Fernandez de Larrea et al reported criteria for the diagnosis and management of plasma cell leukemia (PCL). One lists the criteria for different types of remission. The authors are from the International Myeloma Working Group (IMWG).
Patient selection: plasma cell leukemia following therapy
Parameters:
(1) plasma cells in bone marrow with flow cytometry
(2) peripheral blood smear with flow cytometry
(3) serum immunofixation (IF)
(4) urine immunofixation (IF) in mg per 24 hours
(5) free light chain (FLC) ratio
(6) extramedullary disease
Parameter
Stringent Complete
Complete
Very Good Partial
Partial
bone marrow plasma cells
< 5% with flow cytometry negative for malignant PC
< 5%
< 5%
5 to 25%
peripheral blood
0% with flow cytometry negative
0%
0%
1 to 5%
serum IF
negative
negative
> 90% reduction
>= 50% reduction
urine IF
negative
negative
< 100 mg per 24 hour
>= 90% reduction and < 200 mg per 24 hours
FLC ratio
normal
normal
NA
NA
extramedullary disease
none
none
none
>= 50% reduction
where:
• In a bone marrow aspirate 500 cells are typically counted.
• In a peripheral smear 200 cells are typically counted.
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