# Patent

## Title
Assay to capture and detect circulating multiple myeloma cells from blood

## Abstract

The invention includes methods for isolating circulating multiple myeloma cells as well as method of treating patients suspected of having diseases of abnormal plasma cells.

## Background
RELATED APPLICATIONS
This non-provisional filing claims priority to a provisional patent application, U.S. Patent Application Ser. No. 61/510,170, filed on Jul. 21, 2011.


BACKGROUND OF THE INVENTION
Multiple Myeloma (also known as myeloma or plasma cell myeloma) is a progressive hematologic cancer of the plasma cell. The condition is characterized by excessive numbers of plasma cells in the bone marrow and overproduction of intact monoclonal immunoglobulin or free monoclonal light chains.
Clinically the disease is diagnosed, staged, and treated based on a variety of parameters which include the myeloma tumor cell mass on the basis of the amount of monoclonal (or myeloma) protein (M protein) in the serum and/or urine, along with hemoglobin and serum calcium concentrations, the number of lytic bone lesions based on a skeletal survey, and the presence or absence of renal failure. Additional approaches to characterizing the condition include the detection of greater than ten percent (10%) of plasma cells on a bone marrow examination, the presence of soft tissue plasmacytomas and the detection of free kappa and lambda serum immunoglobulin light chain. Bone marrow examination is done using standard histology and immunohistochemistry techniques. Additional cytogenetics of bone marrow samples may be conducted to determine prognosis. Follow up surveillance consists of chemistry and bone marrow evaluations if clinically indicated due to its invasive nature.
Currently, flow cytometric analysis of bone marrow is being evaluated as a tool for disease characterization and to distinguish between neoplastic plasma cell disorders from normal plasma cells and to detect minimal residual disease. Nonetheless, this approach continues to rely on an invasive procedure. There is significant need to develop less invasive techniques to detect, monitor and characterize the disease throughout its history and the presence of these cells in the blood may provide that opportunity.
In addition, more sensitive tools need to be developed for more accurate assessment of risk and monitoring for progression of disease in earlier stages of disease including monoclonal gammopathy of undetermined significance (MGUS) and Smoldering Multiple Myeloma. Some research data suggest that circulating plasma cells can be detected in earlier stages of disease and may correlate with prognosis, supporting the use of a standardized methodology to capture, enumerate and characterize these cells in earlier stages of disease.
The general consensus within the literature (Report of the European Myeloma Network on Multiparametric Flow Cytometry in Multiple Myeloma and Related Disorders. Andy C. Rawstron et al. Haematologica, 2008; 93 (3).) for the identification of abnormal plasma cells, particularly by flow cytometry, has included several key biomarkers consisting primarily of CD138, CD38 and CD45. Additional biomarkers such as CD19 and CD56 have also demonstrated utility in diagnosis.
The instant invention investigates circulating myeloma cells to evaluate whether these particular biomarkers either alone or in combination with one or more additional biomarkers or with FISH can be used for both the capture and detection of abnormal circulating plasma cells including detection of minimal residual disease. FISH can be used to detect numerous cytogenetic abnormalities that have been described in multiple myeloma. Translocations at the IGH locus, t(4;14), and deletions at the p53 locus, del(17p), have been shown to have prognostic value for event free and overall survival in multiple myeloma. (Genetic Abnormalities and Survival in Multiple Myeloma: The Experience of the InterGroupe Francophone du Myelome. Nerve Avet-Loiseau et al. Blood, 2007; 109: 3489-3495) These probes and several other multiple myeloma markers are available in the Poseidon catalog and could be adapted for use with the CellTracks® platform.
Commercially there exist immunomagnetic selection kits using CD138 magnetic particles. Stem Cell Technologies has an EasySep® Human CD138 Positive Selection Kit which can select CD138 positive cells from bone marrow and peripheral blood mononuclear cells (PBMC) and Miltenyi Biotech has CD138 Microbeads for the selection of CD138 positive cells from bone marrow, PBMC and whole blood. Analysis of collected samples is typically performed using flow cytometry.
SUMMARY OF INVENTION
The invention described here consists of a method for the capture and detection of circulating plasma cells (CPC) and abnormal plasma cells or Multiple Myeloma cells (“CMMC”) including the detection of minimal residual disease from peripheral blood. The instant invention provides a non-invasive means of detecting very low numbers of CMMCs in milliliter volumes of blood sample to detect, monitor and characterize the disease throughout its history, as well as provides the more sensitive tools for more accurate assessment of risk, and monitoring for progression of disease in earlier stages of disease including detecting circulating plasma cells in earlier stages of disease including monoclonal gammopathy of undetermined significance (MGUS) and Smoldering Multiple Myeloma. The capture and characterization of these circulating plasma cells from peripheral blood may provide novel biomarkers for the management of Multiple Myeloma patients.
Blood is collected in CellSave tubes which contains a preservative allowing for blood transport and storage while minimizing cell degradation. Cells are captured using colloidal magnetic particles conjugated to Syndecan-1 or CD138, a cell surface marker present on plasma cells. Once captured the cells are labeled with the additional cell markers CD38-PE (Phycoerythrin), CD19 and CD45-APC (allophycocyanin), and CD56-FITC (fluorescein isothiocyanate) in order to differentiate the Multiple Myeloma cells from background contaminating leukocytes (white blood cells). The ferrofluid and cell marker reagents are all part of a new CellSearch® CMMC service kit. The kit consists of 7 components of which 4 are identical to the reagents found in the Cellsearch® Epithelial Cell kit. These 4 common reagents are Capture Enhancement Reagent, Perm Reagent, Nucleic Acid Dye, and CellFix. The 3 new reagents consist of the CD138 Ferrofluid, a Staining Reagent consisting of CD38-PE, CD19 and CD45-APC and a separate marker staining reagent consisting of CD56-FITC.



