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Multiparameter flow cytometry for the identification of the Waldenström's clone in IgM-MGUS and Waldenström's Macroglobulinemia: new criteria for differential diagnosis and risk stratification.
[waldenström macroglobulinemia]
Although
multiparameter
flow
cytometry
(
MFC
)
has
demonstrated
clinical
relevance
in
monoclonal
gammopathy
of
undetermined
significance
(
MGUS
)
/
myeloma
,
immunophenotypic
studies
on
the
full
spectrum
of
Waldenström
's
Macroglobulinemia
(
WM
)
remain
scanty
.
Herein
,
a
comprehensive
MFC
analysis
on
bone
marrow
samples
from
244
newly
diagnosed
patients
with
an
immunoglobulin
M
(
IgM
)
monoclonal
protein
was
performed
,
including
67
IgM-MGUS
,
77
smoldering
and
100
symptomatic
WM
.
Our
results
show
a
progressive
increase
on
the
number
and
light-chain-isotype-
positive
B-
cells
from
IgM-MGUS
to
smoldering
and
symptomatic
WM
(
P
<
.
001
)
,
with
only
1
%
of
IgM-MGUS
patients
showing
>
10
%
B
cells
or
100
%
light-chain-isotype-
positive
B-
cells
(
P
<
.
001
)
.
Complete
light-chain
restriction
of
the
B-
cell
compartment
was
an
independent
prognostic
factor
for
time-
to
progression
in
smoldering
WM
(
median
26
months
;
HR
:
19
.
8
,
P
=
0
.
001
)
and
overall
survival
in
symptomatic
WM
(
median
44
months
;
HR
:
2
.
6
,
P
=
0
.
004
)
.
The
progressive
accumulation
of
light-chain-isotype-
positive
B-
cells
accompanied
the
emergence
of
a
characteristic
Waldenstrom
's
phenotype
(
CD
22
(
+
dim
)
/
CD
2
5
+
/
CD
27
+
/
IgM
+
)
that
differed
from
other
B-NHL
by
negative
expression
of
CD
5
,
CD
10
,
CD
11
c
or
CD
103
.
In
contrast
to
myeloma
,
light-chain-isotype-
positive
plasma
cells
in
IgM
monoclonal
gammopathies
show
otherwise
normal
antigenic
expression
.
Our
results
highlight
the
potential
value
of
MFC
immunophenotyping
for
the
characterization
of
the
Waldenström
's
clone
,
as
well
as
for
the
differential
diagnosis
,
risk
of
progression
and
survival
in
WM
.
Diseases
Validation
Diseases presenting
"newly diagnosed patients with an immunoglobulin m (igm) monoclonal protein"
symptom
waldenström macroglobulinemia
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