Array-based karyotyping in plasma cell neoplasia after plasma cell enrichment increases detection of genomic aberrations.

The discovery of genomic abnormalities present in monoclonal plasma cells has diagnostic, prognostic, and disease-monitoring implications in plasma cell neoplasms (PCNs). However, technical and disease-related limitations hamper the detection of these abnormalities using cytogenetic analysis or fluorescence in situ hybridization (FISH). In this study, 28 bone marrow specimens with known PCNs were examined for the presence of genomic abnormalities using microarray analysis after plasma cell enrichment. Cytogenetic analysis was performed on 15 of 28 samples, revealing disease-related genomic aberrations in only 3 (20%) of 15 cases. FISH analysis was performed on enriched plasma cells and detected aberrations in 84.6% of specimens while array comparative genomic hybridization (aCGH) detected abnormalities in 89.3% of cases. Furthermore, aCGH revealed additional abnormalities in 24 cases compared with FISH alone. We conclude that aCGH after plasma cell enrichment, in combination with FISH, is a valuable approach for routine clinical use in achieving a more complete genetic characterization of patients with PCN.

Detection of genomic abnormalities in multiple myeloma: the application of FISH analysis in combination with various plasma cell enrichment techniques.

Multiple myeloma (MM) is a hematopoietic neoplasm characterized by malignant plasma cells (PCs) that accumulate in the bone marrow. A number of different genomic abnormalities are associated with MM; however, detection of these by fluorescence in situ hybridization (FISH) can be limited by the percentage of PCs in the specimen. In this study, we tested 20 bone marrow specimens with known MM and a low concentration of monoclonal PCs for the presence of genomic abnormalities using FISH in combination with various PC enrichment techniques: magnetic cell sorting, targeted manual scoring, and automated image analysis. In addition, flow cytometric cell sorting of PCs in combination with FISH analysis was also tested for minimal residual disease applications. Different parameters were evaluated when assessing the detection efficiency of each approach. FISH results are highly dependent on the chosen enrichment method. We describe the evaluation of different techniques applicable for various laboratory settings and specimen parameters.

Demonstrating the impact of nutrition intervention in a heart failure program.

Outpatient heart failure centers using a multidisciplinary approach to management of heart failure are recognized as essential to decreasing costs of treating heart failure. These centers do not typically employ registered dietitians. With hospital foundation funding, our objective was to develop the role of the dietitian and to evaluate the impact of nutrition intervention in a multidisciplinary heart failure program. Based on a needs assessment, the dietitian developed and tested a medical nutrition therapy protocol, education materials, and special education projects. Unannounced 24-hour recalls at 3 points in time were used to determine changes in sodium and fluid intakes. An outcome tracking system was implemented. Intake data were analyzed for patients who were in the program 9 or more months (n = 79). Patients' sodium and fluid intakes at 2 to 3 months and 6 to 9 months were compared with their baseline intakes using paired t test. The sodium decrease of 0.5 g at 2 to 3 months and 6 to 9 months and the fluid decrease of 15 oz at 2 to 3 months and 12 oz at 6 to 9 months were all highly significant (P < .001). Patients active in year 3 (n = 82) completed the Minnesota Quality of Life Questionnaire. Compared with baseline, quality of life scores improved by 6.7 points (P < .003) at 3 months and by 5.9 points (P < .04) at 6 months. Of 83 patients hospitalized over 3 years, 6 hospitalizations were the result of an excessive sodium intake. At the completion of the project, the center provided funding for the dietitian to become a permanent team member. These positive findings indicate dietitians should seek involvement in heart failure centers.