BRIEF DESCRIPTION OF THE FIGURES
FIG. 1 illustrates the reactivity of CD 138 antibodies with certain cell lines
FIG. 2 illustrates the reactivity of CD 38 antibodies with certain cell lines
FIG. 3 illustrates the reactivity of different CD19 APC antibodies testing on PBMC
FIG. 4 illustrates staining of CD 19 APC at various dilutions
FIG. 5 illustrates staining of CD 56 antibodies on PBMC
FIG. 6 illustrates staining of CD 56 staining on various cell lines.
FIG. 7 illustrates staining without CD56
FIG. 8 illustrates CD 56 FITC staining of a cell line at a dilution
FIG. 9 illustrates CD 56 FITC staining of a cell line at a dilution
FIG. 10 illustrates CD 56 FITC staining of a cell line at a dilution
FIG. 11 illustrates representative images from MM 1-S cells
FIG. 12 illustrates representative images from H929 cells
FIG. 13 illustrates representative images of carry-over white blood cells
FIG. 14 illustrates images of a patient sample
FIG. 15 illustrates images of a patient sample
FIG. 16 illustrates images of a patient sample
FIG. 17 illustrates images of a patient sample
FIG. 18 illustrates images from normal donors



DETAILED DESCRIPTION OF THE INVENTION
The invention includes a method of capturing, isolating and analyzing circulating multiple myeloma cells comprising
(a) obtaining a sample of blood from a test subject
(b) contacting said sample with colloidal magnetic particles that are conjugated to a first ligand
(c) subjecting the sample of step (b) to a magnetic field to produce a separated fraction of magnetic particle-bound circulating multiple myeloma cells
(d) treating the sample of step (c) with a first additional marker
(e) analyzing circulating multiple myeloma cells.
As used herein the term “sample” refers to an amount of blood, preferably expressed as a volumetric measurement. The preferred volume of a blood sample is about 2 mL to 10 mL, more preferably 3-7.5 mL, most preferably 4 mL. The term “colloidal magnetic particles” refers to particles that are metallic or organometallic. Examples of such particles are disclosed in U.S. Pat. Nos. 5,597,531; 5,698,271; 5,698,271; 6,365,662, which are hereby incorporated by reference in its entirety, particularly for its description of such colloidal magnetic particles. They may be optionally coated with a polymer, preferably a polymer of biological origin such as bovine serum albumin and casein
The term “ligand” refers to proteins that bind to cell associated markers of CMMCs or of circulating plasma cells (“CPC”s). The preferred proteins are antibodies, preferably anti CD 138, anti-CD 38, and anti-CD 56, more preferably anti CD 138, and anti-CD 38, even more preferably anti CD-138. Such ligands may be conjugated to colloidal magnetic particles by methods that are substantially similar to the methods disclosed U.S. Pat. No. 6,365,662. Two or more ligands may be used in step (b) of the invention and it is preferred that at least two ligands are used in that step.
The term “magnetic field” may be produced by any of a number of methods, particularly by two magnetic separators substantially as described in U.S. Pat. No. 7,901,950, which is incorporated by reference in its entirety. The term “additional marker” means a cell associated protein that is specific for CMMC or excludes CMMCs. Such proteins include but are not limited to antibodies selected from the group consisting of anti-CD38 anti CD19, and anti CD45 anti CD 138, anti CD 56, anti lambda, anti kappa anti CD 200, anti Ki67. Such antibodies may be labeled with indicators such as phycoertythrin, fluorescein isothiocyanate, and allophycocyanin and it is preferable that they are labeled with one or more markers. Additional marker may include nucleic acid dyes such as DAPI. The preferred additional marker is selected from the group consisting of anti-CD38, anti CD19, and anti CD45; the particularly preferred additional marked is anti CD38. Two or more additional markers may be used in step (d) of the invention and it is preferred that at least two additional markers are used, more preferably, three additional markers, most preferably four additional markers.
The term “analyzing” means evaluating the magnetically captured sample to determine one or more of the following: whether the sample contains CMMCs or CPCs. Such identification may be conducted by visually or electronically to determine the degree of fluorescence of a magnetically captured samples. Such analysis methods are disclosed in U.S. Pat. No. 7,011,794 which is hereby incorporated by reference. Particularly, magnetically captured samples that are positive for CD38 and negative for CD19 and CD45 are identified as CMMCs.
The invention includes a method of determining if a patient's is likely candidates for therapeutic intervention for diseases associated with abnormal plasma cells

