Bone marrow trephine combined with immunohistochemistry is superior to bone marrow aspirate in follow-up of myeloma patients
Abstract
Aims: Multiple myeloma (MM) guidelines in the United Kingdom do not advocate performing bone marrow trephine biopsy (BMTB) during follow-up. In a recent study, we found that the plasma cell (PC) % in BMTB performed at the time of autologous stem cell transplant strongly correlated with survival (O'Shea et al, 2006). The current study addresses if BMTB is superior to bone marrow aspiration (BMA) in documenting presence of disease and its volume at follow-up.
Methods: The study involves 106 samples. A conventional 500-cell differential count had been performed on the BMAs to document the PC%. The PC% on BMTB had been estimated on CD138 immunostain. Furthermore, BMTBs had also been immunostained for CD56, cyclin D1 and light chains.
Results: The mean PC% in BMAs and BMTBs was 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 value for BMTB and BMA was 57% and 22% respectively. Among 98 secretory MM cases, the BMTB-PC% showed significant correlation with paraprotein levels, whereas BMA-PC% did not.
Conclusions: We strongly recommend performing BMTB and adequately investigating them with immunohistochemistry during follow-up of MM.
