title: Utility of nine-color, 11-parameter flow cytometry for detection of plasma cell neoplasms: a comparison with bone marrow morphologic findings and concurrent M-protein studies in serum and urine.
abstract: OBJECTIVE
  Multiparameter flow cytometry (MFC) is a widely available laboratory platform for the evaluation of plasma cell (PC) neoplasms. We assess the performance of a nine-color MFC assay that uses stain-lyse-fix processing of bone marrow aspirates, minimal wash steps, and high acquisition rates with analysis of up to 1.8 × 10(6) cells.
  
  
  METHODS
  MFC results were compared with microscopic examinations, immunohistochemical studies, and serum/urine M-protein measurements from patients with documented or suspected PC neoplasms.
  
  
  RESULTS
  Sensitivity exceeded that of microscopic examinations, with or without immunohistochemistry. In patients with PC myeloma, clonal PC detection by MFC fell in concert with M-protein levels. However, in a subset of patients, MFC detected clonal PCs after serum/urine studies turned negative.
  
  
  CONCLUSIONS
  The nine-color analytic cocktail eliminates duplication of PC gating reagents required for evaluation of the same epitopes using a five- or six-color approach. Fewer analytic cocktails result in lower instrument acquisition times per case, a significant factor for the large data sets required for optimal residual disease assessment. Finally, concurrent analysis of nine epitopes and two light scatter parameters aids detection of residual disease, particularly when it is mixed with polyclonal PCs.
authors.affiliation: From the Department of Pathology, University of Michigan, Ann Arbor.
authors.forename: Amir
authors.initials: A
authors.lastname: Behdad
authors.affiliation: From the Department of Pathology, University of Michigan, Ann Arbor.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Ross
authors.affiliation: From the Department of Pathology, University of Michigan, Ann Arbor.
authors.forename: Joshua
authors.initials: J
authors.lastname: Jacques
authors.affiliation: From the Department of Pathology, University of Michigan, Ann Arbor.
authors.forename: Usha
authors.initials: U
authors.lastname: Kota
authors.affiliation: From the Department of Pathology, University of Michigan, Ann Arbor.
authors.forename: David
authors.initials: D
authors.lastname: Keren
authors.affiliation: From the Department of Pathology, University of Michigan, Ann Arbor. stoolman@umich.edu.
authors.forename: Lloyd
authors.initials: L
authors.lastname: Stoolman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000276:immunology / Q000473:pathology*; D048430:Cell Shape; D005260:Female; D005434:Flow Cytometry / Q000379:methods*; D006801:Humans; D016130:Immunophenotyping; D008297:Male; D008875:Middle Aged; D054219:Neoplasms, Plasma Cell / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D010950:Plasma Cells / Q000276:immunology / Q000473:pathology*; D055815:Young Adult
keywords: Flow cytometry; Minimal residual disease; Multiple myeloma; Plasma cell myeloma; Residual disease