Boccadoro M, Omedé P, Dominietto A, Palumbo A, Bringhen S, Giaretta F, Ortolano B, Triolo S, Pileri A
Divisione Universitaria di Ematologia, Azienda Ospedaliera S Giovanni Battista di Torino, Torino, Italy.
Bone Marrow Transplant. 2000 Jan;25(1):25-9. doi: 10.1038/sj.bmt.1702085.
Multiple myeloma (MM) is characterized by the expansion of tumor plasma cells in bone marrow (BM), but neoplastic cells have been consistently detected in peripheral blood (PB). Peripheral blood progenitor cell (PBPC) collections have been widely used to support high-dose therapy for MM patients. A flow cytometric technique has been used to detect plasma cells in PB and PBPC harvests. High CD38 expression identified these cells, and their nature was confirmed by the coexpression of specific antigens, such as CD138 and cytoplasmic immunoglobulins. Malignant plasma cell reinfusion could negatively affect response rate and survival, as demonstrated in other hematological malignancies. To address this issue, the relationship between the number of reinfused plasma cells, response to chemotherapy and event-free survival (EFS) have been analyzed. Sixty-four MM patients were treated with intensified chemotherapy at diagnosis. They were mobilized with cyclophosphamide and G-CSF, and then treated with melphalan 100 mg/m2 (MEL100) followed by PBPC support. A second course was given after 2 months, and a third to patients not in complete remission. There was no correlation between the number of reinfused plasma cells and response rate after this intensified chemotherapy: patients attaining complete remission received 3.6 x 106/kg CD38+ cells, while those with a partial or no response received 5.6 and 2.9 x 106/kg CD38+ cells. Similarly, there was no correlation between the number of reinfused plasma cells and EFS. Patients receiving less than 4.85 x 106/kg CD38+ cells experienced a median EFS of 34.2 months as opposed to 36.4 months for those receiving more than 4.85 x 106/kg CD38+ cells (P = 0.7). Recurrence of the disease is consistently observed in MM: our data suggest that in vivo residual tumor cells, rather than reinfused plasma cells are more likely to be responsible for relapse. Bone Marrow Transplantation (2000) 25, 25-29.
多发性骨髓瘤（MM）的特征是骨髓（BM）中肿瘤浆细胞的扩增，但在外周血（PB）中一直能检测到肿瘤细胞。外周血祖细胞（PBPC）采集已广泛用于支持MM患者的大剂量治疗。一种流式细胞术已用于检测PB和PBPC采集中的浆细胞。高CD38表达可识别这些细胞，其性质通过特异性抗原如CD138和细胞质免疫球蛋白的共表达得以证实。如在其他血液系统恶性肿瘤中所证实的，恶性浆细胞回输可能对缓解率和生存率产生负面影响。为解决这一问题，已分析了回输浆细胞数量、化疗反应和无事件生存期（EFS）之间的关系。64例MM患者在诊断时接受强化化疗。他们接受环磷酰胺和粒细胞集落刺激因子动员，然后接受100 mg/m2美法仑（MEL100）治疗，随后接受PBPC支持。2个月后给予第二个疗程，对未完全缓解的患者给予第三个疗程。在这种强化化疗后，回输浆细胞数量与缓解率之间无相关性：达到完全缓解的患者接受3.6×106/kg CD38+细胞，而部分缓解或无反应的患者分别接受5.6和2.9××106/kg CD38+细胞。同样，回输浆细胞数量与EFS之间也无相关性。接受少于4.85×106/kg CD38+细胞的患者中位EFS为34.2个月，而接受多于4.85×106/kg CD3 +细胞的患者为36.4个月（P = 0.7）。MM中疾病复发一直可见：我们的数据表明，体内残留肿瘤细胞而非回输浆细胞更可能是复发的原因。《骨髓移植》（2000年）25卷，25 - 29页 。
