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Jan 24, 2023
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Feb 26, 2023
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Abstract
Plasma cell myeloma (PCM)/Mutiple myeloma (MM) is hematologic malignancy characterized by the proliferation of neoplastic plasma cells of bone marrow. The manifestation of disease include multifocal lytic bone lesions, increased serum or urine M protein, target organ damage, and can present as an extramedullary mass. Extramedullary tumor mass biopsy can show morphology that overlaps with other plasma cell neoplasms or malignant lymphoma, this become a diagnostic challenge especially if the clinical and radiological information is incomplete. End-organ damage attributable to abnormal plasma cell proliferation is known as CRAB consist of hypercalcemia, renal insufficiency, anemia and bone lesions. The clinical spectrum often varies so the diagnosis of PCM requires the integration of clinical, laboratory, imaging, morphology, and immunophenotype data. Histopathological examination of bone marrow biopsy and tumor mass biopsy needs to be confirmed by immunohistochemical examination and clonality tests to establish an accurate diagnosis. This review intends to explain the clinical, morphological and immunophenotypic aspects as well as construct an approach to the diagnosis of PCM.
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This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
Angelina, A., & Retnani, D. (2023). Plasma cell myeloma: Diagnostic approach from clinico-morphology and immunophenotype aspects . Jurnal Klinik Dan Riset Kesehatan, 2(2), 285-298. https://doi.org/10.11594/jk-risk.02.2.5
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27. Kusuma, ID, Norahmawati E. Case Report: Non Secretory Multiple Myeloma. Jurnal Kedokteran Brawijaya. 2014; 28(2): 159-62. https://doi.org/10.21776/ub.jkb.2014.028.02.19
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Medeiros LJ, Miranda RN. Diagnostic Pathology Lymph Nodes and Extranodal Lymphomas. 2nd ed. Philadelphia: Elsevier; 2018: 534-36
2. Lin P. Multiple myeloma and Other Plasma Cell Neoplasms. In: Hsi ED, eds. Hematopathology: A Volume in the series: Foundations in Diagnostic Pathology. 3rd ed. Philadelphia: Elsevier; 2018: 1341-83
3. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available online: https://gco.iarc.fr/today (diakses : 11 November 2022)
4. Padala SA, Barsouk A, Barsouk A, et al. Epidemiology, Staging, and Management of Multiple Myeloma. Med Sci. 2021; 9(1):3. https://doi.org/10.3390/medsci9010003
5. Cowan AJ, Allen C, Barac A. et al. Global Burden of Multiple Myeloma: A Systematic Analysis for the Global Burden of Disease Study 2016. JAMA Oncol. 2018; 4:1221–1227. DOI: 10.1001/jamaoncol.2018.2128
6. Rajkumar SV, Gahrton G, Bergsagel PL. Approach to the treatment of multiple myeloma: a clash of phylosophies. Blood. 2011; 118(12): 3205-11. https://doi.org/10.1182/blood-2011-06-297853
7. Yohe SL. Classification of Plasma Cell Neoplasms. In: Linden MA, McKenna RW, eds. Plasma Cell Neoplasms. Switzerland: Springer; 2016. https://doi.org/10.1007/978-3-319-10918-3_4
8. Pioli, PD. Plasma Cells, the Next Generation: Beyond Antibody Secretion. Front Immunol. 2019; 10:2768. https://doi.org/10.3389/fimmu.2019.02768
9. Tellier J, Nutt SL. Plasma cells: The programming of an antibody-secreting machine. Eur J Immunol. 2019; 49:30-37. https://doi.org/10.1002/eji.201847517
10. Sans I, Wei C, Jenks SA, et al. Challenges and Opportunities for Consistent Classification of Human B Cell and Plasma Cell Population. Front Immunol. 2019; 10:2458. https://doi.org/10.3389/fimmu.2019.02458
11. Wei A, Juneja S. Bone marrow immunohistology of plasma cell neoplasms. J Clin Pathol. 2003; 56:406–11.
12. Allen HC, Sharma P. Histology, Plasma Cells. [Updated 2022 Jan 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556082/
13. Nutt SL, Taubenheim N, Hasbold J, et al. The genetic network controlling plasma cell differentiation. Semin Immunol. 2011; 23(5):341-9. https://doi.org/ 10.1016/j.smim.2011.08.010.
