Joshi R, Horncastle D, Elderfield K, Lampert I, Rahemtulla A, Naresh K N
Department of Histopathology, Hammersmith Hospital and Imperial College, London, UK.
J Clin Pathol. 2008 Feb;61(2):213-6. doi: 10.1136/jcp.2007.049130. Epub 2007 May 25.
Multiple myeloma (MM) guidelines in the UK do not advocate performing bone marrow trephine biopsy (BMTB) during follow-up. In a recent study, it was found that the plasma cell per cent (PC%) in BMTB performed at the time of autologous stem cell transplant strongly correlated with survival. The current study addresses whether BMTB is superior to bone marrow aspiration (BMA) in documenting presence of disease and its volume at follow-up.
The study involved 106 samples. A conventional 500-cell differential count was performed on the BMAs to document the PC%. The PC% on BMTBs had been estimated on CD138 immunostain. Furthermore, BMTBs had also been immunostained for CD56, cyclin D1 and light chains.
The mean (2SEM) PC% values in BMAs and BMTBs were 13.1 (2.6)% and 31.8 (5.8)% respectively. Based on BMA, BMTB and serum/urine paraprotein or light chain estimation, on 92 occasions (89%) there was detectable disease. The positive predictive value of both BMA and BMTB was 100%, and the negative predictive values for BMTB and BMA were 57% and 22% respectively. Among 98 secretory MM cases, the BMTB-PC% showed significant correlation with paraprotein levels, whereas BMA-PC% did not.
It is strongly recommended that BMTB is performed and adequately investigated with immunohistochemistry during follow-up of MM.
英国的多发性骨髓瘤（MM）指南不主张在随访期间进行骨髓活检（BMTB）。在最近的一项研究中，发现自体干细胞移植时进行的骨髓活检中浆细胞百分比（PC%）与生存率密切相关。本研究探讨在随访中，骨髓活检在记录疾病存在及其体积方面是否优于骨髓穿刺（BMA）。
该研究涉及106个样本。对骨髓穿刺样本进行常规的500细胞分类计数以记录PC%。骨髓活检的PC%通过CD138免疫染色进行估计。此外，骨髓活检还进行了CD56、细胞周期蛋白D1和轻链的免疫染色。
骨髓穿刺和骨髓活检的平均（2标准误）PC%值分别为13.1（2.6）%和31.8（5.8）%。基于骨髓穿刺、骨髓活检以及血清/尿液副蛋白或轻链估计，在92例（89%）中检测到疾病。骨髓穿刺和骨髓活检的阳性预测值均为100%，骨髓活检和骨髓穿刺的阴性预测值分别为57%和22%。在98例分泌型MM病例中，骨髓活检PC%与副蛋白水平显著相关，而骨髓穿刺PC%则不然。
强烈建议在MM随访期间进行骨髓活检并用免疫组织化学进行充分研究。
