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Title: [Correlation between Morphological Typing and Monoclonality of Bone Marrow Plasma Cells and Its Diagnostic Value for High-Risk Smoldering Multiple Myeloma].
Author: Xiao HJ, Wang QJ, Wu S, Dai XB, Zhuang YP.
Journal: Zhongguo Shi Yan Xue Ye Xue Za Zhi; 2024 Aug; 32(4):1146-1151. PubMed ID: 39192411.
Abstract:
OBJECTIVE: To investigate the correlation between morphological typing and monoclonality of bone marrow plasma cells, and explore the diagnostic value of plasma cell morphological typing for high-risk smoldering multiple myeloma(HR-SMM). METHODS: The correlation between the morphological characteristics and the monoclonality of bone marrow plasma cells was analyzed in 84 patients with HR-SMM who treated in our hospital. The consistency of morphologically abnormal bone marrow plasma cells with serum free light chain (sFLC) ratio, next-generation sequencing (NGS) detection results, and its correlation with monoclonal plasma cells detected by flow cytometry (FCM) were further verified. The immunoglobulin types and levels of non-involved immunoglobulins in serum of the patients were detected, and the distribution of plasma cell clusters in patients with different disease was observed. RESULTS: The mean percentage of mature plasma cells were decreased successively in the order of reactive plasmacytosis (RP) group, monoclonal gammopathy of undetermined significance (MGUS) group, smoldering multiple myeloma (SMM) group, HR-SMM group and multiple myeloma (MM) group; while the mean percentage of immature, primitive, reticular and flaming plasma cells were increased successively in the order of RP group, MGUS group, SMM group, and HR-SMM group, and the difference between any two groups was statistically significant (P < 0.05).The average proportion of abnormal plasma cells in the bone marrow of HR-SMM patients was 96.2% of the total plasma cells. The proportion of abnormal plasma cells were in good agreement with the sFLC ratio and the results of NGS detection in HR-SMM patients (kappa=0.879 and kappa=0.891, both >0.75)，and showed good correlation with the monoclonal plasma cells with immunophenotype of CD45^-/CD38⁺/CD138⁺/CD56⁺/CD19^-( γ=0.825). The levels of non-involved immunoglobulin in IgG, IgA and IgM type HR-SMM patients were all decreased by more than 25% compared with the normal reference range, and the differences were statistically significant (P < 0.05). There was no significant difference in the distribution ratio of plasma cell clusters among different disease groups (P >0.05). CONCLUSION: In HR-SMM patients, the immature, primitive, reticular and flaming plasma cells in bone marrow are considered as abnormal plasma cells, and they are correlated with monoclonal plasma cells. The proportion of abnormal plasma cells in total plasma cells of bone marrow and the reduction extent of non-involved immunoglobulin level in patients have certain reference value for the diagnosis of HR-SMM. 题目: 骨髓浆细胞形态分型与单克隆性的相关性及其对高危冒烟型骨髓瘤的诊断价值. 目的: 研究浆细胞的形态学分型与单克隆性的相关性，探讨其对高危冒烟型骨髓瘤（HR-SMM）的诊断价值。. 方法: 分析于本院就诊的84例HR-SMM患者的骨髓浆细胞形态特点与其单克隆性的相关性，并进一步验证异常浆细胞形态分型与sFLC比值、二代测序检测结果的一致性,及其与流式细胞术检测的单克隆浆细胞比例的相关性；检测患者的免疫球蛋白类型及血清中非受累免疫球蛋白水平，并观察不同疾病类型患者浆细胞成簇分布情况。. 结果: 成熟浆细胞比例均数按反应性浆细胞增多症（RP）组、意义未明的单克隆免疫球蛋白血症（MGUS）组、冒烟型骨髓瘤（SMM）组、HR-SMM组、多发性骨髓瘤（MM）组的顺序依次减少；而幼稚型、原始型、网状型及火焰型浆细胞占有核细胞的比例均数按RP组、MGUS组、SMM组、HR-SMM组的顺序依次升高，两两组间比较差异均有统计学意义（P < 0.05）。HR-SMM患者骨髓浆细胞中异常浆细胞的平均比例为96.2%。HR-SMM患者骨髓异常浆细胞比例与sFLC比值及二代测序检测结果有较好的一致性（kappa=0.879及kappa=0.891，均>0.75），与免疫表型为CD45^-/CD38⁺/CD138⁺/CD56⁺/CD19^-的单克隆浆细胞有较好的相关性（ γ=0.825）。IgG型、IgA型及IgM型HR-SMM患者的非受累免疫球蛋白水平比正常参考范围均减低25%以上，差异有统计学意义(P < 0.05)。各疾病组浆细胞成簇分布比例未见明显差异（P >0.05）。. 结论: 在HR-SMM患者中，幼稚型、原始型、网状型及火焰型浆细胞作为骨髓异常浆细胞，与单克隆浆细胞存在较大相关性；异常浆细胞在骨髓总浆细胞中的比例及患者的非受累免疫球蛋白水平减少幅度对HR-SMM的诊断有一定价值。.

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