    
    
        (a) processing said patient's blood to determine how many CMMC are in sample
        (b) determining by counting if the number of CMMC cells present in said sample, is equal to or greater than or equal to the normal range
    
    


As used herein the terms sample has its aforementioned meaning and preferred range. The term “processing” means treating a sample of patient's blood by the methods described herein to isolate and identify CMMCs.
The term “therapeutic intervention” seeking or obtaining any medical intervention for treating diseases associated with abnormal plasma levels. Such diseases include but are not limited to Multiply Myeloma, MGUS, and Smoldering Multiple Myeloma. Such therapeutic intervention includes but is not limited to visiting a physician, obtaining therapeutic treatment such as radiation, and treatment with of drugs that treat any of the diseases associated with abnormal plasma levels, and monitoring the effect of such therapeutic treatments. For example, if a patient is being treated with a drug, the patient's levels of CMMC may be assessed during the course of treatment to determine if the drug is working. Such drugs include but are not limited to, Dexamethasone, cyclophosphamide, Vincristine, Bortezomib, Melphalan, Zometa, Aloxi, Lenalidomide, Doxirubicin, and the like.
The term “normal range” means the number of CMMC cells present in a sample population that does not have diseases associated with abnormal plasma cells. Preferably the normal range is less than 7 CMMCs in a blood sample of about 3 mL to about 7.5 mL. The term “greater than the normal range” is a number of CMMCs in excess of the normal range. The higher this number, the more likely it is that the patient either has one of the diseases associated with abnormal plasma cells. If a patient has between 8 and 20 CMMCs in a sample of blood such patient has a higher probability of having one of the diseases associated with abnormal plasma cells. If a patient has between 21 and 49 CMMCs the patient has an elevated level and is more likely to have one of the diseases associated with abnormal plasma cells, if a patient has between 50 and tens of thousands of CMMCs that patient has a highly elevated level and even more likely to have one of such diseases.
Yet still further, the invention includes a method of determining whether a patient undergoing therapeutic intervention is reducing the number of CMMCs comprising

    
    
        (a) processing said patient's blood to determine how many CMMC are in sample at a first point in time
        (b) determining by counting if the number of CMMCs present in said sample, is equal to or greater than or equal to the normal range
        (c) processing said patient's blood to determine how many CMMC are in sample at a second point in time
        (d) determining by counting if the number of CMMCs present in said sample, is equal to or greater than or equal to the normal range
        (e) comparing the numbers in steps (b) and (d).

All of the afore-defined terms have their same meaning and preferred range.

    
    


Still further, the invention includes a method of determining whether a patient who had a disease of abnormal plasma cells and has been successfully treated for such disease, remains in remission comprising

    
    
        (a) processing said patient's blood to determine how many CMMC are in sample at a first point in time
        (b) determining by counting if the number of CMMCs present in said sample, is equal to or greater than or equal to the normal range
        (c) processing said patient's blood to determine how many CMMC are in sample at a second point in time
        (d) determining by counting if the number of CMMCs present in said sample, is equal to or greater than or equal to the normal range
        (e) comparing the numbers in steps (b) and (d).

All of the afore-defined terms have their same meaning and preferred ranges.

