Detection of low level (minimal residual disease) myeloma cells after therapy
High-sensitivity flow cytometry test for detection of minimal residual myeloma cells, post treatment
Adopted EuroFlow guidelines and Cytognos software
Sensitivity of 10(-5) or better, depending on the antigenic profile of abnormal plasma cells
Immunophenotyping for Minimal Residual Disease (MRD)
Multiple Myeloma MRD
Myeloma MRD
Plasma cell MRD
Bone Marrow
MRDMM should be ordered when monitoring Multiple Myeloma patients after treatment. This test should not be ordered on known relapsing patients or at diagnosis, see PCPRO / Plasma Cell DNA Content and Proliferation, Bone Marrow or MSMRT / Mayo Algorithmic Approach for Stratification of Myeloma and Risk-Adapted Therapy Report if indicated for these situations.
It is recommended that specimens arrive within 48 hours of draw. Draw and package specimen as close to shipping time as possible.
1. Include patient's disease state (untreated, treated, monoclonal gammopathy of undetermined significance, stable).
2. Indicate if patient is on anti-CD38 therapy.
3. Provide Immunofix information if available.
Specimen Type: Redirected bone marrow
Container/Tube:
Preferred: Yellow top (ACD)
Acceptable: Lavender top (EDTA
Specimen Volume: 4 mL
If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.
2 mL
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Bone Marrow | Ambient (preferred) | 72 hours | |
Refrigerated | 72 hours |
Detection of low level (minimal residual disease) myeloma cells after therapy
Multiple myeloma is an incurable malignant neoplasm of plasma cells. One of the best prognostic factors in multiple myeloma is the level of minimal residual disease post chemotherapy or autologous stem cell transplantation. The greater depth of the response (less malignant cells present), the longer time to progression and overall survival.(1)
An interpretive report will be provided.
This test will be processed as a laboratory consultation. An interpretation of the immunophenotypic findings and correlation with the previous patient history will be provided by a hematopathologist for every case.
The interpretation of the test is done by an evaluating automated and manually gated populations to isolate abnormal plasma cells. If there is an abnormal plasma cell population (cluster of 20 cells or more), then the result is minimal residual disease (MRD)-positive, with the percentage of abnormal plasma cells out of total analyzed events. If no abnormal population is found, then the result will be interpreted as MRD-negative.
There are situations in which current gating strategies are insufficient to identify abnormal plasma cells. This can occur if the abnormal plasma cells do not phenotypically differ from normal plasma cells. In addition, in patients who have undergone therapeutic antibody treatment (anti-CD38, for example), decreased antigen expression on plasma cells may interfere with the gating strategy.
1. Martinez-Lopez J, Lahuerta JJ, Pepin F, et al: Prognostic value of deep sequencing method for minimal residual disease detection in multiple myeloma. Blood. 2014 May 15;123(20):3073-3079
2. Rawstron AC, Child JA, de Tute RM, et al: Minimal residual disease assessed by multiparameter flow cytometry in multiple myeloma: impact on outcome in the medical research council myeloma IX Study. J Clin Oncol 2013 Jul 10;31(20):2540-2547
3. Roschewski M, Stetler-Stevenson M, Yuan C, et al: Minimal residual disease: What are the minimum requirements? J Clin Oncol 2014 32(5): 475-476
4. Rawstron AC, Orfao A, Beksac M, et al: Report of the European Myeloma Network on multiparametric flow cytometry in multiple myeloma and related disorders. Haematologica 2008 Mar;93(3): 431-438
5. Stetler-Stevenson M, Paiva B, Stoolman L, et al: Consensus guidelines for myeloma minimal residual disease sample staining and data acquisition. Cytometry B Clin Cytom 2016 Jan;90(1):26-30 doi: 10.1002/cyto.b.21249
Flow cytometric immunophenotyping for minimal residual disease of bone marrow is performed using the following antibodies:
Tube 1: CD138, CD27, CD38, CD56, CD45, CD19, CD117, and CD81.
Tube 2: CD138, CD27, CD38, CD56, CD45, CD19, cyKappa, and cyLambda.
Abnormal plasma cell populations are detected through demonstrating CD38 (multiepitope) and CD138 positivity along with immunoglobulin light chain restriction (ie, the presence of either predominately kappa or predominately lambda light chains) and abnormality of CD56, CD117, CD27, CD81, CD19 and/or CD45 expression.
The percentage of clonal plasma cells estimated by flow cytometry is affected by specimen processing and antigen loss with specimen aging. Minimal residual disease reporting is affected by sample volume and cellularity.(Unpublished Mayo method)
Monday through Friday
This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.
88184-Flow Cytometry; first cell surface, cytoplasmic or nuclear marker
88185 x 9-Flow Cytometry; additional cell surface, cytoplasmic or nuclear marker
88188-Flow Cytometry Interpretation, 9 to 15 Markers
Test Id | Test Order Name |
Order LOINC Value
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
|
---|---|---|
MRDMM | Multiple Myeloma MRD by Flow, BM | 93022-2 |
Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
---|---|---|
CK146 | % Minimal Residual Disease (MRD) | 93021-4 |
CK147 | % Normal Plasma Cells (of total PC) | 93020-6 |
CK148 | Non-Aggregate Events | 38257-2 |
CK149 | Total Plasma Cell Events | 93019-8 |
CK150 | Poly PC Events | 93018-0 |
CK151 | Abnormal PC Events | 93017-2 |
CK152 | Final Diagnosis | 74226-2 |