Circulating tumor plasma cells quantification in newly diagnosed transplant ineligible real world multiple myeloma patients: Comparison of single‐platform flow cytometry versus next generation flow

Circulating tumor plasma cells (CTCs) at diagnosis are independent prognostic markers in newly diagnosed multiple myeloma (NDMM). Flow cytometry (FC) enables sensitive and cost-effective CTC quantification, but prognostic cut-offs vary across studies. The methodological approach used for quantification may affect the determination of the CTC percentage. In this study we compare head-to-head two FC techniques [single-platform FC versus Next Generation Flow (NGF)] to measure CTC levels in NDMM patients. Methodological differences between the two techniques can be found in sample processing (NGF includes fixation and permeabilization steps that are not required for CTC quantification by single-platform FC) and analytical sensitivity, which is higher for NGF than for single-platform FC. The percentage of CTCs was simultaneously assessed with both techniques in the peripheral blood (PB) of 34 patients enrolled in the REAL MM trial (NCT03829371) at screening. Single-platform FC detected CTCs in 29/34 patients (85.3%) patients, while NGF detected CTCs in 31/34 patients (91.2%), including 2 cases that were negative by single-platform FC. The CTC percentage measured using the NGF technique (median 0.0049%, range 0%-0.377%) was significantly lower than that obtained using single-platform FC (median 0.009%, range 0%-0.59%) (p < 0.0001). Indeed, quantifying CTCs with FC after fixation and permeabilization (comparably to NGF) led to results that were similar to NGF. In conclusion, NGF demonstrated higher sensitivity than single-platform FC to detect CTCs at diagnosis in MM patients. Employing standardized techniques like NGF may avoid variability across different laboratories and centers.

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Publication Details

Journal
Cytometry Part B Clinical Cytometry
Published
2026-09-14
DOI
https://doi.org/10.1002/cyto.b.70068
Primary Topic
Multiple Myeloma Research and Treatments
Type
article
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article

Circulating tumor plasma cells quantification in newly diagnosed transplant ineligible real world multiple myeloma patients: Comparison of single‐platform flow cytometry versus next generation flow

Cristina Velluti, Alessandro Allegra, Tania Villanova, Ilaria FEDELE et al.
Cytometry Part B Clinical Cytometry
Multiple Myeloma Research and Treatments
article

Circulating tumor plasma cells quantification in newly diagnosed transplant ineligible real world multiple myeloma patients: Comparison of single‐platform flow cytometry versus next generation flow

Cristina Velluti, Alessandro Allegra, Tania Villanova, Ilaria FEDELE, Matilde Scaldaferri, Antonietta Falcone, Donato Mannina, Alessandra Larocca, Iolanda Donatella Vincelli, Sonia Ronconi, Anna Maria Cafro, Benedetto Bruno, Silvia Mangiacavalli, Maide Maria Cavalli, Mariagrazia Michieli, Ilaria Rizzello, Renato Zambello, Angelo Belotti, Maria Letizia Mosca Siez, Elona Saraci, Marcello Capriata, Sonia Morè, Mario Boccadoro, Sara Bringhen, Patrizia Tosi, Giulia Benevolo, Roberto Ria, Marco Burdisso, Mattia D'Agostino, Elisabetta Antonioli, Nicola Giuliani
article en

Abstract

Circulating tumor plasma cells (CTCs) at diagnosis are independent prognostic markers in newly diagnosed multiple myeloma (NDMM). Flow cytometry (FC) enables sensitive and cost-effective CTC quantification, but prognostic cut-offs vary across studies. The methodological approach used for quantification may affect the determination of the CTC percentage. In this study we compare head-to-head two FC techniques [single-platform FC versus Next Generation Flow (NGF)] to measure CTC levels in NDMM patients. Methodological differences between the two techniques can be found in sample processing (NGF includes fixation and permeabilization steps that are not required for CTC quantification by single-platform FC) and analytical sensitivity, which is higher for NGF than for single-platform FC. The percentage of CTCs was simultaneously assessed with both techniques in the peripheral blood (PB) of 34 patients enrolled in the REAL MM trial (NCT03829371) at screening. Single-platform FC detected CTCs in 29/34 patients (85.3%) patients, while NGF detected CTCs in 31/34 patients (91.2%), including 2 cases that were negative by single-platform FC. The CTC percentage measured using the NGF technique (median 0.0049%, range 0%-0.377%) was significantly lower than that obtained using single-platform FC (median 0.009%, range 0%-0.59%) (p < 0.0001). Indeed, quantifying CTCs with FC after fixation and permeabilization (comparably to NGF) led to results that were similar to NGF. In conclusion, NGF demonstrated higher sensitivity than single-platform FC to detect CTCs at diagnosis in MM patients. Employing standardized techniques like NGF may avoid variability across different laboratories and centers.

Cytometry Part B Clinical Cytometry
University of Messina (IT), Marche Polytechnic University (IT), University of Parma (IT), Centro Studi GISED (IT), University of Padua (IT), Casa Sollievo della Sofferenza (IT), Policlinico Umberto I (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Ospedale degli Infermi (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IT), Azienda ospedaliera "Bianchi-Melacrino-Morelli" (IT), Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT), Azienda Ospedaliero-Universitaria Careggi (IT), Istituto di Ematologia di Bologna (IT), Azienda USL di Bologna (IT), Torino e-district (IT), Centro di Riferimento Oncologico (IT), Ospedale Infermi di Rimini (IT), Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo (IT), Policlinico San Matteo Fondazione (IT), Ospedale degli Infermi (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte (IT), University of Turin (IT), University of Bari Aldo Moro (IT), University of Bologna (IT)
Openalex Percentile: Top 10%
Multiple Myeloma Research and Treatments
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