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Prepublished online as a Blood First Edition Paper on September 5, 2002; DOI 10.1182/blood-2002-06-1698.
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Blood, 1 February 2003, Vol. 101, No. 3, pp. 827-830
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Circulating peripheral blood plasma cells as a prognostic
indicator in patients with primary systemic amyloidosis
Animesh Pardanani,
Thomas
E. Witzig,
Georgene Schroeder,
Edwin A. McElroy,
Rafael Fonseca,
Angela Dispenzieri,
Martha Q. Lacy,
John A. Lust,
Robert A. Kyle,
Philip R. Greipp,
Morie A. Gertz, and
S. Vincent Rajkumar
From the Division of Hematology and Internal Medicine
and the Division of Biostatistics, Mayo Clinic, Rochester, MN.
This study examined the prognostic value of circulating peripheral
blood plasma cells (PBPCs) in patients with primary systemic amyloidosis (AL). A sensitive slide-based immunofluorescence technique was used to assess 147 patients for circulating PBPCs. Circulating monoclonal plasma cells were quantified as a percentage of circulating cytoplasmic immunoglobulin-positive cells (PBPC%). The absolute circulating plasma cell count was also determined. When analyzed retrospectively, 24 (16%) of 147 patients were found to have
detectable circulating PBPCs. Overall survival for patients with high
PBPC%'s (> 1%) was poorer (median survival, 10 vs 29 months;
P = .002). Similarly, overall survival for
patients with high PBPC counts (> 0.5 × 106/L) was
significantly poorer (median, 13 vs 31 months;
P = .003). Increased percentages of bone
marrow plasma cells (BMPC%; P = .0004),
increased levels of serum  2-microglobulin
(P = .04), and dominant cardiac amyloid
involvement (P = .03) also predicted poorer
survival. The combined consideration of circulating PBPCs and
BMPC% identified low-, intermediate-, and high-risk groups with median
survivals of 37.5, 15.5, and 10 months, respectively (P = .0003). Multivariate analysis revealed
circulating PBPCs and BMPC% to be independent prognostic factors for
survival. Patients with PBPC%'s of 2% or higher were significantly
more likely to have a coexisting clinical diagnosis of multiple myeloma
(50% vs 12%, P = .008). The prognostic
value of circulating PBPCs may help select treatment for patients with AL.
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