Greipp P R, Katzmann J A, O'Fallon W M, Kyle R A
Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
Blood. 1988 Jul;72(1):219-23.
Beta 2-microglobulin (beta 2M) has been proposed as a prognostic factor in multiple myeloma (MM), but beta 2M levels are reported to correlate with other prognostic indicators such as stage and creatinine level. This study addressed the independent prognostic values of these and other variables, including plasma cell labeling indices (LI), in patients with newly diagnosed MM. beta 2M levels were measured with an enzyme-linked immunosorbent assay. LI were determined with a [3H]thymidine autoradiography method. By multivariate analysis and Kaplan-Meier survival analysis, the uncorrected beta 2M level remained the most significant prognostic factor after adjustment for age. Stage and creatinine level were closely related to beta 2M level and were no longer predictive of outcome after adjustment for age and beta 2M. Plasma cell LI varied independently of beta 2M level and remained predictive. A subset of patients with plasma-blastic myeloma had poor survival since beta 2M level and plasma cell LI were high. By using beta 2M level and LI, three risk groups were defined: low (beta 2M less than 4 micrograms/mL and LI less than 0.4%, median survival 48 months); intermediate (beta 2M less than 4 micrograms/mL and LI greater than or equal to 0.4%, median survival 29 months); and high (beta 2M greater than or equal to 4 micrograms/mL, median survival 12 months). Such grouping may better identify MM patients who might benefit from new treatment regimens.
β2微球蛋白（β2M）已被提出作为多发性骨髓瘤（MM）的一个预后因素，但据报道β2M水平与其他预后指标相关，如分期和肌酐水平。本研究探讨了这些及其他变量（包括浆细胞标记指数（LI））在新诊断MM患者中的独立预后价值。采用酶联免疫吸附测定法测量β2M水平。用[3H]胸苷放射自显影法测定LI。通过多变量分析和Kaplan-Meier生存分析，校正年龄后，未校正的β2M水平仍然是最显著的预后因素。分期和肌酐水平与β2M水平密切相关，校正年龄和β2M后不再能预测预后。浆细胞LI独立于β2M水平变化且仍然具有预测性。一部分浆细胞骨髓瘤患者生存较差，因为β2M水平和浆细胞LI较高。通过使用β2M水平和LI，定义了三个风险组：低风险组（β2M小于4微克/毫升且LI小于0.4%，中位生存期48个月）；中风险组（β2M小于4微克/毫升且LI大于或等于0.4%，中位生存期29个月）；高风险组（β2M大于或等于4微克/毫升，中位生存期12个月）。这种分组可能能更好地识别可能从新治疗方案中获益的MM患者。
