Diagnostic evaluation for pPCL
| Medical history and physical examination . |
|---|
| Blood |
| Complete blood count with differential, peripheral blood smear |
| BUN, creatinine, liver enzymes, bilirubin, alkaline phosphatase, total protein, CRP |
| Tumor lysis parameters (LDH, uric acid, calcium, phosphate, potassium) |
| β2-microglobulin and albumin |
| Serum protein electrophoresis, immunofixation, serum free light chain analysis |
| Immunophenotyping |
| Urine |
| 24-hour urine collection for electrophoresis and immunofixation |
| 24-hour urine for total protein |
| BM |
| Biopsy for histology |
| Aspirate for: |
| Morphology |
| Immunophenotyping |
| Cytogenetic analysis by FISH* focused on del(17p13), del(13q), del(1p21), ampl(1q21), t(11;14), t(4;14), and t(14;16) |
| Radiographic skeletal survey, including skull, pelvis, vertebral column, and long bones |
| Additional investigations, which may be useful under certain circumstances |
| Lumbar puncture (cell counts, chemistry, cytology, immunophenotyping): suspicion of leptomeningeal involvement |
| MRI: evaluation of cord compression or painful area of the skeleton (suspicion of soft tissue plasmacytomas arising from bone) |
| CT or 18F-FDG-PET/CT: suspicion of extramedullary plasmacytomas |
| Survey for evaluation of AL amyloidosis |
| Bleeding time, APTT, PT |
| Cryoglobulins, cold agglutinins |
| Serum viscosity, fundoscopy: symptoms of hyperviscosity |
| HLA typing: in case allo-SCT is considered |
| Medical history and physical examination . |
|---|
| Blood |
| Complete blood count with differential, peripheral blood smear |
| BUN, creatinine, liver enzymes, bilirubin, alkaline phosphatase, total protein, CRP |
| Tumor lysis parameters (LDH, uric acid, calcium, phosphate, potassium) |
| β2-microglobulin and albumin |
| Serum protein electrophoresis, immunofixation, serum free light chain analysis |
| Immunophenotyping |
| Urine |
| 24-hour urine collection for electrophoresis and immunofixation |
| 24-hour urine for total protein |
| BM |
| Biopsy for histology |
| Aspirate for: |
| Morphology |
| Immunophenotyping |
| Cytogenetic analysis by FISH* focused on del(17p13), del(13q), del(1p21), ampl(1q21), t(11;14), t(4;14), and t(14;16) |
| Radiographic skeletal survey, including skull, pelvis, vertebral column, and long bones |
| Additional investigations, which may be useful under certain circumstances |
| Lumbar puncture (cell counts, chemistry, cytology, immunophenotyping): suspicion of leptomeningeal involvement |
| MRI: evaluation of cord compression or painful area of the skeleton (suspicion of soft tissue plasmacytomas arising from bone) |
| CT or 18F-FDG-PET/CT: suspicion of extramedullary plasmacytomas |
| Survey for evaluation of AL amyloidosis |
| Bleeding time, APTT, PT |
| Cryoglobulins, cold agglutinins |
| Serum viscosity, fundoscopy: symptoms of hyperviscosity |
| HLA typing: in case allo-SCT is considered |
BUN indicates blood urea nitrogen; CRP, C-reactive protein; MRI, magnetic resonance imaging; CT, computed tomography; 18F-FDG-PET, 18F-fluorodeoxyglucose positron emission tomography; AL, amyloid light chain; APTT, activated partial thromboplastin time; and PT, prothrombin time.
FISH is preferably performed on purified tumor cells or with simultaneous staining of cytoplasmic immunoglobulins (cIg-FISH).