Arefi Sigaroudi Niloofar, Vakili Sadeghi Mohsen, Ghorbani Housein, Jahansouz Davood, Shirafkan Hoda, Ranaee Mohammad
Student Research Committee, Babol University of Medical Sciences, Babol, Iran.
Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
Caspian J Intern Med. 2025 Jun 23;16(3):562-569. doi: 10.22088/cjim.16.3.562. eCollection 2025 Summer.
Multiple myeloma is still one of deadliest malignancies known. Although many attempts to prognosticate the disease have been done like the International Staging System (ISS), most of the proposed prognostic tools are based merely on laboratory tests and hence prone to analytical errors in large and high-volume centers. This study aims to evaluate the prognostic effectiveness of histopathologic components of bone marrow and compare it to the results of laboratory-based prognostic tools.
This cross-sectional study, bone marrow specimens of 93 multiple myeloma patients underwent aspiration and biopsy evaluated. The primary outcome was overall survival (OS) based on plasma cell percentage. The secondary outcomes were also OS based on angiogenesis using IHC marker CD34, nuclear atypia level, BM involvement pattern and the presence of fibrosis in bone marrow specimens. All biopsy specimens assessed using light microscopy on Hematoxylin and Eosin and IHC staining. Giemsa staining assessed for aspirate specimens.
Of 93 patients, 63.4% were dead. Median survival was 34.0 months (95% CI [24.6; 43.3]) and the average age at diagnosis was 65 years (highest 84 and lowest 40). Patients with bone marrow plasma cell count of over 70%, had a hazard ratio (HR) of death of 4.7 times more than those with plasma cell count between 10-25%. Similarly, diffuse infiltration pattern (HR 4.67) and blastic morphology (HR 4.17) associated with a significant worse prognosis (p=0.03).
Comparing to laboratory-based ISS, wider HR of death spectrum in this study proposes a potential more precise, robust and easy-to-use prognostication tool.
多发性骨髓瘤仍是已知最致命的恶性肿瘤之一。尽管已经进行了许多预测该疾病的尝试，如国际分期系统（ISS），但大多数提出的预后工具仅基于实验室检查，因此在大型和高容量中心容易出现分析误差。本研究旨在评估骨髓组织病理学成分的预后有效性，并将其与基于实验室的预后工具的结果进行比较。
在这项横断面研究中，对93例多发性骨髓瘤患者的骨髓标本进行了抽吸和活检评估。主要结局是基于浆细胞百分比的总生存期（OS）。次要结局还包括基于免疫组化标记CD34的血管生成、核异型程度、骨髓受累模式以及骨髓标本中纤维化的存在情况的OS。所有活检标本均使用苏木精和伊红染色及免疫组化染色进行光学显微镜评估。对抽吸标本进行吉姆萨染色评估。
93例患者中，63.4%死亡。中位生存期为34.0个月（95%CI[24.6；43.3]），诊断时的平均年龄为65岁（最大84岁，最小40岁）。骨髓浆细胞计数超过70%的患者，死亡风险比（HR）是浆细胞计数在10%-25%之间患者的4.7倍。同样，弥漫浸润模式（HR 4.67）和成骨细胞形态（HR 4.17）与显著更差的预后相关（p=0.03）。
与基于实验室的ISS相比，本研究中更宽的死亡风险比谱提出了一种可能更精确、稳健且易于使用的预后工具。
