Division of Hematology, Mayo Clinic, Rochester, Minnesota.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
Am J Hematol. 2020 Mar;95(3):310-315. doi: 10.1002/ajh.25709. Epub 2020 Jan 8.
Our prior studies identified the prognostic significance of quantifying cPCs by multiparametric flow cytometry (MFC) in newly diagnosed multiple myeloma (NDMM) patients. We evaluated if a similar quantification of cPCs could add prognostic value to the current R-ISS classification of 556 consecutive NDMM patients seen at the Mayo Clinic, Rochester from 2009 to 2017. Those patients that had ≥5 cPCs/μL and either R-ISS stage I or stage II disease were re-classified as R-ISS IIB stage for the purposes of this study. The median time to next therapy (TTNT) and overall survival (OS) for patients with ≥5 cPCs/μL at diagnosis was as follows: R-ISS I (N = 110) - 40 months and not reached; R-ISS II (N = 69) - 30 and 72 months; R-ISS IIB (N = 96) - 21 and 45 months and R-ISS III (N = 281) - 20 and 47 months respectively. Finally, ≥ 5 cPCs/μL retained its adverse prognostic significance in a multivariable model for TTNT and OS. Hence, quantifying cPCs by MFC can potentially enhance the R-ISS classification of a subset of NDMM patients with stage I and II disease by identifying those patients with a worse than expected survival outcome.
我们之前的研究通过多参数流式细胞术（MFC）定量检测初诊多发性骨髓瘤（NDMM）患者中的循环肿瘤细胞（cPCs），确定了其预后意义。我们评估了在 2009 年至 2017 年期间，Mayo 诊所罗切斯特分部的 556 例连续 NDMM 患者中，是否可以通过类似的 cPCs 定量方法为当前的 R-ISS 分类增加预后价值。为了进行这项研究，将 R-ISS 分期 I 或 II 期且 cPCs≥5/μL 的患者重新分类为 R-ISS IIB 期。诊断时 cPCs≥5/μL 的患者，其下一次治疗的中位时间（TTNT）和总生存期（OS）如下：R-ISS I（N=110）-40 个月和未达到；R-ISS II（N=69）-30 个月和 72 个月；R-ISS IIB（N=96）-21 个月和 45 个月；R-ISS III（N=281）-20 个月和 47 个月。最后，在 TTNT 和 OS 的多变量模型中，cPCs≥5/μL 保留了其不良预后意义。因此，通过 MFC 定量检测 cPCs，可通过识别那些预期生存结果较差的患者，潜在地增强 R-ISS 分类中 I 期和 II 期疾病的部分患者的预后判断。
