Rajkumar S, Fonseca R, Lacy M, Witzig T, Lust J, Greipp P, Therneau T, Kyle R, Litzow M, Gertz M
Division of Hematology and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Bone Marrow Transplant. 1999 Sep;24(5):497-503. doi: 10.1038/sj.bmt.1701943.
We compared the prognostic value of conventional cytogenetic analysis and established factors such as beta2-microglobulin and plasma cell labeling index in 70 patients undergoing autologous blood cell transplantation for multiple myeloma. Patients underwent transplantation 5 to 88 months (median, 20 months) after the initial diagnosis of myeloma. Factors studied were age, sex, beta2-microglobulin, response to prior therapy, plasma cell labeling index, cytogenetic analysis, bone marrow plasma cell percentage, lactate dehydrogenase and C-reactive protein. Twenty-eight of 65 patients (43%) had abnormal marrow cytogenetics. Overall survival measured from transplantation was significantly better in patients with normal cytogenetics than in those with abnormal cytogenetics (median survival, 25 vs 12 months, P = 0.003). Progression-free survival was better, with median times of 12 vs7 months, respectively (P = 0.005); overall survival measured from the time myeloma was first diagnosed was also longer, with median survivals of 62 and 39 months, respectively (P = 0.001). Median plasma cell labeling index was 1.5% in patients with abnormal cytogenetics and 0. 2% in those with normal cytogenetics (P < 0.001). Abnormal bone marrow cytogenetics predict poor survival after blood cell transplantation for myeloma. There is a significant correlation between abnormal cytogenetics and high plasma cell labeling index, suggesting that certain cytogenetic abnormalities may offer a proliferative advantage to myeloma cells.
我们比较了70例接受自体血细胞移植治疗多发性骨髓瘤患者的传统细胞遗传学分析以及诸如β2微球蛋白和浆细胞标记指数等既定因素的预后价值。患者在骨髓瘤初始诊断后5至88个月（中位数为20个月）接受移植。研究的因素包括年龄、性别、β2微球蛋白、对先前治疗的反应、浆细胞标记指数、细胞遗传学分析、骨髓浆细胞百分比、乳酸脱氢酶和C反应蛋白。65例患者中有28例（43%）骨髓细胞遗传学异常。从移植开始测量的总生存期，细胞遗传学正常的患者明显优于细胞遗传学异常的患者（中位生存期分别为25个月和12个月，P = 0.003）。无进展生存期更好，中位时间分别为12个月和7个月（P = 0.005）；从骨髓瘤首次诊断时开始测量的总生存期也更长，中位生存期分别为62个月和39个月（P = 0.001）。细胞遗传学异常患者的浆细胞标记指数中位数为1.5%，细胞遗传学正常患者为0.2%（P < 0.001）。骨髓细胞遗传学异常预示着骨髓瘤患者血细胞移植后生存期较差。细胞遗传学异常与高浆细胞标记指数之间存在显著相关性表明，某些细胞遗传学异常可能赋予骨髓瘤细胞增殖优势。
