Witzig T E, Meyers C, Therneau T, Greipp P R
Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Leuk Lymphoma. 2000 Jul;38(3-4):345-50. doi: 10.3109/10428190009087025.
Malignant plasma cells can be detected in the blood of patients with multiple myeloma (MM) using flow cytometry (FC), immunofluorescence microscopy (IM), or a variety of molecular techniques. Increased numbers of light chain-restricted blood plasma cells as detected by IM is associated with a diagnosis of overt MM and a decreased overall survival. The IM technique is time consuming; therefore, a prospective study was designed to test whether CD38 CD45 FC could simplify the procedure. Blood samples from 769 patients with plasma cell proliferative disorders were studied prospectively by FC and IM over a one-year period. The FC technique was performed on 1 ml of whole blood after ammonium chloride red blood cell lysis and utilized anti-CD38PE and anti-CD45PerCP. The number of CD38+ 45- events were enumerated and compared to the number of light chain-restricted plasma cells detected by the standard IM technique. In 46% (353/769) of cases > or = 1 CD38+ CD45- events were detected by FC whereas IM was positive for light chain restricted plasma cells in 33%; there was concordance between FC and IM in 73% of cases. In 20% of cases FC was positive and IM was negative; however, in 7% of cases FC was negative yet light chain-restricted plasma cells were detected by IM. FC was positive in 88% (134/153) of cases where the IM technique showed a high number of circulating plasma cells. This study demonstrates that two-color CD38/45 FC identifies most cases with a high IM result and reduces the workload in the clinical laboratory. The prognostic implications of a positive FC screen but a negative IM will require long-term patient follow-up.
使用流式细胞术（FC）、免疫荧光显微镜检查（IM）或多种分子技术，可以在多发性骨髓瘤（MM）患者的血液中检测到恶性浆细胞。通过IM检测到的轻链受限血浆细胞数量增加与显性MM的诊断及总生存期缩短相关。IM技术耗时较长；因此，设计了一项前瞻性研究来测试CD38 CD45 FC是否可以简化该程序。在一年的时间里，对769例浆细胞增殖性疾病患者的血样进行了FC和IM的前瞻性研究。FC技术在氯化铵裂解红细胞后对1 ml全血进行检测，并使用抗CD38PE和抗CD45PerCP。对CD38+ 45-事件的数量进行计数，并与标准IM技术检测到的轻链受限浆细胞数量进行比较。在46%（353/769）的病例中，FC检测到≥1个CD38+ CD45-事件，而IM检测到轻链受限浆细胞呈阳性的比例为33%；73%的病例中FC和IM结果一致。20%的病例中FC呈阳性而IM呈阴性；然而，7%的病例中FC呈阴性但IM检测到轻链受限浆细胞。在IM技术显示循环浆细胞数量较多的病例中，88%（134/153）的病例FC呈阳性。这项研究表明，双色CD38/45 FC可识别大多数IM结果较高的病例，并减少临床实验室的工作量。FC筛查阳性但IM阴性的预后意义需要对患者进行长期随访。