    
    


Still even further the invention includes a reagent for capturing circulating multiple myeloma cells comprising colloidal magnetic particles and at least one ligand.
All of the afore-defined terms have their same meaning and preferred ranges.
Yet still further, the invention includes methods of capturing isolating, and analyzing circulating plasma cells comprising
(a) obtaining a sample of blood from a test subject
(b) contacting said sample with colloidal magnetic particles that are conjugated to a first ligand
(c) subjecting the sample of step (b) to a magnetic field to produce a separated fraction of magnetic particle-bound circulating multiple myeloma cells
(d) treating the sample of step (c) with a first additional marker
(e) analyzing circulating plasma cells.
All of the afore-defined terms have their same meaning and preferred ranges.
Circulating Multiple Myeloma Cells (CMMC), a form of abnormal plasma cells, captured from blood have been captured and analyzed using the CellTracks® AutoPrep® and CellTracks Analyzer II® System. In this procedure, a combination of capture reagent (ferrofluid) and fluorescent biomarkers (such as anti-CD38-Phycoerythrin (PE) antibody) and dyes (such as the nucleic acid dye DAPI) are used to identify abnormal plasma cells and to distinguish them from contaminating leukocytes and debris. CD138 or Syndecan-1 is a cell surface marker found on mature plasma cells and on plasma cell malignancies such as multiple myeloma but not on other normal peripheral blood leukocytes. For this reason anti-CD138 was coupled to ferrofluid, magnetic nanoparticles, which are used to magnetically select circulating plasma cells from a sample of peripheral blood. In order to detect the abnormal plasma cells from contaminating leukocytes several fluorescent biomarkers are used. Anti-CD38 is conjugated to phycoerythrin (PE) and is used as a positive marker for the detection of plasma cells. However since CD38 is also found on some types of leukocytes (activated T and B cells) the assay also uses allophycocyanine (APC) conjugated anti-CD45 and anti-CD19 conjugated to allophycocyanin (APC) as a negative marker. CD45 is a pan-leukocyte marker found on peripheral blood leukocytes and CD19 is a specific B cell marker. Myeloma cells are functionally differentiated B cells which do not express either CD45 or CD19. A final marker in this assay is anti-CD56 conjugated to fluorescein isothiocyanate (FITC). CD56 can be found on some peripheral leukocyte subsets such as NK cells but is also expressed on 75% of myeloma cells and is often associated with poorer patient prognosis. So while CD56 is neither a positive or negative marker for multiple myeloma its expression levels on cells can be monitored during patient drug therapy.
The assay was initially developed using cell lines such as RPMI 8226, H929 and MM.1S to evaluate different antibodies to the markers determined to be present on Multiple Myeloma cells which include CD138, CD38 and CD56. Since these cells lines were negative for CD45 and CD19, PBMC were used instead to evaluate those antibodies.
The enriched and stained cells were transferred to a CellTracks® cartridge and MagNest® for magnetic mounting. The cartridge was scanned using the CellTracks Analyzer II®. Individual images of cells were presented to the operator for review, and scored as CMMCs, based on fluorescence and cell morphology. In a model spike-in system the assay consistently recovered  ̃60% of the cells from the Multiple Myeloma cell line H929 spiked into 4.0 mL of blood from healthy donors. The assay was linear over the tested range of from 0 to 2000 spiked H929 cells (r2 0.98, slope 0.50, intercept 10). The assay was validated using blood from age matched healthy donors (n=22) and patients with Multiple Myeloma (n=66) and MGUS (n=7). In 4.0 mL blood from normal donors, 0 CPC were detected in 12/22 (55%) and low numbers (1-6 CPC) were detected in 10/22 (45%) samples. Interestingly, one CD56 positive CPC was found in a normal donor. CMMC in Multiple Myeloma patients ranged from 0-17,000/4.0 mL blood. One or more CMMC were detected in 91% of the patients, ≧5 in 68%, ≧10 in 58% and ≧100 in 35%. Expression of CD56 was highly variable in the patient population. CMMC in MGUS patients ranged from 0-112/4.0 mL blood. One or more CMMC were detected in 6/7 of the patients, >5 in 4/6, >10 in 2/6 and >100 in 1/6.
To further characterize CMMC, and differentiate CPC from CMMC, an interphase fluorescent in situ hybridization (FISH) assay was developed to be used with the capture and detection system described above. A four color FISH probe was used to simultaneously detect high risk mutations. The following examples illustrate the invention
EXAMPLES
Abbreviations
PE—Phycoerythrin
FITC—Fluorescein isothiocyanate
APC—Allophycocyanin
PBMC—peripheral blood mononuclear cell
Antibody Sources—
CD138:
Gen-Probe Diaclone SAS
1 Bd A Fleming, BP 1985
F-25020 Besancon Cedex, France
CD38 and CD19
R&D Systems
614 McKinley Place N.E.
Minneapolis, Minn. 55413
Example 1
Capture Targets
