Institute for Myeloma and Bone Cancer Research, West Hollywood, CA, USA.
Berenson Cancer Center, West Hollywood, CA, USA.
Eur J Haematol. 2021 Sep;107(3):318-323. doi: 10.1111/ejh.13666. Epub 2021 Jun 14.
Multiple myeloma (MM) patients with smoldering (S) disease are defined by a lack of CRAB/SLiM criteria but may transform into disease requiring treatment. The International Myeloma Working Group risk stratification model for SMM uses serum M-protein, serum-free light chain ratio, and bone marrow plasma cell percentage. We investigated whether baseline serum B-cell maturation antigen (sBCMA) levels are predictive of disease progression among 65 patients with SMM. A receiver operating characteristic curve was used to establish a definition for high-risk baseline sBCMA. Mantel Byar analysis was used to examine whether high-risk sBCMA was correlated with shorter time to transformation, and a time-dependent cox proportional hazard was used to determine whether it is independent of other risk factors. A z test for proportions was used to compare the percentage of patients that progressed among high-risk versus low-risk sBCMA patients. A baseline sBCMA level ≥137.5 mg/ml was found to be the optimal cutoff between high- and low-risk SMM patients. Patients with high-risk sBCMA levels had a shorter time to transformation (P = .000332). sBCMA was also higher at the time of transformation than baseline levels (P = .0116). sBCMA was the only variable found to be significantly predictive of time to transformation and additionally was found to be independent of other risk factors. In this study, we have shown for the first time that sBCMA levels predict transformation of SMM to active disease and that these levels increase at the time of transformation. These results are consistent with other studies showing that active MM patients undergoing therapy with higher baseline sBCMA levels are more likely to progress early and its levels increase at the time of disease progression.
冒烟型多发性骨髓瘤(SMM)患者缺乏 CRAB/SLiM 标准,但可能会转化为需要治疗的疾病。国际骨髓瘤工作组的 SMM 风险分层模型使用血清 M 蛋白、血清游离轻链比和骨髓浆细胞百分比。我们研究了 65 例 SMM 患者的基线血清 B 细胞成熟抗原(sBCMA)水平是否可预测疾病进展。使用受试者工作特征曲线确定高危基线 sBCMA 的定义。Mantel Byar 分析用于检查高危 sBCMA 是否与转化时间较短相关,时间依赖性 Cox 比例风险用于确定其是否独立于其他危险因素。比例的 z 检验用于比较高危和低危 sBCMA 患者中进展的患者百分比。发现基线 sBCMA 水平≥137.5mg/ml 是区分高危和低危 SMM 患者的最佳截止值。高危 sBCMA 水平的患者转化时间更短(P=.000332)。转化时 sBCMA 也高于基线水平(P=.0116)。sBCMA 是唯一发现与转化时间显著相关的变量,并且独立于其他危险因素。在这项研究中,我们首次表明 sBCMA 水平可预测 SMM 向活动性疾病的转化,并且这些水平在转化时会增加。这些结果与其他研究一致,表明接受治疗的活动性 MM 患者基线 sBCMA 水平较高,更有可能早期进展,其水平在疾病进展时增加。
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