Department of Internal Medicine III, University Hospital Olomouc, Czech republic.
Eur J Haematol. 2009 Dec 1;83(6):528-34. doi: 10.1111/j.1600-0609.2009.01321.x. Epub 2009 Jul 18.
To assess the outcome of the measurement of apoptotic index in myeloma patients treated by conventional chemotherapy and novel drugs with biological mechanism of action, thalidomide and bortezomib.
In a cohort of 189 patients with newly diagnosed multiple myeloma from November 1997 through February 2008, we assessed the prognostic significance of plasma cell apoptotic index (PC-AI) using annexin-V. The whole group was subsequently divided according to treatment approach (conventional chemotherapy only vs. inclusion of novel drugs, thalidomide and bortezomib), and curves of overall survival were constructed.
In the whole group (n = 189), low levels of PC-AI <4.5% significantly separated patients with unfavorable prognosis (median OS 16 vs. 38 months, P = 0.004). In patients treated with conventional chemotherapy only (n = 139) the results were similar (median OS 10 vs. 25 months, P = 0.02), and the apoptotic index maintained its significance even within the group of 50 patients treated also with novel drugs (median OS 30 vs. 54 months, P = 0.027). PC-AI was found to be independent on both Durie-Salmon staging system and the International Prognostic Index.
Presented results suggest the use of apoptotic index by flow cytometry measurement as a fast and accessible method for prognostic stratification of myeloma patients in routine practice.
评估采用常规化疗和具有生物作用机制的新型药物（沙利度胺和硼替佐米）治疗的骨髓瘤患者的细胞凋亡指数测量结果。
在 1997 年 11 月至 2008 年 2 月期间，我们对 189 例新诊断的多发性骨髓瘤患者的浆细胞凋亡指数（PC-AI）进行评估，使用 Annexin-V 进行评估。根据治疗方法（仅常规化疗与包括新型药物沙利度胺和硼替佐米）将整个组分为两组，并构建总生存曲线。
在整个组（n=189）中，低水平的 PC-AI<4.5% 将预后不良的患者显著区分开（中位 OS 分别为 16 个月和 38 个月，P=0.004）。在仅接受常规化疗的患者中（n=139），结果相似（中位 OS 分别为 10 个月和 25 个月，P=0.02），并且即使在接受新型药物治疗的 50 例患者中，凋亡指数也保持其意义（中位 OS 分别为 30 个月和 54 个月，P=0.027）。PC-AI 独立于 Durie-Salmon 分期系统和国际预后指数。
本研究结果表明，流式细胞术测量的凋亡指数可作为常规实践中骨髓瘤患者预后分层的快速、可及的方法。