FIG. 1 shows that of the anti-CD138 antibodies tested for reactivity with the cell lines RPMI 8226, H929, and MM.1S, the best performing antibody was clone B-A38. The cell lines were first labeled with the different antibodies, which were all mouse anti-human antibodies, then subsequently labeled with an anti-mouse PE conjugate and analyzed by flow cytometry. Clone B-A38 gave the highest fluorescent staining on all the Multiple Myeloma cell lines.
Example 2
Detection Targets
FIG. 2 shows that of the anti-CD38 antibodies tested for reactivity with the cell lines RPMI 8226, H929, and MM.1S the best performing antibody was clone 240742. The cell lines were initially tested using a direct anti-CD38-FITC conjugate but the FITC conjugate was later found to be not sufficiently suitable for detection on the CellTracks® platform. A PE conjugate of this antibody was subsequently prepared and tested and found to be suitable for detection.
Example 3
Dilution Determination
Anti CD19 and anti-CD45, both as APC conjugates, were chosen as negative detection markers as the absence of both is indicative of abnormal plasma cells. Anti-CD45APC is already a component of the CellSearch® CTC staining reagent so no further optimization was necessary. And since none of the myeloma cell lines under evaluation expressed CD19, PBMC were used to evaluate the different anti-CD19APC clones. Results of anti-CD19 testing on PBMC can be seen in FIG. 3. Staining was conducted according to the manufacturer's recommended protocols on PBMC collected from EDTA and CellSave tubes. Clone SJ25C1 was chosen as the best performing conjugate. The conjugate was then tested at various dilutions in the same reaction volumes used on AutoPrep®, FIG. 4. A dilution of 1:5 was chosen as the final dilution for staining.
Example 4
Staining CD56 and PBMC
Anti-CD56 was chosen as a FITC marker reagent as it is expressed on 75% of myeloma cases with abnormal expression. Testing was conducted on cell lines (FIG. 6) and PBMC (FIG. 5) according to the manufacturer's recommended protocol. NCAM 16.2 was chosen as the best performing conjugate.
Example 5
CD 56 FITC Dilutions
The anti-CD56 FITC conjugate NCAM 16.2 was tested at various dilutions with H929 cells on AutoPrep®, see FIG. 7-10. No clear dilution tested was best on the cell line. A dilution of 1:4 was chosen as the final dilution for staining until patient samples could be tested to help determine the optimum concentration.
Example 6
Images
A CMMC prototype kit was then constructed consisting of anti-CD138 ferrofluid, staining reagent consisting of anti-CD38 PE, anti-CD45 APC and anti-CD19 APC, and an anti-CD56 FITC marker reagent. The remaining components of the kit were Capture Enhancement Reagent (PN 7037), Permeabilization Reagent (PN 7038), Nucleic Acid Dye (PN 7041), and CellFix (PN 7042). The first round of testing used anti-CD138 ferrofluid at different concentrations. The final anti-CD38 PE concentration was set at 1 μg/ml (staining reagent concentration of 5.7 μg/ml) based on the previous flow data. Final anti-CD45 APC concentration was approximately 2 μg/ml (staining reagent concentration of 13 μg/ml—same as in the CellSearch® CTC Kit) and the stock anti-CD19 APC conjugate was diluted 1:5 in the staining reagent. Anti-CD56 FITC was used at a concentration of 1:4 in the marker reagent vial. H929 cells were spiked into 7.5 mls of CellSave blood and processed on AutoPrep® at ferrofluid concentrations of 135, 185, 220, and 270 μg/ml. Samples were then analyzed on the CellTracks Analyzer II® and the recovery of H929 cells reached a plateau of 55-60% at around 220 μg/ml.
It was therefore decided that the final ferrofluid concentration in the kit would be 220 μg/ml per 7.5 ml blood sample which is similar to concentrations used in many other CellSearch® kits.
CellTracks® images of recovered H929 and MM.1S cells can be seen in FIGS. 11 and 12 respectively. Note the greater CD56 staining of H929 cells compared to the MM.1S cells. Carryover white blood cells (CD38+/CD45+) can be seen in FIG. 13.
Example 7
Patient Samples
A total of 66 Multiple Myeloma patient samples were tested for CMMC. These samples were acquired from Conversant and originally 7.5 mLs of blood was tested using the CellTracks® CMMC service kit but as it became apparent that many samples had high numbers of CMMC a decision was made to reduce the volume of blood tested to 4 mLs. Samples were processed on the CellTracks® AutoPrep® and then scanned on the CellTracks Analyzer II®. FIG. 10 is a table of data generated from the patient blood samples. CMMC in Multiple Myeloma patients ranged from 0-17,000/4.0 mL blood. One or more CMMC were detected in 91% of the patients, ≧5 in 68%, ≧10 in 58% and ≧100 in 35%. Expression of CD56 was highly variable in the patient population. CMMC in MGUS patients ranged from 0-112/4.0 mL blood. One or more CMMC were detected in 6/7 of the patients, >5 in 4/6, >10 in 2/6 and >100 in 1/6. FIGS. 14-17 shows some representative CellTracks® images from patient samples.
Legend Table 1
Stage: A diagnostic classification of the extent and characteristics of myeloma cells comprising Stages I, II, and III. The number of cancers cells progresses from relatively few to moderate to relatively large as the Stages progress. Additional symptoms such as M protein, anemia, and serum calcium also increase as the Stages progress.

