Coexistent Multiple Myeloma or Increased Bone Marrow Plasma Cells Define Equally High-Risk Populations in Patients With Immunoglobulin Light Chain Amyloidosis
Coexistent Multiple Myeloma or Increased Bone Marrow Plasma Cells Define Equally High-Risk Populations in Patients With Immunoglobulin Light Chain Amyloidosis
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DOI：
10.1200/jco.2013.50.8499
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发表时间：
2013-12-01
影响因子：
45.3
通讯作者：
Dispenzieri, Angela
中科院分区：
文献类型：
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作者：
Kourelis, Taxiarchis V.;Kumar, Shaji K.;Dispenzieri, Angela
目的 人们一致认为，轻链 (AL) 淀粉样变性伴高钙血症、肾功能衰竭、贫血和浆细胞克隆性扩张导致的溶骨性病变（CRAB 标准）患者也患有多发性骨髓瘤 (MM)。本研究的目的是检查伴有和不伴有 MM 的免疫球蛋白 AL 淀粉样变性谱，目的是确定符合 MM AL 淀粉样变性资格的最佳骨髓浆细胞 (BMPC) 数量。 患者和方法 我们确定了 2000 年 1 月 1 日至 2010 年 12 月 31 日之间诊断后 90 天内出现的 1,255 名 AL 淀粉样变性患者。共存MM基于CRAB标准（AL-CRAB）的存在。受试者操作特征分析确定了最佳 BMPC 切点，以预测无 CRAB 的 AL 淀粉样变性患者的 1 年死亡率，从而产生另外两个组：仅 AL（10% BMPC）和 AL 浆细胞 MM（AL-PCMM；> 10% BMPC）。 结果 在 1,255 名患者中，100 名（8%）患有 AL-CRAB，476 名（38%）患有 AL-CRAB。 AL-PCMM，679 人 (54%) 仅患有 AL。他们各自的中位总生存率分别为 10.6、16.2 和 46 个月 (P < .001)。由于 AL-CRAB 和 AL-PCMM 的结果相似，因此将它们合并进行单变量和多变量分析。在多变量分析中，合并的 AL-CRAB 和 AL-PCMM 保留负预后值，与年龄、Mayo Clinic AL 淀粉样变性分期、既往自体干细胞移植以及受累和不受累游离轻链之间的差异无关。结论 BMPC 超过 10% 的 AL 淀粉样变患者预后不良，与 AL-CRAB 患者相似，因此应与 AL 淀粉样变性和 AL 淀粉样变性患者一起考虑。 MM。 (C) 2013 年美国临床肿瘤学会
Purpose There is consensus that patients with light chain (AL) amyloidosis with hypercalcemia, renal failure, anemia, and lytic bone lesions attributable to clonal expansion of plasma cells (CRAB criteria) also have multiple myeloma (MM). The aim of this study was to examine the spectrum of immunoglobulin AL amyloidosis with and without MM, with a goal of defining the optimal bone marrow plasma cell (BMPC) number to qualify as AL amyloidosis with MM.Patients and Methods We identified 1,255 patients with AL amyloidosis seen within 90 days of diagnosis between January 1, 2000, and December 31, 2010. We defined a population of patients with coexisting MM on the basis of the existence of CRAB criteria (AL-CRAB). Receiver operating characteristic analysis determined the optimal BMPC cut point to predict for 1-year mortality in patients with AL amyloidosis without CRAB to produce two additional groups: AL only ( 10% BMPCs) and AL plasma cell MM (AL-PCMM; > 10% BMPCs).Results Among the 1,255 patients, 100 (8%) had AL-CRAB, 476 (38%) had AL-PCMM, and 679 (54%) had AL only. Their respective median overall survival rates were 10.6, 16.2, and 46 months (P < .001). Because the outcomes of AL-CRAB and AL-PCMM were similar, they were pooled for univariate and multivariate analyses. On multivariate analysis, pooled AL-CRAB and AL-PCMM retained negative prognostic value independent of age, Mayo Clinic AL amyloidosis stage, prior autologous stem-cell transplantation, and difference between the involved and uninvolved free light chain.Conclusion Patients with AL amyloidosis who have more than 10% BMPCs have a poor prognosis, similar to that of patients with AL-CRAB, and should therefore be considered together as AL amyloidosis with MM. (C) 2013 by American Society of Clinical Oncology