Prognostic value of bone marrow angiogenesis in patients with multiple myeloma undergoing high-dose therapy
Prognostic value of bone marrow angiogenesis in patients with multiple myeloma undergoing high-dose therapy
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DOI：
10.1038/sj.bmt.1704555
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发表时间：
2004-08-01
影响因子：
4.8
通讯作者：
Rajkumar, SV
中科院分区：
文献类型：
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作者：
Kumar, S;Gertz, MA;Rajkumar, SV
多发性骨髓瘤的骨髓血管生成增加，是一个重要的预后因素。然而，以前的研究主要是对接受常规化疗的患者进行的，并且在接受大剂量治疗（HDT）作为初始治疗的患者中，其预后价值的数据有限。我们研究了88例新诊断患者的骨髓血管生成的微血管密度（MVD），这些患者均接受了3 - 4个周期的诱导化疗，然后进行HDT。我们研究了诊断时MVD是否可预测诱导治疗或随后的HDT的反应。此外，我们还研究了其在这些患者中的预后价值。原发性难治性患者的中位MVD为28（范围，2 - 84），而缓解患者为27（范围，2 - 99）（P = 0.7）。高级别血管生成患者的中位无进展生存期（PFS）为21个月，而低级别血管生成患者为42个月，P = 0.017。对于高级别血管生成和尚未达到的患者，诊断后的中位总生存期（OS）为40个月，对于低级别血管生成患者，P = 0.007。在接受自体移植作为骨髓瘤一线治疗的患者中，初次诊断时的BM MVD是OS和PFS的重要预后因素。
Bone marrow ( BM) angiogenesis is increased in multiple myeloma and is an important prognostic factor. However, prior studies were mainly done on patients receiving conventional chemotherapy and there is limited data on its prognostic value in patients undergoing high-dose therapy (HDT) as initial therapy. We studied BM angiogenesis in terms of microvessel density (MVD) in 88 newly diagnosed patients, who were uniformly treated, with 3 - 4 cycles of induction chemotherapy followed by HDT. We examined if MVD at diagnosis was predictive of response to induction therapy or to subsequent HDT. In addition, we also examined its prognostic value in these patients. The median MVD for primary refractory patients was 28 ( range, 2 - 84) compared to 27 ( range, 2 - 99) for responding patients ( P = 0.7). The median progression-free survival (PFS) was 21 months for those with high-grade angiogenesis compared to 42 months for those with low-grade angiogenesis, P = 0.017. The median overall-survival ( OS) from diagnosis was 40 months for those with high-grade angiogenesis and not yet reached, for those with low-grade angiogenesis, P = 0.007. BM MVD at the time of initial diagnosis is an important prognostic factor for OS and PFS in patients undergoing autologous transplantation as frontline therapy for myeloma.