Treatment status: Reflects the disease status and approach to treatment

Treatment type: Drug or radiation therapy

Volume: Volume of peripheral blood processed on the CellSearch® System

Total events: Total number of CellTracks® browser images presented to the user for a manual classification of Multiple Myeloma cells

Total MM Cells (CD38+, CD19/45−): Total number of images from the total events that the user has determined to meet the criteria of a Multiple Myeloma (MM) cell. These cells are CD38 positive and CD19/45 negative.

CD38+, CD19/45−, CD56+: The number of Multiple Myeloma cells that were CD56 positive

CD38+, CD19/45—, CD56−: The number of Multiple Myeloma cells that were CD56 negative

Unassigned events: The total events minus the total MM cells, which were events the user classified as Multiple Myeloma cells. Unassigned events are a combination of white blood cells, computer noise, or other debris not classified as MM cells.








TABLE 1







Table of CMMC Multiple Myeloma Patient Samples
























Total MM












Cells
CD38+,
CD38+,



Gender/
Treatment
Treatment

Volume
Total
CD38+,
CD45/19−
CD45/19−
Unassigned


Sample
Age
Status
Type
Stage
(mLs)
Events
CD45/19−
CD56+
CD56−
Events




















1
M/78
Active
Revlimid,
II
7.5
5491
1
1
0
5490





Decadron


2
M/66
Active
Velcade,
III
7.5
2118
4
3
1
2114





Doxil,





Decadron


3
F/78
Refractory
Post
III
7.5
3179
16
15
1
3163





Velcade,





Doxil,





Dexamethasone,





Revlimid


4
M/61
Active
Revlimid,
III
7.5
33090
20681
19399
1282
12409





Doxil


5
M/54
Pre
N/A
I
7.5
4387
6
0
6
4381


6
F/62
Active
Dexamethasone,
II
7.5
6500
1931
1515
416
4569





Doxil,





Velcade


7
F/63
Post
NA

4
20383
16814


3569


8
M/56
Active
Decadron
II
7.5
21091
17779
0
17779
3312


9
M/57
Active
Radiation

4
42388
16447
0
16447
25941


10
F/67
Active
Velcade
I
7.5
3879
11
10
1
3868


11
M/48
Active
Velcade,
III
7.5
8664
2
1
1
8662





Decadron,





Doxil


12
F/53
Active
Velcade
II
7.5
1102
3
2
1
1099


13
F/77
Active
Velcade,
I
4
5104
23
8
15
5081





Dexamethasone


14
M/79
Active
Revalmid,
III
4
2893
0
0
0
2893





Dexamethasone


15
F/68
Active
Cytoxan
III
4
960
3
0
3
957


16
F/40
Active
Velcade
II
4
6937
5092
2213
2879
1845


17
F/41
Post
NA

4
760
0


760


18
M/76
Active
Velcade
II
4
1818
6
4
2
1812


19
M/53
Active
Dexamethasone
I
4
6966
3
0
3
6963


20
F/76
Active
Velcade
III
4
1630
26
4
22
1604


21
F/79
Recurrent
NA
III
4
12834
5428
2451
2977
7406


22
F/80
Post
In between

4
9472
4
1
3
9468


23
F/80
Pre
NA

4
2408
145


2263


24
F/80
Pre
NA

4
1197
249


948


25
M/79
Active
Velcade
II
4
6792
788
68
720
6004


26
M/79
Active
Aloxi,

4
17128
103
18
85
17025





Doxil,





Vincristin


27
M/73
Post
NA

4
552
48
34
14
504


28
M/74
Post
NA

4
584
22
5
17
562


29
M/74
Post
NA

4
5293
13


5280


30
M/59
Active
Velcade,

4
2302
3
1
2
2299





Doxil


31
F/60
Post
NA

4
1237
148
110
38
1089


32
F/60
Post
NA

4
4436
89
81
8
4347


33
F/61
Between
NA

4
1804
27


1778


34
F/61
