Plasma cells in peripheral blood stem cell harvests from patients with multiple myeloma are predominantly polyclonal

A flow cytometric technique has been developed to detect individual plasma cells in PBSC harvests and to establish light chain restriction as a surrogate marker of their clonality. Plasma cells were identified by high intensity CD38 (CD38++) and cytoplasmic immunoglobulin (cIg) expression. The ratio of cytoplasmic kappa to lambda expression was used to detect light chain restriction. All 25 PBSC harvests studied contained CD38++/cIg plasma cells (mean 0.7%, range 0.03-2%). Harvests from non-myeloma patients also contained plasma cells (mean 0.4%, range 0.01-1.5%). Most of the plasma cells detected in the harvests from myeloma patients were immature (CD45+/CD45++) rather than mature (CD45-). When the total plasma cell population was studied, definite isotype restriction could be detected in only 16% of harvests. Light chain restriction was found in 53% of harvests when the mature plasma cells (CD45-) were analysed but only in 9% of harvests when immature (CD45+/CD45++) plasma cells were analysed. Five percent of patients with myeloma had detectable light chain restriction in peripheral blood CD19+ cells. There was concordance between the ratio of malignant (CD19-/CD56+) to normal (CD19+/CD56-) plasma cells and light chain expression in 86% of patients studied. This study has demonstrated that the majority of plasma cells in PBSC harvests from patients with myeloma are not only immature but are also predominantly polyclonal and that monoclonality is best detected in mature plasma cells.