La citometría de flujo en el estudio de las discrasias de células plasmáticas

Flow cytometry in the study of plasma cell dyscrasias In the last decade survival of patients suffering from plasma cell dyscrasias has improved mainly due to a better understanding of its cellular and molecular pathophysiology. Flow cytometry and genetic studies have decisively contributed to a better categorization of the disease and to set the adequate treatment in each patient. Flow cytometry facilitates the phenotypic characterization of plasma cells (CD38++CD138+), the differentiation between malignant (generally CD19-CD56+) and normal or reactive plasma cells (generally CD19+CD56-), and at the same time provides us with relevant prognostic parameters (CD27, CD28, CD45, CD117, CD200 y CD221). Clonality analysis of immunoglobulin heavy and/or light chains allows to define and to precisely quantify the ratio of pathologic/healthy plasma cells, also with prognostic interest. Flow cytometry offers additional prognostic information such as the presence of aneuploidy as well as the plasma cell proliferative and apoptotic indexes. The high sensitivity of multiparametric flow cytometry makes it also useful for monitoring the residual disease after treatment, providing relevant predictive information of the evolution of the disease, particularly with the use of the new drugs such as Bortezomib and Lenalidomide. As a consequence, flow cytometry is becoming an essential tool for diagnosis, the selection of prognostic-directed therapies and for monitoring the treatment of plasma cell dyscrasias.