The progressive accumulation of light-chain-isotype-positive B-cells accompanied the emergence of a characteristic Waldenstrom?s phenotype (CD22+dim/CD25+/CD27+/IgM+) that differed from other B-NHL by negative expression of CD5, CD10, CD11c or CD103. In contrast to myeloma, light-chain-isotype-positive plasma cells in IgM monoclonal gammopathies show otherwise normal antigenic expression. Our results highlight the potential value of MFC immunophenotyping for the characterization of the Waldenström?s clone, as well as for the differential diagnosis, risk of progression and survival in WM.

 Fuente: Leukemia, 2014, 28(1), 166-173

 Editorial: Nature Publishing Group

 Año de publicación: 2014

 Tipo de publicación: Artículo de Revista

 DOI: 10.1038/leu.2013.124

 ISSN: 0887-6924,1476-5551

 Url de la publicación: https://doi.org/10.1038/leu.2013.124

Autoría

PAIVA, BRUNO

MONTES, MARÍA CARMEN

GARCÍA-SANZ, RAMÓN

ALONSO, JUAN MANUEL

DE LAS HERAS, NATALIA

ESCALANTE, F. CÁRDENAS

CUELLO, REBECA

DE COCA, ALFONSO GARCÍA

GALENDE, JOSEFINA

HERNÁNDEZ, JOSÉ MARIANO

SIERRA, MAGDALENA

MARTÍN GARCÍA-SANCHO, ALEJANDRO PÉREZ

PARDAL, EMILIA

BÁREZ, ABELARDO

ALONSO, JOSÉ MARÍA

SUAREZ, LISBETT

GONZÁLEZ-LÓPEZ, TOMÁS JOSÉ

PEREZ, JOSÉ JUAN

ORFAO, ALBERTO