Kantarjian H M, Smith T, Estey E, Polyzos A, O'Brien S, Pierce S, Beran M, Feldman E, Keating M J
Department of Hematology, Anderson Cancer Center, Houston, Texas 77030.
Am J Med. 1992 Dec;93(6):599-604. doi: 10.1016/0002-9343(92)90191-d.
Elevated serum beta-2 microglobulin (beta 2M) levels are associated with poor prognosis in several lymphoproliferative disorders including multiple myeloma and lymphoma. Their prognostic relevance in acute lymphocytic leukemia (ALL) is unknown. We analyzed the associations of serum beta 2M levels at diagnosis with pretreatment characteristics and with prognosis in adult ALL.
One hundred fifty-nine adults with newly diagnosed ALL were investigated. Serum beta 2M levels were determined at diagnosis, on fresh peripheral blood samples, using a radioimmunoassay, the Pharmacia beta 2 Micro RIA (Pharmacia Diagnostics, Uppsala, Sweden). Statistical correlations were assessed by standard methods, and further independent prognostic value of serum beta 2M was determined by multivariate analysis.
Patients with beta 2M levels of 4.0 mg/L or above had a lower complete response rate (61% versus 80%; p = 0.02), a significantly worse survival (p < 0.01), and a significantly higher association with development of central nervous system (CNS) leukemia (p < 0.01). High beta 2M levels were more common among patients with older age, with elevated creatinine, bilirubin, and alkaline phosphatase levels, with low albumin levels, and with B-cell disease. Multivariate analysis for survival indicated the beta 2M level to be an independent prognostic variable (after adjusting for pretreatment creatinine level and age). The evaluation of beta 2M levels within low- and high-risk groups for CNS disease suggested an association of elevated beta 2M levels with a worse incidence of CNS disease in the high-risk patients.
Monitoring serum beta 2M levels may provide significant prognostic information in adults with ALL and should be included in their pretreatment evaluation. Its importance in childhood ALL requires investigation.
血清β2微球蛋白（β2M）水平升高与包括多发性骨髓瘤和淋巴瘤在内的多种淋巴增殖性疾病的不良预后相关。其在急性淋巴细胞白血病（ALL）中的预后相关性尚不清楚。我们分析了成人ALL诊断时血清β2M水平与预处理特征及预后的关系。
对159例新诊断的成人ALL患者进行了研究。诊断时，采用放射免疫分析法（Pharmacia β2 Micro RIA，Pharmacia Diagnostics，瑞典乌普萨拉）测定新鲜外周血样本中的血清β2M水平。采用标准方法评估统计相关性，并通过多变量分析确定血清β2M的进一步独立预后价值。
β2M水平在4.0mg/L及以上的患者完全缓解率较低（61%对80%；p = 0.02），生存率显著较差（p < 0.01），中枢神经系统（CNS）白血病的发生率显著较高（p < 0.01）。高β2M水平在年龄较大、肌酐、胆红素和碱性磷酸酶水平升高、白蛋白水平低以及B细胞疾病患者中更为常见。生存的多变量分析表明，β2M水平是一个独立的预后变量（在调整预处理肌酐水平和年龄后）。对CNS疾病低风险和高风险组内β2M水平的评估表明，高风险患者中β2M水平升高与CNS疾病的较差发生率相关。
监测血清β2M水平可能为成人ALL患者提供重要的预后信息，应纳入其预处理评估中。其在儿童ALL中的重要性需要进一步研究。
