Prognostic correlation of plasma cell acid phosphatase and beta-
glucuronidase in multiple myeloma: a Southwest Oncology Group study [see
comments]
SM Saeed, D Stock-Novack, R Pohlod, J Crowley and SE Salmon
Henry Ford Hospital, Detroit, MI.
In 1982 a randomized trial of either alternating or syncopated VMCP/VBAP
regimens for the treatment of active multiple myeloma was begun (Southwest
Oncology Group Study 8229/30). A concurrent investigation was undertaken to
evaluate the clinical importance and significance of cytochemically
stainable plasma cell acid phosphatase (AP) and beta-glucuronidase enzymes
(BG). Pretreatment bone marrow aspirates were available for analysis from
399 patients for AP and 398 patients for BG. The AP scores ranged between
42 and 395, and the BG scores ranged between 1 and 346. There was a
significant increase of AP (P = .001) and BG (P = .002) in multiple myeloma
as compared with a set of patients with benign plasmacytosis. The enzyme
scores did not significantly relate to Ig idiotype of myeloma or other
prognostic variables except that the BG scores varied significantly with
the level of albumin (P = .03) and hemoglobin (P = .01). Analysis of
patient groups with different levels of enzyme scores showed that 61 of 398
patients with an AP score of less than 130 had a poorer median survival of
1.7 versus 2.8 years for patients with higher scores (P = .001). In the
multivariate analysis of survival, low AP score was an important prognostic
factor (P = .006), but BG did not contribute significantly. It is suggested
that the subset of patients presenting with low AP should be considered for
specialized or more aggressive therapy.
Volume 78,
Issue 12,
pp. 3281-3287,
12/15/1991
Copyright © 1991 by The American Society of Hematology
