Plasmablastic morphology - An independent prognostic factor with clinical and laboratory correlates: Eastern Cooperative Oncology Group (ECOG) myeloma trial E9486 report by the ECOG Myeloma Laboratory Group
Plasmablastic morphology - An independent prognostic factor with clinical and laboratory correlates: Eastern Cooperative Oncology Group (ECOG) myeloma trial E9486 report by the ECOG Myeloma Laboratory Group
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DOI：
10.1182/blood.v91.7.2501.2501_2501_2507
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发表时间：
1998-04-01
期刊：
影响因子：
20.3
通讯作者：
Kyle, RA
中科院分区：
文献类型：
--
作者：
Greipp, PR;Leong, T;Kyle, RA
我们在东部肿瘤协作组III期试验E9486中研究了血浆白蛋白（PB）对多发性骨髓瘤（MM）的预后意义。两名审查员独立审查了453例病例。他们同意37例（8.2%）PB病例和416例非PB病例，达到85%的一致性（P <0.0001）。这些PB病例的血红蛋白和血清白蛋白水平显著降低，钙和β 2-微球蛋白水平升高，免疫荧光显示BM浆细胞（PC）百分比升高。他们有更高的骨髓PC标记指数，更高的血清可溶性白细胞介素-6受体（sIL-6 R）水平，ras基因突变的概率更高。采用三种治疗方案：长春新碱、双氯乙基亚硝基脲（BCNU）、美法仑、环磷酰胺。和单独的泼尼松（VBMCP）; VBMCP与添加的环磷酰胺（HiCy）;或重组干扰素α 2（rIFN α 2）。尽管数量较少，但接受VBMCP治疗的PB MM患者的缓解率显著低于非PB MM患者（治疗组，47.1% vs未治疗组，66.5% [P = 0.015]）。PB无反应患者的进展率显著高于非PB患者（30.6% v11.8%[P < .0001]），尤其是单独使用VBMCP（35.3% v15.8%[P = .002]）和添加HiCy（37.5% v9.8%[P < .0001]），但不添加rIFN α 2。PB MM的无事件生存期和总生存期较短（中位年分别为1.1 v2.7和1.9 v3.7 [两者P <0.0001]）。在多变量分析中，PB分类也是高度预后的。两名评审员分类为PB的患者与仅一名评审员分类为PB的患者之间的生存率无差异。我们的结论是，PB MM是一个独立的实体与更积极的疾病和缩短生存期。肿瘤细胞ras突变和sIL-6 R升高可能导致增殖率升高和生存率降低。在VBMCP中加入HiCy和rIFN α 2后，反应和进展有显著改善，但数量很少，无法显示生存率的改善。(C)1998年，美国血液学会。
We studied the prognostic significance of plasmablastic (PB) multiple myeloma (MM) in Eastern Cooperative oncology Group Phase ill trial E9486. Two reviewers independently reviewed 453 cases. They agreed on 37 PB (8.2%) cases and 416 non-PB cases, achieving an 85% concordance (P < .0001). These PB eases had significantly lower hemoglobin and serum albumin levels, higher calcium and beta 2-microglobuin levels, and higher percentage BM plasma cells (PC) by immunofluorescence. They had higher bone marrow PC labeling indices, higher serum soluble interleukin-6 receptor (sIL-6R) levels, and a higher probability of ras mutations. Three treatment regimens were used: vincristine, bis-chloro-ethyl nitrosourea (BCNU) melphalan, cyclophosphamide. and prednisone (VBMCP) alone; VBMCP with added cyclophosphamide (HiCy); or recombinant interferon alpha 2 (rIFN alpha 2). Although the numbers are low patients with PB had a significantly lower response rate versus non-PB MM when treated with VBMCP (treated, 47.1% v nontreated, 66.5% [P = .015]). Patients with nonresponding PB had a significantly higher progression rate than non-PB cases (30.6% v 11.8% [P < .0001]), especially with VBMCP alone (35.3% v 15.8% [P = .002]), and with added HiCy (37.5% v 9.8% [P < .0001]), but not with added rIFN alpha 2. Event-free and overall survival of PB MM was shorter (median years, 1.1 v 2.7 and 1.9 v 3.7, respectively [P < .0001 for both]). In multivariate analysis, PB classification was also highly prognostic. There is no survival difference between the patients who were classified as PB by both reviewers versus patients classified as PB by only one reviewer. We conclude that PB MM is a discrete entity associated with more aggressive disease and shortened survival. Tumor cell ras mutations and increased sIL-6R may contribute to a higher proliferation rate and reduced survival. There were significant improvements in response and progression with the addition of HiCy and rIFN alpha 2 to VBMCP, but the numbers were small and improved survival could not be shown. (C) 1998 by The American Society of Hematology.