Section of Hematology/Oncology, Boston Medical Center, Boston, MA.
Hematology and Oncology Department, Veterans Administration Boston Healthcare System, West Roxbury, MA.
Blood Adv. 2023 Feb 28;7(4):482-490. doi: 10.1182/bloodadvances.2022008021.
With the growing knowledge of multiple myeloma (MM) pathobiology and the introduction of novel therapies, risk stratification continues to evolve. Myeloid-derived suppressor cells and tumor-associated macrophages, derived from peripheral blood monocytes, support malignant plasma cell proliferation in the bone marrow. Because peripheral blood absolute monocyte count (AMC) is thought to reflect the bone marrow microenvironment, we sought to evaluate the prognostic significance of AMC in MM. We retrospectively analyzed 10 822 patients newly diagnosed with MM between 2000 and 2019 at Veteran's Administration hospitals. We obtained AMC closest to diagnosis and every 3 months thereafter up to 2.5 years. Patients were stratified into 4 groups: low, normal, elevated, and severely elevated AMC (<0.2, 0.2-<0.8, 0.8-<1.25, and ≥1.25 × 103/mm3, respectively). Abnormal AMC at diagnosis was observed in 25.3% of the patients and was associated with an inferior overall survival (OS). In patients with low, severely elevated, elevated, and normal AMC, respectively, median OS at diagnosis was 2.3, 2.7, 3.1, and 3.6 years (P < .001) and at 2.5 years was 2.0, 2.6, 3.4, and 3.9 years (P < .001). Patients with normal AMC at diagnosis who developed an abnormal AMC >1 year after diagnosis also had an inferior OS relative to patients who maintained a normal AMC. Abnormal AMC was also associated with inferior OS independent of validated prognostic markers, including the international staging system and lactate dehydrogenase. Our findings provide novel clues for future prospective studies on the functional role of monocytes in MM, which could be a readily available metric for risk stratification.
随着对多发性骨髓瘤（MM）病理生物学认识的不断提高和新型疗法的引入，风险分层不断发展。髓源性抑制细胞和肿瘤相关巨噬细胞来源于外周血单核细胞，支持骨髓中恶性浆细胞的增殖。由于外周血绝对单核细胞计数（AMC）被认为反映骨髓微环境，我们试图评估 AMC 在 MM 中的预后意义。我们回顾性分析了 2000 年至 2019 年期间在退伍军人事务部医院新诊断为 MM 的 10822 例患者。我们获得了最接近诊断的 AMC，并在之后的每 3 个月进行一次，最长可达 2.5 年。患者被分为 4 组：低、正常、升高和显著升高 AMC（分别为 <0.2、0.2-<0.8、0.8-<1.25 和 ≥1.25×103/mm3）。诊断时异常 AMC 的发生率为 25.3%，与总体生存（OS）较差相关。在 AMC 低、显著升高、升高和正常的患者中，诊断时的中位 OS 分别为 2.3、2.7、3.1 和 3.6 年（P<0.001），2.5 年时的 OS 分别为 2.0、2.6、3.4 和 3.9 年（P<0.001）。诊断时 AMC 正常但在诊断后 1 年以上出现异常 AMC 的患者，其 OS 较 AMC 正常的患者差。异常 AMC 与 OS 相关，与验证后的预后标志物（包括国际分期系统和乳酸脱氢酶）无关。我们的研究结果为单核细胞在 MM 中的功能作用的未来前瞻性研究提供了新的线索，这可能是一种易于获得的风险分层指标。