Pre
NA

4
3941
99
27
72
3842


35
F/61
Active
Velcade

4
2126
14


2112


36
F/61
Active
Bortezomib

4
1289
7


1282


37
M/69
Active
Revlimid

4
934
38
26
12
896


38
F/69
Active
Cytoxan

4
890
12
0
12
878


39
F/72
Active
Doxil,

4
669
0
0
0
669





Velcade


40
F/59
Active
Doxil,

4
4921
335
100
235
4586





Velcade


41
F/59
Active
Doxil,

4
3098
221
37
184
2877





Velcade


42
F/60
Active
Velcade

4
272
0
0
0
272


43
F/60
Active
Bortezomib

4
277
1


276


44
F/61
Active
Doxil,

4
2511
253
171
82
2258





Velcade


45
F/61
Active
Doxil,

4
933
215
46
169
718





Velcade


46
F/61
Pre
NA

4
2264
95


2169


47
M/70
Active
Doxil,

4
1300
0
0
0
1300





Melphalan


48
M/75
Active
Velcade

4
4658
2
0
2
4656


49
M/63
Post
NA

4
14448
1
0
1
14447


50
M/76
Post
Zometa

4
25095
2
1
1
25093


51
F/68
Post
Zometa

4
5099
5
0
5
5094


52
M/71
Active
Aloxi,

4
18684
49
9
40
18635





Doxil,





Vincristin


53
F/45
Active
Decadron

4
3285
0
0
0
3285





and





Revlimid


54
M/78
Post
NA

4
2182
16
0
16
2166


55
F/62
Active
Velcade

4
1481
15
11
4
1466


56
F/63
Pre
NA

4
5681
581


5100


57
F/63
Pre
NA

4
1530
389


1141


58
M/75
Pre
NA

4
14232
199
4
195
14033


59
F/63
Post
NA

4
9610
1
0
1
9609


60
M/79
Active
Radiation

4
4121
4121
0
4121
0


61
M/62
Post
NA

4
1494
8


1486


62
F/59
Active
Bortezomib

4
1956
398


1558


63
M/50
Active
Lenalidomide

4
1276
7


1269


64
M/62
Active
Doxirubicin

4
9470
1842


7628


65
M/60
Post
NA

4
1055
2
0
2
1053


66
M/53
Active
Bortezomib

4
813
376
131
244
437









Example 8
Normal Subjects
Twenty two age-matched normals were then tested as well. These samples were also acquired from Conversant and 4 mls of blood was tested using the CellTracks® CMMC service kit. Samples were processed on the CellTracks® AutoPrep® and then scanned on the CellTracks Analyzer II®. Table 2 is a table of data generated from the 4 ml blood samples. In 4.0 mL blood from normal donors, 0 CPC were detected in 12/22 (55%) and low numbers (1-6 CPC) were detected in 10/22 (45%) samples. Interestingly, one CD56 positive CPC was found in a normal donor. See FIG. 18. The average number of total browser events was approximately 1500.
To further characterize CMMC, and differentiate CPC from CMMC, an interphase fluorescent in situ hybridization (FISH) assay was developed to be used with the capture and detection system described above. A four color FISH probe was used to simultaneously detect high risk mutations including two recurrent translocations of the IgH locus (t(4;14)(p16;q32) and t(14;16)(q32;q23)) as well as deletion of the TP53 locus (Δ17p13). The FISH assay was verified on cell lines H929, MM1s, and U266, which showed mutations at t(4;14), t(14;16) and Δ17p13, respectively. The FISH assay was tested on 9 CMMC patient samples and 8 samples yielded evaluable results. Two samples showed t(4;14) fusions, 3 patients showed aberrant FISH signal patterns indicating aneuploidy of chromosome 4 or 14 and the remaining patients showed normal FISH patterns.







