To create an algorithm for FISH and karyotype testing for plasma cell myeloma specimens to optimize results based on (1) CD138 enrichment; (2) quantity of clonal plasma cells; and (3) quantity of specimen

Chastain, Elizabeth

Moore, Frank

Wilson, Carla

English

University of New Mexico

Journal of Quality improvement in healthcare  39
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 nAlgorithm for fisH and Karyotype testing for Plasma cell 
Myeloma specimens to optimize results
aim of project:
To create an algorithm for FISH and karyotype testing 
for plasma cell myeloma specimens to optimize 
results based on (1) CD138 enrichment; (2) quantity 
of clonal plasma cells; and (3) quantity of specimen.
Background of project:
Plasma cell myeloma prognosis and treatment is 
significantly impacted by the identification of specific 
abnormalities, typically identified by fluorescence 
in-situ hybridization (FISH) and karyotype analysis. 
However, limitations with regard to quantity of 
clonal plasma cells and quantity of specimen exist. 
A uniform and algorithmic approach to plasma cell 
myeloma specimen processing with testing tailored to 
plasma cell concentration and specimen volume may 
(1) reduce unnecessary testing; (2) improve diagnostic 
yield; and (3) yield significant cost savings.
planned intervention tested
An algorithmic approach has been developed for 
use in our department with regard to specimen 
triaging based on (1) the presence clonal plasma cells; 
(2) plasma cell concentration of specimen; and (3) 
quantity of specimen. A 6-month retrospective review 
was performed that identified all cases with clonal 
plasma cells. Metrics for our study included number 
of cases where: (1) cytogenetic testing was unneces-
sarily performed on cases without clonal plasma 
cells; (2) cases with > 30% clonal plasma cells where 
purification methods were unnecessarily used and/
or appropriate cytogenetic stimulation was not used; 
and (3) cases with <30% clonal plasma cells where 
appropriate specimen triage was not followed. A 
6-month prospective analysis of these metrics will be 
reviewed following the implementation of our newly 
developed “Algorithm for Myeloma Testing.”
prediction of results and/or intended results:
The goals of the intervention were to standardize the 
approach to plasma cell myeloma FISH and karyotype 
testing within our laboratory. We anticipate (1) 
reduction in unnecessary testing and (2) improvement 
in diagnostic yield. Given the cost of testing, we 
further anticipate (3) an overall cost-savings to our 
organization as a result of this quality improvement.
FRaNK MOORe, MD, eLizabetH CHastaiN, MD and 
CaRLa WiLsON, MD, PHD
Department of Pathology
triCore Reference Laboratory and  
University of New Mexico


Algorithm for FISH and Karyotype Testing for Plasma Cell Myeloma Specimens to Optimize Results

https://digitalrepository.unm.edu/cgi/viewcontent.cgi?article=1029&amp;context=cir_jqih

Algorithm for FISH and Karyotype Testing for Plasma Cell Myeloma Specimens to Optimize Results

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University of New Mexico