Plasma cell labeling index and beta 2-microglobulin predict survival independent of thymidine kinase and C-reactive protein in multiple myeloma [see comments]

Abstract

The plasma cell labeling index (PCLI) and serum beta 2-microglobulin (beta 2M) are independent prognostic factors in multiple myeloma (MM). Recently, levels of thymidine kinase (TK) and C-reactive protein (CRP) have been shown to have prognostic value. We studied 107 patients with newly diagnosed myeloma to determine whether TK and CRP values added prognostic information not already available using the PCLI and beta 2M. Univariate survival analysis showed prognostic significance for the PCLI, TK, beta 2M, age, serum albumin, and CRP. Multivariate analysis showed that only PCLI and beta 2M have independent prognostic significance. The survival curves were better separated using the PCLI and beta 2M than with other combinations of variables. Among nine patients under age 65 with low PCLI and low beta 2M, eight were alive almost 6 years after starting chemotherapy. These good-risk patients could not be identified by standard clinical features. Although creatinine and calcium were normal, other features such as bone lesions, osteoporosis, fracture, and anemia were present and stage distribution was similar to other patients in the study. In conclusion, PCLI and beta 2M measured at diagnosis are independent prognostic factors. They must be considered when interpreting the results of clinical trials and should be helpful in counseling patients and in designing new trials. When the PCLI and beta 2M values are known, the TK and CRP values do not add useful additional prognostic information.

Clinical significance of telomerase activity in multiple myeloma

“…Previous reports have suggested that the combined measurement of PCLI and β2M could predict the prognosis of myeloma patients 23, 24. The telomerase activity in myeloma cells was thus shown to correlate with both the proliferating capacity and the tumor mass burden.…”

Utility and prognostic value of 18F‐FDG positron emission tomography‐computed tomography scans in patients with newly diagnosed multiple myeloma

“…Third, several well‐established laboratory biomarkers that predict outcomes in multiple myeloma are incorporated in the International Staging System. The PCPI correlates with survival of patients with myeloma, and we have now shown a close association between PET‐CT findings and traditional markers of disease activity such as the PCPI and the International Staging System. Altogether, our data suggest that imaging findings reflect disease burden and tumor behavior.…”

Advances in understanding prognosis in myeloma

“…Despite this, Ki67 has not been widely used to assess proliferation in myeloma (Hose et al , ). The plasma cell labelling index measures the percentage of cells in S phase, determined by fluorescent microscopy, and its association with poorer outcome has been known for some time (Greipp et al , ). The percentage of cells in S phase which confers a poor prognosis is low (1–3%), reflecting the low cell turnover in most myeloma tumours, although in the new era with novel agents and increasingly effective regimens, the threshold may change.…”