TABLE 2







Table of CMMC from 4 mls Age-Matched Normal


Blood Donors

















CD38+,
CD38+,
Un-



Gender/
Volume
Total
CD45/19−
CD45/19−
assigned


Sample
Age
(mLs)
Events
CD56+
CD56−
Events
















1
F/43
4
3281
0
1
2538


2
M/71
4
1939
0
0
759


3
F/54
4
3584
0
1
2794


4
F/61
4
399
0
0
102


5
F/70
4
645
0
0
114


6
F/60
4
526
0
0
273


7
F/49
4
273
0
0
80


8
F/55
4
2502
1
2
1559


9
M/47
4
811
0
1
209


1
F/55
4
1512
0
2
940


11
M/42
4
1032
0
0
485


12
F/54
4
576
0
0
287


13
M/44
4
6211
0
1
4742


14
F/55
4
1891
0
0
1182


15
M/43
4
1233
0
0
745


16
M/50
4
816
0
0
524


17
F/50
4
661
0
1
362


18
F/55
4
668
0
1
367


19
M/60
4
1621
0
0
696


20
F/58
4
414
0
0
249


21
F/60
4
2221
0
1
2220


22
M/51
4
762
0
6
756









Example 9
Capture Using Anti-CD 38 and Anti CD 138 Patient Samples
Anti CD138, the cell surface marker conjugated to colloidal magnetic particles used to capture myeloma cells in the present invention can be shed from the myeloma cell surface over time. CD38, a surface marker also present on myeloma cells, does not undergo shedding from the cell surface. A magnetic nanoparticle was developed that was coupled to both anti-CD138 and anti-CD38 and tested with both patient samples and normal donors for the ability to capture myeloma cells. Anti-CD38 and anti CD 138 both conjugated to phycoerythrin (PE), and both recognizing a different epitopes than the anti CD38 and anti-CD 138 used in making the magnetic nanoparticle, was used for detection along with anti-CD45 and anti-CD19 conjugated to allophycocyanin (APC).
A total of 22 Multiple Myeloma patient samples were tested for CMMC using the alternate capture reagent. These samples were acquired from Conversant and 4 mls were processed on the CellTracks® AutoPrep® and then scanned on the CellTracks Analyzer II®. Table 3 is a table generated from the patient samples. CMMC in Multiple Myeloma patients ranged from 0-2244/4.0 mL blood. One or more CMMC were detected in 82% of patients, ≧5 in 64%, ≧10 in 59%, and ≧100 in 23%.







TABLE 3







of CMMC from Multiple Myeloma Patients














CD38+, CD 138+
Unassigned



Sample
Total Events
CD19/45− Cells
Events
















1
19065
737
18328



2
5420
433
4987



3
6098
12
6086



4
7680
22
7658



5
26561
2244
24317



6
7682
52
7630



7
18621
63
18558



8
14889
111
14778



9
7039
13
7026



10
12608
15
12593



11
9708
2
9706



12
34273
5
34268



13
21771
182
21589



14
7097
0
7097



15
2988
3
2985



16
7936
1
7935



17
10879
69
10810



18
4990
0
4990



19
6153
12
6141



20
4248
0
4248



21
13757
0
13757



22
3334
1
3333










Example 9
Capture Using Anti-CD 38 and Anti CD 138 Normal Samples
Twelve normal donors were then tested as well, using the same kit configuration as Example 8. These samples were in house donors and 4 mLs of blood was processed on the CellTracks® AutoPrep® and then scanned on the CellTracks Analyzer II®. Table 4 is a table generated from the 4 mL blood samples. In 4.0 mL blood from normal donors, 0 CPC were detected in 5/12 (42%) and low numbers (1-3 CPC) were detected in 7/12 (58%) of samples.







TABLE 4







of CPC from Normal Donors














CD38+ CD 138+,
Unassigned



Sample
Total Events
CD19/45− Cells
Events
















1
7120
2
7118



2
13075
3
13072



3
9208
3
9205



4
29057
3
29054



5
20525
1
20526



6
19619
2
19617



7
6004
1
6003



8
14456
0
14456



9
8528
0
8528



10
7966
0
7966



11
17311
0
17311



12
5924
0
5924

## Claims

1. A reagent for capturing circulating multiple myeloma cells comprising colloidal magnetic particles and at least two ligands, wherein the ligands are selected from the group consisting of anti CD 138, anti-CD 38, and anti-CD56.

2. The reagent of claim 1 further comprising at least three ligands.