Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan, China.
Ann Med. 2024 Dec;56(1):2338604. doi: 10.1080/07853890.2024.2338604. Epub 2024 Apr 10.
Circulating plasma cells (CPCs) are defined by the presence of peripheral blood clonal plasma cells, which would contribute to the progression and dissemination of multiple myeloma (MM). An increasing number of studies have demonstrated the predictive potential of CPCs in the past few years. Therefore, there is a growing need for an updated meta-analysis to identify the specific relationship between CPCs and the prognosis of MM based on the current research status.
The PubMed, Embase, and Cochrane Library databases were screened to determine eligible studies from inception to November 5, 2023. Publications that reported the prognostic value of CPCs in MM patients were included. Hazard ratios (HRs) with 95% confidence intervals (CIs) of overall survival (OS) and progression-free survival (PFS) were extracted to pool the results. Subgroup analyses were performed based on region, sample size, cut-off value, detection time, initial treatment, and data type. The association between CPCs level and clinicopathological characteristics, including the International Staging System (ISS), Revised-ISS (R-ISS), and cytogenetic abnormalities were also evaluated. Statistical analyses were conducted using STATA 17.0 software.
Twenty-two studies with a total of 5637 myeloma patients were enrolled in the current meta-analysis. The results indicated that myeloma patients with elevated CPCs were expected to have a poor OS (HR = 2.19, 95% CI: 1.81-2.66, < 0.001) and PFS (HR = 2.45, 95% CI: 1.93-3.12, < 0.001). Subgroup analyses did not alter the prognostic role of CPCs, regardless of region, sample size, cut-off value, detection time, initial treatment, or data type. Moreover, the increased CPCs were significantly related to advanced tumour stage (ISS III vs. ISS I-II: pooled OR = 2.89, 95% CI: 2.41-3.46, < 0.001; R-ISS III vs. R-ISS I-II: pooled OR = 3.65, 95% CI: 2.43-5.50, < 0.001) and high-risk cytogenetics (high-risk vs. standard-risk: OR = 2.22, 95% CI: 1.60-3.08, < 0.001).
Our meta-analysis confirmed that the increased number of CPCs had a negative impact on the PFS and OS of MM patients. Therefore, CPCs could be a promising prognostic biomarker that helps with risk stratification and disease monitoring.
循环血浆细胞（CPCs）的定义是外周血克隆性浆细胞的存在，这将有助于多发性骨髓瘤（MM）的进展和播散。近年来，越来越多的研究表明 CPCs 具有预测潜力。因此，需要根据当前的研究现状，进行更新的荟萃分析，以确定 CPCs 与 MM 预后之间的具体关系。
从开始到 2023 年 11 月 5 日，筛选了 PubMed、Embase 和 Cochrane 图书馆数据库，以确定符合条件的研究。纳入了报告 CPCs 在 MM 患者中的预后价值的出版物。提取总体生存（OS）和无进展生存（PFS）的风险比（HRs）及其 95%置信区间（CIs）以汇总结果。根据区域、样本量、截断值、检测时间、初始治疗和数据类型进行亚组分析。还评估了 CPCs 水平与临床病理特征（包括国际分期系统（ISS）、修订的 ISS（R-ISS）和细胞遗传学异常）之间的关联。使用 STATA 17.0 软件进行统计分析。
本荟萃分析共纳入 22 项研究，共 5637 例骨髓瘤患者。结果表明，CPCs 升高的骨髓瘤患者 OS（HR=2.19，95%CI：1.81-2.66， <0.001）和 PFS（HR=2.45，95%CI：1.93-3.12， <0.001）较差。亚组分析无论在区域、样本量、截断值、检测时间、初始治疗还是数据类型上均未改变 CPCs 的预后作用。此外，CPCs 的增加与晚期肿瘤分期（ISS III 与 ISS I-II：汇总 OR=2.89，95%CI：2.41-3.46， <0.001；R-ISS III 与 R-ISS I-II：汇总 OR=3.65，95%CI：2.43-5.50， <0.001）和高危细胞遗传学（高危与标准风险：OR=2.22，95%CI：1.60-3.08， <0.001）显著相关。
本荟萃分析证实，CPCs 数量的增加对 MM 患者的 PFS 和 OS 产生负面影响。因此，CPCs 可能是一种有前途的预后生物标志物，有助于风险分层和疾病监测。
