Kuroda Yoshiaki, Sakai Akira, Okikawa Yoshiko, Munemasa Shoso, Katayama Yuta, Hyodo Hideo, Imagawa Jun, Takimoto Yasuo, Okita Hajime, Ohtaki Megu, Kimura Akiro
Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima734-8553, Japan.
Int J Hematol. 2005 May;81(4):335-41. doi: 10.1532/IJH97.04189.
We analyzed both morphologic and phenotypic findings of myeloma cells before and after chemotherapy in 21 patients with multiple myeloma. The morphologic analysis was based on the Greipp classification, and phenotypic analysis was performed by 3-color flow cytometry using the CD38 plasma gating method (Marrow plasma 38). Results with flow cytometry using a combination of MPC1, CD49e, and CD45 supported the morphologic findings for the myeloma cells. Treatment with 3 or 4 cycles of VAD (vincristine, doxorubicin, and dexamethasone) therapy was effective in reducing the total numbers of myeloma cells, but the proportion of immature myeloma cells increased after this treatment. However, the immature myeloma cells were reduced by high-dose melphalan (HD-Mel) therapy followed by autologous stem cell transplantation (ASCT). High-dose cyclophosphamide treatment for stem cell harvesting did not show an effect on the residual immature myeloma cells after VAD treatment. In addition, thalidomide was not effective in reducing the numbers of immature myeloma cells. These results suggest that VAD (3 or 4 cycles) therapy plus HD-Mel followed by ASCT is a reasonable treatment for multiple myeloma and that Marrow plasma 38 analysis is a useful method for monitoring the response of multiple myeloma to chemotherapy.
我们分析了21例多发性骨髓瘤患者化疗前后骨髓瘤细胞的形态学和表型特征。形态学分析基于Greipp分类法，表型分析采用CD38血浆门控法（骨髓血浆38）通过三色流式细胞术进行。使用MPC1、CD49e和CD45组合的流式细胞术结果支持了骨髓瘤细胞的形态学发现。3或4周期的VAD（长春新碱、阿霉素和地塞米松）治疗可有效减少骨髓瘤细胞总数，但治疗后未成熟骨髓瘤细胞的比例增加。然而，大剂量美法仑（HD-Mel）治疗后进行自体干细胞移植（ASCT）可减少未成熟骨髓瘤细胞。用于干细胞采集的大剂量环磷酰胺治疗对VAD治疗后残留的未成熟骨髓瘤细胞没有影响。此外，沙利度胺在减少未成熟骨髓瘤细胞数量方面无效。这些结果表明，VAD（3或4周期）治疗加HD-Mel后进行ASCT是多发性骨髓瘤的合理治疗方法，并且骨髓血浆38分析是监测多发性骨髓瘤化疗反应的有用方法。
