• Document: MRD detection in multiple myeloma: comparison between MSKCC 10-color single-tube and EuroFlow 8-color 2-tube methods
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REGULAR ARTICLE MRD detection in multiple myeloma: comparison between MSKCC 10-color single-tube and EuroFlow 8-color 2-tube methods Mikhail Roshal,1 Juan A. Flores-Montero,2-4 Qi Gao,1 Maesa Koeber,5 Jessica Wardrope,1 Brian G. M. Durie,6 Ahmet Dogan,1 Alberto Orfao,2-4 and Ola Landgren5 1 Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY; 2Cancer Research Institute of Salamanca, Universidad de Salamanca–Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain; 3General Cytometry Service, The Research Support Service of the University of Salamanca, Salamanca, Spain; 4 Department of Medicine, Universidad de Salamanca, Salamanca, Spain; 5Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; and 6International Myeloma Foundation, North Hollywood, CA In patients with multiple myeloma, obtaining posttreatment minimal residual disease (MRD) Key Points negativity is associated with longer progression-free survival and overall survival. Here, we • Methods that use an compared the diagnostic performance of a single 10-color tube with that of a EuroFlow 8-color MSKCC single 10-color 2-tube panel for MRD testing. Bone marrow samples from 41 multiple myeloma patients were tube or EuroFlow two tested in parallel using the 2 approaches. Compared with the sum of the cells from the 8-color tubes provide EuroFlow two 8-color tubes, the Memorial Sloan Kettering Cancer Center (MSKCC) single 10- similar sensitivity in the color tube had a slight reduction in total cell number with a mean ratio of 0.85 (range, 0.57- detection of MRD in 1.46; P , .05), likely attributable to permeabilization of the cells. Percent of plasma cells multiple myeloma. showed a high degree of concordance (r2 5 0.97) as did normal plasma cells (r2 5 0.96), consistent with no selective plasma cell loss. Importantly, concordant measurement of residual disease burden was seen with abnormal plasma cells (r2 5 0.97). The overall concordance between the 2 tests was 98%. In 1 case, there was a discrepancy near the limit of detection of both tests in favor of the slightly greater theoretical sensitivity of the EuroFlow 8-color 2-tube panel (analytical sensitivity limit of MSKCC single 10-color tube: 6 cells in 1 million with at least 3 million cell acquisitions; EuroFlow 8-color 2-tube panel: 2 cells in 1 million with the recommended 10 million cell acquisitions). Introduction Minimal residual disease (MRD) negativity is associated with longer progression-free and overall survival in multiple myeloma.1-7 Flow cytometry offers rapid, comparatively inexpensive MRD monitoring with a proven sensitivity of 2 3 1026.8-10 The EuroFlow Consortium proposed an MRD test (including 10 specific antigens) that uses two 8-color tubes: a surface only tube and a surface/cytoplasmic tube.9 Although these methods are clearly effective, the inevitable drawback is increased costs resulting from multiple antibody duplication and labor, which may pose barriers for wide clinical adoption of the test outside dedicated centers and for applicability to patients treated outside major clinical trials. For example, in the United States, reimbursement is not provided for the increased cost and effort of implementing this resource-intensive method. Nonetheless, the updated 2016 International Myeloma Working Group (IMWG) clinical response criteria call for EuroFlow or an equivalent test to determine response to deep treatment.11 To reduce additional costs and labor burden for the laboratories, we investigated whether a streamlined approach of combining surface and cytoplasmic staining in a single 10-color tube previously proposed by the Eur

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