title: Bone marrow trephine combined with immunohistochemistry is superior to bone marrow aspirate in follow-up of myeloma patients.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  It is strongly recommended that BMTB is performed and adequately investigated with immunohistochemistry during follow-up of MM.
authors.affiliation: Department of Histopathology, Hammersmith Hospital and Imperial College, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Joshi
authors.forename: D
authors.initials: D
authors.lastname: Horncastle
authors.forename: K
authors.initials: K
authors.lastname: Elderfield
authors.forename: I
authors.initials: I
authors.lastname: Lampert
authors.forename: A
authors.initials: A
authors.lastname: Rahemtulla
authors.forename: K N
authors.initials: KN
authors.lastname: Naresh
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism; D001706:Biopsy / Q000379:methods; D001707:Biopsy, Needle; D001853:Bone Marrow / Q000473:pathology*; D001856:Bone Marrow Examination / Q000379:methods; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D018365:Neoplasm, Residual; D010950:Plasma Cells / Q000473:pathology; D053668:Syndecan-1 / Q000378:metabolism
chemical_list: D014408:Biomarkers, Tumor; C508241:SDC1 protein, human; D053668:Syndecan-1