“The current study is important because it further supports, when evaluated in a large cohort of patients, what many oncologists observe anecdotally in clinical practice,” said Hans Lee, MD, assistant professor in the department of lymphoma/myeloma at The University of Texas MD Anderson Cancer Center, Houston, who was not involved in the study, in an interview with Cancer Therapy Advisor. “With a more refined definition of PCL supported by several different studies, we should consider including such patients with lower circulating plasma cells in clinical trials and treatment algorithms that target PCL.”

Anastasios Raptis, MD, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, echoed a similar sentiment when he spoke to Cancer Therapy Advisor. Dr Raptis said the threshold should be lowered to 5% and noted that some oncologists already use the proposed lower cutoff of 5% to define PCL. He was not involved in the study.

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“At the Mayo Clinic, our clinical practice has already been alert to identifying such high-risk patients based on these cutoffs,” Dr Gonsalves said. 

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Revising the definition could lead to the identification of more patients who have PCL and ultimately affect treatment decisions. Dr Raptis explained that, with a diagnosis of PCL, these patients would receive more aggressive treatment and be more closely monitored compared with patients with just a simple multiple myeloma diagnosis.

“Future discussions, presentations, and information dissemination among the multiple myeloma community will be key to having this definition be universally accepted,” Dr Gonsalves said. “It will eventually make its way into the guidelines and this will also help in it being considered the new definition.”


  1. Ravi P, Kumar SK, Roeker L, et al. Revised diagnostic criteria for plasma cell leukemia: results of a Mayo Clinic study with comparison of outcomes to multiple myeloma. Blood Cancer J. 2018;8(12):116.