This study compares the detection of residual multiple myeloma (MM) in bone marrow biopsy specimens using immunoperoxidase staining with noninvasive studies using serum protein electrophoresis (SPE) and urine protein electrophoresis (UPE). The study analyzed 83 bone marrow biopsies and found that SPE and UPE were sensitive methods for detecting residual disease. Negative SPE and UPE results made bone marrow biopsies unnecessary for monitoring residual MM.

1. Monitoring Residual Myeloma High-Resolution Serum/Urine Electrophoresis or Marrow Biopsy With Immunohistochemical Analysis? Vanessa Agudelo Vásquez ID: 000170813 María Mercedes Barros Daza ID: 000170833 3rd Semester Medicine Amanda D. Tatsas, MD, Madan H. Jagasia, MBBS, MS, Heidi Chen, PhD, and Thomas L. McCurley, MD. American Society for Clinical Pathology

2. INTRODUCTION MARROW BIOPSY A bone marrow biopsy is the removal of soft tissue, called marrow, from inside bone. Bone marrow is found in the hollow part of most bones. It helps form blood cells .

3. ELECTROPHORESIS Electrophoresis is a separations technique that is based on the mobility of ions in an electric field.

4. IMMUNOHISTOCHEMICAL ANALYSIS Structural and morphological studies of tissues.

6. GENERAL OBJETIVE This study to compare the detection of residual MM in BM biopsy specimens with immunoperoxidase staining with noninvasive studies by SPE and UPE in routine patient follow-up and show that SPE and UPE are sensitive and effective methods to detect residual disease, and negative results for both can obviate the need for a BM biopsy.

8. INMUNOHISTOQUIMICA: Identificación de un tejido por medio de la interacción de un antígeno con un anticuerpo (marcado). La célula se colorea para demostrar la relación y localización de un molécula de interés. INMUNOFIJACIÒN: Es una técnica de laboratorio que se utiliza para identificar proteínas o anticuerpos en la sangre, suero y orina. MATERIALES Y METODOS CP: Cadenas pesadas (G- A- M – D – E) Cadenas ligeras: (K- L)

11. RELACION INMUNOHISTOQUIMICA 65 casos de análisis inmunohistoquímica con células plasmáticas con CD138 (Syndecan-1) INMUNOFIJACIÒN Manchas κ y λ en la cadena ligera

12. RESULTADOS

13. RESULTADOS

14. IMAGEN 1: UPE RESULTADOS

15. Conclusión: El método UPE no invasivo ( sedimento urinario) es igual de efectivo a la biopsia que es invasivo.

16. IMAGEN 2: SPE RESULTADOS

17. Conclusión: La técnica no invasiva de análisis del suero, es mas efectiva porque detectó en mayor cantidad las proteínas monoclonales que lo detectado por inmunohistoquímica con los CD138 en la biopsia de medula ósea.

18. DISCUSSION AUTHOR SAID YES OR NOT Rasmussen T, et al. A variety of methods for monitoring disease activity are available. yes Owen RG et, al. The use of multiple consensus primers allows detection of a clone in 80% of patients but increases cost. yes Jaskowski TD et, al. κ and λ FLC assays are more sensitive than IFX but are less specific. yes Catrou PG, May TA et, al. Because the money spent on health care in the United States increases exponentially, cost-effectiveness is becoming increasingly important to the practice of health care. yes

20. MAPA CONCEPTUAL : Vanessa Agudelo Vásquez

21. MAPA CONCEPTUAL : María Mercedes Barros Daza