Peripheral Blood Lymphocyte Surface Antigen Expression and Prognosis in Myeloma: Australian Leukaemia Study Group Study |
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Authors: | Doug Joshua Max Wolf Jane Matthews Lee Tan William Sheridan Glenn Pilkingtonh Fiona Page |
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Institution: |
a Haematology Department, Royal Prince Alfred Hospital, NSW, Victoria, Australia
b Department of Haematology, Medical Oncology, Victoria, Australia
c Statistical Centre, Peter MacCallum Cancer Institute, Victoria, Australia
d Department of Clinical Haematology and Medical Oncology, Royal Melbourne Hospital, Victoria, Australia
e Clinical Immunology and Immunogenetic Unit, Peter MacCallum Cancer Institute, Victoria, Australia |
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Abstract: | The Australian Leukaemia Study Group myeloma study (MM1) aimed to determine the prognostic significance of clinical and immunophenotypic markers in patients with multiple myeloma. All patients were treated with standard dose melphalan and prednisone. Seventy-four patients were entered and the median survival was 27 months. Serum beta 2-microglobulin (βM) and albumin levels were the only significant clinical factors influencing survival (p = 0.007 and p = 0.008, respectively). Patients with raised levels of CD38+ lymphocytes at presentation had a significantly shorter survival than patients with normal levels (p = 0.01, logrank test, median 19 months vs 33 months). CD38 antigen expression was independent of β2M but patients with raised levels of CD38 had significantly lower levels of albumin than patients with normal levels (p = 0.001) which may explain their poorer survival. Salmon and Durie stage was not associated with antigen expression. No other B-cell antigens (CD10, CD19, CD20, CD21, CD22, CD23, FMC1 or FMC7) or plasma cell antigens tested (PCA-1) were found to be associated with prognosis. Patients who achieved plateau phase had a better prognosis than those who did not (p = 0.04 in a landmark analysis). Patients who achieved plateau phase following an objective response appeared to have a better prognosis than those who were in plateau phase at presentation (p = 0.09 in a landmark analysis). Light chain isotype suppression (LCIS) was not associated with a significant survival advantage and did not correlate with any known prognostic indicator. We conclude that phenotypic analysis of peripheral blood lymphocytes for CD38 antigen at diagnosis may be useful as a prognostic indicator in patients with myeloma. |
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Keywords: | Multiple myeloma chemotherapy lymphocyte antigens prognosis |
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