Bartl R, Frisch B, Diem H, Mündel M, Fateh-Moghadam A
Eur J Haematol Suppl. 1989;51:88-98. doi: 10.1111/j.1600-0609.1989.tb01499.x.
Bone marrow biopsies of 720 patients with multiple myeloma (MM) were investigated from 1968-1989. Histologic variables were correlated with clinical parameters and survivals to determine prognostic factors. In 207 of these patients initial levels of serum beta 2 microglobulin (SB2M) were also measured for prognostic evaluation. Four tumour growth patterns were distinguished: interstitial (56%), interstitial/sheets (13%), nodular (15%) and packed marrow (16%) with median survivals of 46, 31, 22 and 16 months. When grouped according to the tumour cell mass in the biopsy, four histologic stages were recognized. Cellular characteristics were used to classify MM into 6 histologic types which were subsequently combined into 3 grades of malignancy: low, intermediate and high, analogous to the malignant lymphomas. With respect to tumour products, only SB2M proved to be a valuable prognostic indicator for staging and follow-up. Complications of MM such as anaemia, azotaemia, osteolytic lesions, hypercalcaemia and hypoalbuminaemia all predicted a poor prognosis, highly significant in the test statistics. We propose a new prognostic approach in MM, comprising 1) parameters defining the tumour itself, 2) the tumour products (SB2M) and 3) the tumour complications. This prognostic strategy combines information both on stage and malignancy of MM and enables definition of smouldering and of aggressive variants of MM at an early stage.
对1968年至1989年间720例多发性骨髓瘤（MM）患者的骨髓活检进行了研究。将组织学变量与临床参数及生存率相关联，以确定预后因素。在这些患者中的207例中，还检测了血清β2微球蛋白（SB2M）的初始水平用于预后评估。区分出四种肿瘤生长模式：间质型（56%）、间质/片状型（13%）、结节型（15%）和骨髓密集型（16%），其中位生存期分别为46、31、22和16个月。根据活检中的肿瘤细胞量进行分组时，识别出四个组织学阶段。利用细胞特征将MM分为6种组织学类型，随后将其合并为3个恶性程度等级：低、中、高，类似于恶性淋巴瘤。关于肿瘤产物，只有SB2M被证明是分期和随访的有价值的预后指标。MM的并发症如贫血、氮质血症、溶骨性病变、高钙血症和低白蛋白血症均预示预后不良，在检验统计中具有高度显著性。我们提出了一种MM的新预后方法，包括1）定义肿瘤本身的参数，2）肿瘤产物（SB2M）和3）肿瘤并发症。这种预后策略结合了MM分期和恶性程度的信息，并能够在早期定义MM的惰性和侵袭性变体。
