Overview of process. Bone marrow aspirates taken in the clinic are sent to Hematopathology laboratory to determine abnormal plasma cell count by flow cytometry. Samples underwent CD138⁺ magnetic cell sorting, followed by purity assessment by flow cytometry. DNA was extracted from up to 0.5 million CD138⁺ cells. DNA from both CD138⁺ cells and DNA from saliva or peripheral blood from the same patient underwent library preparation, hybridization, and sequencing. Excess CD138⁺ and CD138⁻ cells were viably frozen for research purposes. Targeted sequencing data were analyzed for somatic abnormalities and discussed in a molecular tumor board. CLIA NGS, Clinical Laboratory Improvement Amendments Next Generation Sequencing; IU, Indiana University.