14. Jurczyszyn A, Suska A. Multiple Myeloma. In: Rattan, S.I.S, eds. Encyclopedia of Biomedical Gerontology. Academic Press: Elsevier. 2022; (2): 461–78. https://dx.doi.org/10.1016/B978-0-12-801238-3.11412-6
15. Ali B. Introduction to Immunoglobulins: Structure and Research. https://www.ukessays.com/essays/sciences/introduction-immunoglobulins-structure-4000.php. Diakses 28 November 2022.
16. Robillard N, Wuilleme S, Moreau P, et al. Immunophenotype of normal and myelomatous-plasma cell subsets. Front Immunol. 2014; 5:137. https://dx.doi.org/10.3389/fimmu.2014.00137
17. Frigyesi I, Adolfsson J, Ali M, et al. Robust isolation of malignant plasma cells in multiple myeloma". Blood. 2014; 123(9): 1336–40. https://dx.doi.org/10.1182/blood-2013-09-529800
18. Soh KT, Tario JD Jr, Hahn T, et al. CD319 (SLAMF7) an alternative marker for detecting plasma cells in the presence of daratumumab or elotuzumab. Cytometry. 2021; 100(4):497-508. https://dx.doi.org/10.1002/cyto.b.21961
19. Ajise OE, Roshal M, Wang L. Clinical utility of morphology, immunohistochemistry, flow cytometry, and FISH analysis in monitoring of plasma cell neoplasms in the bone marrow. J Hematopathol. 2016; 9:9-18. http://dx.doi.org/10.1007/s12308-015-0264-1
20. Swerdlow SH, Campo E, Harris NL, et al, eds. World Health Organization Classification of Tumours of Hematopoietic and Lymphoid Tissue. Revised 4th ed. Lyon, France: IARC Press; 2017
21. Sewell WA, Chng WJ. Plasma cell neoplasms and other diseases with paraproteins. In: WHO Classification of Tumours Editorial Board. Haematolymphoid tumours [Internet; beta version]. Lyon (France) : International Agency for Research on Cancer ; 2022. [cited 28 November 2022]. (WHO classsification of tumours series, 5th ed.; vol 11). Available from https://tumourclassification.iarc.who.int/chaptercontent/63/187
22. Korde N, Kristinsson, SY Landgren O. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM): Novel biological insights and development of early treatment strategies. Blood. 2011; 117 (21): 5573–81.
23. Manier S, Salem K, Glavey SV, et al. Genomic aberrations in multiple myeloma. In: Roccaro, A.M., Ghobrial, I.M. (Eds.), Plasma cell Dyscrasias. Switzerland: Springer International Publishing, 2016. pp. 23–34. DOI: 10.1007/978-3-319-40320-5_3
24. Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014; 15:e538–e548.
25. Rajkumar SV. Multiple myeloma: 2016 update on diagnosis, risk-stratification, and management. Am J Hematol. 2016; 91:720-34. https://doi.org/10.1002/ajh.24402
26. Kim K, Lee JH, Kim JS, et al. Clinical profiles of multiple myeloma in Asia-An Asian Myeloma Network Study. Am J Hematol. 2014(89): 7. https://doi.org/10.1002/ajh.23731
27. Kusuma, ID, Norahmawati E. Case Report: Non Secretory Multiple Myeloma. Jurnal Kedokteran Brawijaya. 2014; 28(2): 159-62. https://doi.org/10.21776/ub.jkb.2014.028.02.19
28. Hanggara DS, Budiman B. Leukemia Sel Plasma Primer. Jurnal Kedokteran Brawijaya. 2017; 29(3):276-280. https://doi.org/10.21776/ub.jkb.2017.029.03.17
29. Dispenzieri, A. POEMS syndrome: 2021 Update on diagnosis, risk-stratification, and management. Am J Hematol. 2021; 96: 872– 888. https://doi.org/10.1002/ajh.26240
30. Sykes DB, O'Connell C, Schroyens W. The TEMPI syndrome. Blood. 2020; 9;135(15):1199-1203. https://doi.org/10.1182/blood.2019004216.
31. Medeiros LJ. Ioachim’s lymph node pathology. 5th ed. Philadelphia: Wolters Kluwer Health; 2021.
Medeiros LJ, Miranda RN. Diagnostic Pathology Lymph Nodes and Extranodal Lymphomas. 2nd ed. Philadelphia: Elsevier; 2018: 534-36