Test ID: SMART    
Mayo Stratification for Myeloma and Risk-Adapted Therapy Report

Chromosomes, mSMART Evaluation, Bone Marrow:

A cell count is performed on the specimen to establish a plating volume. Based on the cell count, a corresponding volume of bone marrow is added to 2 culture flasks containing culture medium and incubated for 24 to 48 hours at 37 degrees C. In the harvest process, the cells are exposed to colcemid, and hypotonic solution and fixed with glacial acid and methanol. Metaphases cells are dropped onto microscope slides and are routinely stained by G-banding, but other staining methods are frequently employed as needed. Twenty metaphases are usually examined. However, if a clone is suspected, but not confirmed within 20 metaphases, 30 metaphases will be analyzed. Minimal evidence for the presence of an abnormal clone is defined as 2 or more metaphases with the same structural abnormality or chromosome gain (trisomy), or 3 or more metaphases lacking the same chromosome. All cells analyzed are captured using a computerized imaging system, and 1 or more karyograms from each clone are prepared to document the type of abnormality and to permit systematic interpretation of the anomalies.(Dewald GW, Allen JE, Strutzenberg DK, Pierre RV: A cytogenetic method for mailed-in bone marrow specimens for the study of hematologic disorders. Lab Med 1982;13:225-229)

Plasma Cell Proliferative Disorder (PCPD), FISH:

This test uses commercially available and laboratory-developed chromosome-specific fluorescent-labeled DNA probes for FISH. Bone marrow samples are processed to keep the cytoplasm of the leukocytes intact. At least 2 slides with 2 hybridization sites each are prepared using a cytospin centrifuge. Each probe set is hybridized to a separate hybridization site. Plasma cells are specifically detected by using immunoglobulin staining techniques with commercially available antibodies (cIg) for kappa and lambda. Deletions or monosomies of chromosomes 13 and 17 are detected using FISH enumeration strategies. Centromere probes are used to detect chromosomal aneusomies for chromosomes 3, 7, 9, and 15. Translocation involving chromosome 14 (IGH) with chromosomes 4 (FGFR3), 11 (CCND1), or 16 (MAF) are detected by D-FISH strategies. For each probe set, 50 plasma cells (if possible) are scored and the result for each probe is reported.(Shaughnessy J, Tian E, Sawyer J, et al: High incidence of chromosome 13 deletion in multiple myeloma detected by multiprobe interphase FISH. Blood 2000 Aug 15;96[4]:1505-1511)

Plasma Cell DNA Content and Proliferation, Bone Marrow:

Monday through Sunday