Mateo Gema, Montalbán M Angeles, Vidriales Maria-Belén, Lahuerta Juan J, Mateos Maria V, Gutiérrez Norma, Rosiñol Laura, Montejano Laura, Bladé Joan, Martínez Rafael, de la Rubia Javier, Diaz-Mediavilla Joaquín, Sureda Anna, Ribera José M, Ojanguren José M, de Arriba Felipe, Palomera Luis, Terol Maria J, Orfao Alberto, San Miguel Jesús F
Hospital Universitario de Salamanca, Salamanca, Spain.
J Clin Oncol. 2008 Jun 1;26(16):2737-44. doi: 10.1200/JCO.2007.15.4120. Epub 2008 Apr 28.
To analyze the prognostic impact of immunophenotyping in patients with multiple myeloma (MM).
We have prospectively analyzed the prognostic impact of antigenic markers, assessed by multiparametric flow cytometry, in a series of 685 newly diagnosed MM patients that were uniformly treated according to the GEM 2000 protocol.
Our results show that expression of both CD19 and CD28 as well as the absence of CD117 were associated with a significantly shorter progression free-survival (PFS) and overall survival (OS). Interestingly, the CD28 expression correlated with t(14;16) and del(17p), while CD117-negative patients were associated with t(4;14) and del(13q). Simultaneous assessment of CD28 and CD117 antigens allowed stratification of patients with MM into three risk categories: poor risk (CD28 positive CD117 negative), intermediate (either both markers negative or both positive), and good risk (CD28 negative CD117 positive), with PFS rates of 30, 37, and 45 months, respectively (P = .01), and OS rates of 45, 68, and not reached, respectively (P = .0001).
To the best of our knowledge, this is the first prospective analysis in which the prognostic impact of a relatively high number of antigenic markers has been simultaneously analyzed in a large series of uniformly treated patients, showing that the expression of several antigens (particularly CD28 and CD117) on bone marrow plasma cells from patients with MM can help to identify patients at high risk of progression.
分析免疫表型对多发性骨髓瘤（MM）患者预后的影响。
我们前瞻性地分析了通过多参数流式细胞术评估的抗原标志物对预后的影响，研究对象为685例新诊断的MM患者，这些患者均按照GEM 2000方案进行治疗。
我们的结果显示，CD19和CD28的表达以及CD117的缺失与无进展生存期（PFS）和总生存期（OS）显著缩短相关。有趣的是，CD28表达与t(14;16)和del(17p)相关，而CD117阴性患者与t(4;14)和del(13q)相关。同时评估CD28和CD117抗原可将MM患者分为三个风险类别：高风险（CD28阳性CD117阴性）、中风险（两个标志物均为阴性或均为阳性）和低风险（CD28阴性CD117阳性），PFS率分别为30、37和45个月（P = .01），OS率分别为45、68和未达到（P = .0001）。
据我们所知，这是首次在前瞻性分析中对大量接受统一治疗的患者同时分析了相对较多抗原标志物的预后影响，表明MM患者骨髓浆细胞上几种抗原（特别是CD28和CD117）的表达有助于识别进展风险高的患者。
