SOHO Italy 2025 | The diagnosis of extramedullary disease and plasma cell leukemia

Well, about the plasma cell leukemia, we need the immunophenotyping of the plasma monoclonal plasma cell that is different than the multiple myeloma because we have an expression of CD20 and a low expression of CD55. And we need a proper count of the plasma cells because according to the new criteria of diagnosis of plasma cell leukemia from the International Working Group, we need more than 5% of the plasma cell. In the old classification and definition, we need more than 20%. Because the multiple myeloma with 5% of the plasma cell leukemia has the same outcome of the patient with more than 20%. This is about the plasma cell leukemia, and we need a FISH. Because a high rate of the patient with the plasma cell leukemia have a translocation t(11;14) that will be a target for the venetoclax. This is very important. It’s similar to the diagnosis or the tools for the diagnosis that we have in myeloma. 

About the extramedullary disease, we need, of course, yes, a FISH and of course the study of the biology, but it’s important, it’s mandatory, the radiologic techniques. And the PET/CT is very important to follow the patient and particularly to follow their response to the therapy, radiotherapy and immunochemotherapy. The principal is the main tools that we can use about the extramedullary disease.

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