Detalle Publicación

Flow cytometry for fast screening and automated risk assessment in systemic light-chain amyloidosis

Autores: Puig, N. ; Paiva, Bruno (Autor de correspondencia); Lasa Ventura, Marta; Burgos Rodríguez, Leire; Perez, J. J. ; Merino Roncal, Juana María; Moreno Parado, Cristina; Vidriales, M. B.; Gomez-Toboso, D.; Cedena, M. T. ; Ocio, E. M.; Lecumberri Villamediana, Ramón; de Coca, A. G. ; Labrador, J.; Gonzalez, M. E.; Palomera, L.; Gironella, M. ; Cabanas, V. ; Casanova, M.; Oriol, A. ; Krsnik, I. ; Perez-Montana, A.; de la Rubia, J. ; de la Puerta, J. E. ; de Arriba, F.; Prosper Cardoso, Felipe; Martinez-Lopez, J.; Lecrevisse, Q.; Verde, J.; Mateos, M. V. ; Lahuerta, J. J.; Orfao, A. ; San Miguel Izquierdo, Jesús
Título de la revista: LEUKEMIA
ISSN: 0887-6924
Volumen: 33
Número: 5
Páginas: 1256 - 1267
Fecha de publicación: 2019
Early diagnosis and risk stratification are key to improve outcomes in light-chain (AL) amyloidosis. Here we used multidimensional-flow-cytometry (MFC) to characterize bone marrow (BM) plasma cells (PCs) from a series of 166 patients including newly-diagnosed AL amyloidosis (N = 9 4) , MGUS (N = 20) and multiple myeloma (MM, N = 52) vs. healthy adults (N= 30). MFC detected clonality in virtually all AL amyloidosis (99%) patients. Furthermore, we developed an automated risk-stratification system based on BMPCs features, with independent prognostic impact on progression-free and overall survival of AL amyloidosis patients (hazard ratio: >= 2.9;P <= .03). Simultaneous assessment of the clonal PCs immunophenotypic protein expression profile and the BM cellular composition, mapped AL amyloidosis in the crossroad between MGUS and MM; however, lack of homogenously-positive CD56 expression, reduction of B-cell precursors and a predominantly-clonal PC compartment in the absence of an MM-like tumor PC expansion, emerged as hallmarks of AL amyloidosis (ROC-AUC = 0.74;P < .001), and might potentially be used as biomarkers for the identification of MGUS and MM patients, who are candidates for monitoring pre-symptomatic organ damage related to AL amyloidosis. Altogether, this study addressed the need for consensus on how to use flow cytometry in AL amyloidosis, and proposes a standardized MFCbased automated risk classification ready for implementation in clinical practice.