Witzig T E, Gonchoroff N J, Katzmann J A, Therneau T M, Kyle R A, Greipp P R
Department of Laboratory Medicine, Mayo Clinic, Rochester, MN 55905.
J Clin Oncol. 1988 Jun;6(6):1041-6. doi: 10.1200/JCO.1988.6.6.1041.
Labeling indices (LI) provide a rapid measure of the bone marrow (BM) plasma cell proliferation rate and are useful in the diagnosis and prognosis of monoclonal gammopathies. Because circulating B cells may be a part of the neoplastic clone, we examined peripheral blood B cells that were producing the same cytoplasmic light chain isotype as the patient's monoclonal; protein (M-protein) and determined the peripheral blood LI (PBLI) by a two-color immunofluorescence bromodeoxyuridine method. The 105 patients studied were divided into three disease activity groups by standard clinical criteria. Median PBLI was 0.2% for the 29 patients with inactive monoclonal gammopathies (monoclonal gammopathy of undetermined significance [MGUS] and smoldering multiple myeloma [SMM]), 0.8% for the 35 patients with new, untreated multiple myeloma (MM), and 1.7% for the 41 patients with relapsed MM. These differences between groups were statistically significant (P less than .001, Wilcoxon). Four patients had high PBLI but clinically inactive gammopathy at the time of study, and all developed active MM within 6 months that required treatment. In 92 patients a BMLI was performed simultaneously with the PBLI (rank correlation coefficient, 0.69). In patients with new, untreated MM, use of both tests identified 72% of patients (23 of 32) with high LI, rather than 56% (18 of 32) by BMLI alone or 63% (20 of 32) by PBLI alone. These results suggest that PB B cells bearing the same cytoplasmic light chain isotype as the monoclonal protein are part of the malignant clone and can be kinetically active. The LI of these cells can provide a measure of disease activity and may help to differentiate active from inactive disease.
标记指数（LI）可快速衡量骨髓（BM）浆细胞增殖率，对单克隆丙种球蛋白病的诊断和预后有帮助。由于循环B细胞可能是肿瘤克隆的一部分，我们检测了产生与患者单克隆蛋白相同胞质轻链同种型的外周血B细胞，并通过双色免疫荧光溴脱氧尿苷法测定外周血LI（PBLI）。根据标准临床标准，将研究的105例患者分为三个疾病活动组。29例单克隆丙种球蛋白病不活跃患者（意义未明的单克隆丙种球蛋白病[MGUS]和冒烟型多发性骨髓瘤[SMM]）的PBLI中位数为0.2%，35例新诊断、未治疗的多发性骨髓瘤（MM）患者为0.8%，41例复发MM患者为1.7%。组间差异具有统计学意义（P＜0.001，Wilcoxon检验）。4例患者在研究时PBLI较高，但临床丙种球蛋白病不活跃，且均在6个月内发展为需要治疗的活动性MM。92例患者同时进行了骨髓LI（BMLI）检测与PBLI检测（等级相关系数为0.69）。在新诊断、未治疗的MM患者中，两种检测方法联合使用可识别72%（32例中的23例）LI较高的患者，而单独使用BMLI识别率为56%（32例中的18例），单独使用PBLI识别率为63%（32例中的20例）。这些结果表明，携带与单克隆蛋白相同胞质轻链同种型的外周血B细胞是恶性克隆的一部分，且可能具有动力学活性。这些细胞LI可衡量疾病活动度，可能有助于区分活动性疾病与非活动性疾病。
