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A new staging system for multiple myeloma based on the number of S- phase
plasma cells
JF San Miguel, R Garcia-Sanz, M Gonzalez, MJ Moro, JM Hernandez, F Ortega, D Borrego, M Carnero, F Casanova and R Jimenez
Department of Hematology, University Hospital of Salamanca, Spain.
In the present study, we analyzed the cell cycle distribution of bone
marrow (BM) cells in 120 untreated multiple myeloma patients using a
DNA/CD38 double-staining technique at flow cytometry in which plasma cells
(PCs) can be clearly discriminated from residual BM cells based on their
CD38 expression. This approach allows us to determine the proliferative
activity of both PCs and residual normal BM cells. The percentage of
S-phase cells in the myelomatous population was found to be significantly
lower than that of the residual normal BM cells (P < .001). Regarding
the proliferative activity of myelomatous cells, patients with a high
number of S-phase PCs (> 3%) showed a significantly (P < .05)
increased incidence of anemia and hypercalcemia; higher values of beta
2-microglobulin (beta 2M), urea, and creatinine; and higher numbers of
peripheral blood natural killer cells, as well as a poor prognosis as
assessed both by response duration and overall survival. With respect to
the residual BM normal fraction, a low proliferative activity was
significantly (P < .05) associated with the presence of anemia and
neutropenia together with increased numbers of BM PCs, a higher incidence
of Bence Jones myelomas, and DNA diploidy. Multivariate analysis showed
that the number of S-phase PCs was the most important independent
prognostic factor, allowing us to discriminate two subgroups of patients
with different prognoses, even within the same clinical stage. Moreover,
the S-phase PCs, together with beta 2M, age, and performance status,
represent the best combination of disease characteristics for stratifying
patients according to prognosis and allow the establishment of a simple and
powerful staging system for multiple myeloma patients. In addition, this
classification can be used for planning treatment in patients who are
candidates for transplantation.
Volume 85,
Issue 2,
pp. 448-455,
01/15/1995
Copyright © 1995 by The American Society of Hematology
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