Pretreatment tumor mass, cell kinetics, and prognosis in multiple myeloma.
Pretreatment tumor mass, cell kinetics, and prognosis in multiple myeloma.
复制标题
多发性骨髓瘤的治疗前肿瘤质量、细胞动力学和预后。
作者：
Durie Bg;Salmon Se;T. Moon
对 150 名多发性（浆细胞）骨髓瘤患者进行了治疗前肿瘤质量分期，79 名患者还进行了治疗前标记指数 (LI%) 测量。不同治疗前疾病阶段的生存率存在明显差异。在单因素和多变量回归分析中，治疗前骨髓浆细胞的 LI% 都是独立的预后因素，包括骨髓瘤分期（p 小于 0.02）。其他重要的预后因素（多变量）包括体能状态、血清肌酐、Bence Jones 蛋白的存在、年龄和 kappa/lambda 亚型。低于 1% 的 LI% 与每个患者组的长期生存相关。患有良性丙种球蛋白病的患者具有良好的生存率和非常低的标记指数。对于 DNA 合成细胞 (S) 总数较高的高细胞量患者，预处理 LI% 大于 3% 预后极差 (p = 0.002)。这个具有高S值的亚组患者中枢神经系统复发（27%）、Bence Jones蛋白尿和血清尿酸水平升高的发生率也很高。我们的结论是，除了肿瘤质量分期之外，治疗前标记指数还提供有用的预后信息。
One-hundred fifty patients with multiple (plasma cell) myeloma had pretreatment tumor mass staging, and 79 also had measurement of the pretreatment labeling index (LI%). There were clear differences in survival by pretreatment stage of disease. The pretreatment LI% of bone marrow plasma cells was an independent prognostic factor both in single factor and multivariate regression analyses, including myeloma stage (p less than 0.02). Other important prognostic factors (multivariate) included performance status, serum creatinine, presence of Bence Jones protein, age, and kappa/lambda subtype. A LI% of less than 1% was associated with long survival in each patient group. Patients with benign gammopathy had excellent survival and very low labeling indices. A pretreatment LI% of greater than 3% in high cell mass patients with a high total number of DNA synthesizing cells (S) conferred a very poor prognosis (p = 0.002). This subgroup of patients with high S values also had a high incidence of central nervous system relapse (27%), Bence Jones proteinuria, and elevated serum uric acid levels. We conclude that the pretreatment labeling index provides helpful prognostic information in addition to tumor mass staging.