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In a letter to the editor of the Blood Cancer Journal, N. Lee and colleagues from the Seoul National University Hospital, Korea, described their findings regarding discrepancies between the percentage of plasma cells (PCs) as assessed by bone marrow (BM) aspiration (BMA) and BM biopsy (BMB). With new guidelines (issued by the International myeloma working group, IMWG) placing more emphasis on the PC percentage, and less emphasis on previously used CRAB symptoms (hypercalcemia, renal insufficiency, anemia, bone lesion), the need for accurate measurement of PC percentage is critical. Previous measurements of BMA did not take into account dilution of peripheral blood and there was no consensus regarding the volume taken, resulting in significant user error. In addition, routine methods to calculate PC percentage using BMB lacked objectivity.
Currently, the presence of clonal PC >10% is the main indicator for Multiple Myeloma (MM). The new guidelines indicate that BMB can be used in addition to BMA to assess PC percentage and that in cases of discrepancy, the higher value for either method should be considered. Therefore, this study set out to evaluate the percentage PC of BMB in patients with a low measured BMA PC (<10%), and to track the conversion rate from BMA PC (<10%) to BMB PC (≥10%), in order to assess user error and to compare PC estimates using the two different methods.
Obtaining an accurate PC count has become increasingly important for the accurate diagnosis of MM. The authors established that the BMB PC count provides more diagnostic relevance than BMA, and better reflects the recently revised criteria, although combined evaluation (of both BMA and BMB) is more reliable for diagnosis. The use of CD138 staining and image analysis for PC% by BMB enables greater objectivity and decreased user error, and is practical enough for routine clinical use.
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