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Peripheral blood monoclonal plasma cells as a predictor of survival in
patients with multiple myeloma [see comments]
TE Witzig, MA Gertz, JA Lust, RA Kyle, WM O'Fallon and PR Greipp
Division of Internal Medicine and Hematology, Mayo Clinic, Rochester, MN
55905, USA.
The purpose of this study was to quantitate the number and labeling index
of monoclonal plasma cells in the blood of patients with newly diagnosed
multiple myeloma (MM) to learn if these values were independent prognostic
factors for survival. Patients were candidates for this study if they had
untreated myeloma requiring therapy, were evaluated at our institution
between 1984 and 1993, and had a sample of blood analyzed with a sensitive
immunofluorescence technique for monoclonal plasma cells and the blood
B-cell labelling index (BLI). The % blood monoclonal plasma cells (%BPC)
and the BLI were analyzed along with stage, marrow plasma cell LI, % marrow
plasma cells, calcium, creatinine, albumin, beta-2-microglobulin, and
C-reactive protein as univariate and multivariate factors for survival.
Eighty percent of the 254 patients accrued to this study had monoclonal BPC
detected. The median % BPC was 6% and 57% (144 of 254) of patients had a
high number (> or = 4%). Patients with > or = 4% BPC had a median
survival of 2.4 years vs 4.4 years for those with < 4% BPC (P <
.001). The BLI was also prognostic (P = .008). In a multivariate analysis,
the % BPC, age, albumin, stage, marrow plasma cell LI, and the BLI were
independent factors for survival. The %BPC and the marrow plasma cell LI
best separated the group into low, intermediate, and high risk myeloma with
median survivals of 52, 35, and 26 months, respectively. Patients with high
%BPC were less likely to have lytic bone disease from their MM (P = .002).
The %BPC and the BLI are independent prognostic factors for survival and
are useful in identifying patients as low, intermediate, and high risk.
Clonal cells in the blood should be quantified in future clinical trials
for myeloma.
Volume 88,
Issue 5,
pp. 1780-1787,
09/01/1996
Copyright © 1996 by The American Society of Hematology
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