Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter
  • Published:

MULTIPLE MYELOMA, GAMMOPATHIES

Peripheral Blood Flow Cytometry-based Definition of Plasma Cell Leukemia

Leukemia volume 39, pages 2039–2041 (2025)Cite this article

Subjects

TO THE EDITOR:

Plasma cell leukemia (PCL), an aggressive form of MM, is defined by the International Myeloma Working Group (IMWG) as the presence of ≥5% circulating plasma cells (CPCs) in the peripheral blood [1]. Moreover, PCL cases are frequently enriched in the translocation t(11;14), which presents with a lympho-plasmacytoid morphology, complicating detection through standard morphological examination [2].

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Comparison of test characteristics for CPC detection of peripheral blood smear versus peripheral blood flow (index test).
Fig. 2: Test characteristics (sensitivity and specificity) by circulating plasma cell (CPC) thresholds detected via peripheral blood flow cytometry (PBF) for ≥5% CPCs on PBS.

Data availability

De-identified data from this study are available from the corresponding author upon reasonable request.

References

  1. Fernández de Larrea C, Kyle R, Rosiñol L, Paiva B, Engelhardt M, Usmani S, et al. Primary plasma cell leukemia: consensus definition by the International Myeloma Working Group according to peripheral blood plasma cell percentage. Blood Cancer J. 2021;11:192.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bal S, Kumar SK, Fonseca R, Gay F, Hungria VT, Dogan A, et al. Multiple myeloma with t(11;14): unique biology and evolving landscape. Am J Cancer Res. 2022;12:2950–65.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Gonsalves WI, Jevremovic D, Nandakumar B, Dispenzieri A, Buadi FK, Dingli D, et al. Enhancing the R-ISS classification of newly diagnosed multiple myeloma by quantifying circulating clonal plasma cells. Am J Hematol. 2020;95:310–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Garcés JJ, Cedena MT, Puig N, Burgos L, Perez JJ, Cordon L, et al. Circulating tumor cells for the staging of patients with newly diagnosed transplant-eligible multiple myeloma. J Clin Oncol J Am Soc Clin Oncol. 2022;40:3151–61.

    Article  Google Scholar 

  5. Chakraborty R, Lentzsch S. Circulating tumor cell burden as a component of staging in multiple myeloma: ready for prime time? J Clin Oncol. 2022;40:3099–102.

    Article  PubMed  Google Scholar 

  6. Gupta R, Jevremovic D, Mathew SJ, Kumar S. Multiparametric flow cytometry in the evaluation of plasma cell proliferative disorders: current paradigms for clinical practice. Clin Lymphoma Myeloma Leuk. 2024;24:e88–95.

    Article  CAS  PubMed  Google Scholar 

  7. Cohen JF, Korevaar DA, Altman DG, Bruns DE, Gatsonis CA, Hooft L, et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open. 2016;6:e012799.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Jevremovic D, Shi M, Horna P, Otteson GE, Timm MM, Baughn LB, et al. Real-life sensitivity of flow cytometry minimal residual disease assessment for plasma cell neoplasms. Blood Cancer J. 2024;14:126.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jung SH, Kim K, Yoon SE, Moon JH, Kim D, Kim HJ, et al. Validation of the revised diagnostic criteria for primary plasma cell leukemia by the Korean Multiple Myeloma Working Party. Blood Cancer J. 2022;12:1–6.

    Article  Google Scholar 

  10. Li F, Gao YJ, Li SS, Xi YY, Yang XW, Su YH. [Effect of Circulating Plasma Cells on the Prognosis of Patients with Multiple Myeloma]. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2023;31:1771–9.

    PubMed  Google Scholar 

  11. Jelinek T, Bezdekova R, Zihala D, Sevcikova T, Sithara AA, Pospisilova L, et al. More than 2% of circulating tumor plasma cells defines plasma cell leukemia–like multiple myeloma. J Clin Oncol. 2023;41:1383.

    Article  CAS  PubMed  Google Scholar 

  12. Kostopoulos IV, Ntanasis-Stathopoulos I, Rousakis P, Eleutherakis-Papaiakovou E, Panteli C, Malandrakis P, et al. Circulating plasma cells in newly diagnosed multiple myeloma: prognostic and more. J Clin Oncol. 2023;41:708–10.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the Mayo Clinic Department of Hematology and the Hematopathology Laboratory for facilitating access to clinical and laboratory data used in this study.

Author information

Authors and Affiliations

  1. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    Arwa Bohra, Rafla Hassan, Saurabh Zanwar, Wilson I. Gonsalves, S. Vincent Rajkumar & Shaji Kumar

  2. Division of Hematopathology, Mayo Clinic, Rochester, MN, USA

    Dragan Jevremovic, Horatiu Olteanu & Pedro Horna

  3. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Gregory Otteson

Authors
  1. Arwa Bohra
    View author publications

    Search author on:PubMed Google Scholar

  2. Rafla Hassan
    View author publications

    Search author on:PubMed Google Scholar

  3. Saurabh Zanwar
    View author publications

    Search author on:PubMed Google Scholar

  4. Dragan Jevremovic
    View author publications

    Search author on:PubMed Google Scholar

  5. Horatiu Olteanu
    View author publications

    Search author on:PubMed Google Scholar

  6. Wilson I. Gonsalves
    View author publications

    Search author on:PubMed Google Scholar

  7. Gregory Otteson
    View author publications

    Search author on:PubMed Google Scholar

  8. Pedro Horna
    View author publications

    Search author on:PubMed Google Scholar

  9. S. Vincent Rajkumar
    View author publications

    Search author on:PubMed Google Scholar

  10. Shaji Kumar
    View author publications

    Search author on:PubMed Google Scholar

Contributions

SK, AB, and DJ contributed to the study concept and design and prepared the initial draft of the manuscript. AB collected and analyzed the data with oversight from SK. RH assisted with data collection. SZ contributed to review and editing of the manuscript. DJ, HO, WG, GO, PH, and SVR contributed patient data and reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Shaji Kumar.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

All study procedures were conducted in accordance with relevant institutional guidelines and regulatory standards. The study was approved by the Mayo Clinic Institutional Review Board (IRB #23-010440). As this was a retrospective analysis of existing clinical data, informed consent was waived by the IRB.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bohra, A., Hassan, R., Zanwar, S. et al. Peripheral Blood Flow Cytometry-based Definition of Plasma Cell Leukemia. Leukemia 39, 2039–2041 (2025). https://doi.org/10.1038/s41375-025-02653-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41375-025-02653-z

Search

Advanced search

Quick links