الفهرس 
Introduction
Multiple MyelomaOnly 14 pages are availabe for public view
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Abstract
Multiple myeloma (MM) is a clonal plasma cell disorder in which malignant plasma cells (PCs) accumulate in the bone marrow, producing lytic lesions, excessive amounts of monoclonal protein in the serum or urine, and evidence of end-organ damage (hypercalcemia, renal insufficiency, anemia, or bone lesions) (Aasen and McKenna, 2016). MM accounts for 1% of all malignancies and 10% of hematologic cancers. The incidence has been increasing by 0.7% each year for the last 10 years while mortality has come down by 1.7% each year over the same period (Ailawadhi et al., 2018). A conventional diagnosis in MM is based on a variety of laboratory results: morphologic features, analysis of M component, hematologic features, biochemical parameters, immunophenotyping, cytogenetics and labeling index–proliferative activity of PCs (Bhutani et al., 2016). The updated criteria for the diagnosis of myeloma represent a paradigm shift in the approach to myeloma and have considerable impact on the management of the disease (Rajkumar, 2016). Patients with MM have a median survival of approximately 5 years, during which they may experience significant morbidity (Rawstron et al., 2016).Results of our study: We retrospectively analyzed 50 MM patients (base line without treatment) (26 males and 24 females), 29 patients were elder than 50 years old and 21 younger than 50. According to ISS, 13 were diagnosed as in stage I, 20 patients were in stage II, 17 patients in stage III. Morphological assessment in diagnosis was based on (WHO, 2016) diagnostic criteria, so patients were divided into two groups, BMA PCs% ≥10% or less than 10%, also, each group subdivided according to BMB PCs% to ≥10% PCs or less. 43 cases were diagnosed as MM (BMA PCs ≥10%), the remaining 7 cases were diagnosed by BMB, FCMI could diagnose 44 cases as monoclonal MM with more than 10% plasma cell, The last 6 cases assessed by FCMI as monoclonal plasma cell but < 10%, with sensitivity of 100% in diagnosis of MM compared to 86% for BMA, 95% for BMB.
In 15 cases (follow up), combined BMA and BMB can assess that 8 cases were not in remission compared to FCMI which could assess that 7 cases were having >5% neoplastic plasma cells (not in remission) and the remaining case was with reactive plasma cells with 87% sensitivity. In the other hand, 7 cases /15 were morphologically in remission (57% specificity) compared to only 4 cases in remission by FCMI with 100% specificity. Regarding prognosis, the following factors associated with poor outcome, B2microglobulin>3.5mg/dl, Hb<10 gm/dl, CD56 negative myeloma cells, CD19 positive myeloma cells, lytic bone lesions. Conclusion Multiparameter flow cytometry is an essential tool for diagnosis multiple myeloma. It has a very important role in detecting minimal residual disease (MRD). On comparing 4 colors FCM with BM morphology, BM morphology is still a gold standard method in diagnosis of MM, as a quantitative method, in contrast FCM is a standard qualitative method for assessing the immunophenotype and light chain clonality of PCs. All of those combined contribute to the tailored medical management for myeloma patients. Finally, it ensures that each MM case has a complete baseline to be able to build upon it the MRD study. However, Large scale studies are recommended in a larger number of cases and for long-term follow up and should include other prognostic markers like CD117 and CD200.