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.

Increased serum levels of β2m‐free HLA class I heavy chain in multiple myeloma

“…It is likely that in our study this staging system was not predictive of survival as indicated by the lack of statistical difference of median b2m concentration between stage I±II and III MM groups. If this conclusion is correct, then our ®ndings parallel similar observations by Blade  et al (1989) and Greipp et al (1993) and are at variance with those of Bataille et al (1984) and Durie et al (1990), who found that the Durie and Salmon staging system was predictive of MM survival.…”

“…Even so, staging and evaluation of prognosis are still inadequate. For instance, CRP parallels IL-6 activity (Heinrich et al, 1990), an important growth factor for myeloma cells, but its usefulness in staging is still controversial (Boccadoro et al, 1993;Greipp et al, 1993). The labelling index re¯ects plasma cell proliferative activity (Greipp et al, , 1993, but its use is not as simple as standard methods (Bataille et al, 1992).…”

Syndecan‐1 and angiogenic cytokines in multiple myeloma: correlation with bone marrow angiogenesis and survival

“…This fact has spurred the search for valid prognostic factors. Several prognostic markers have been identified (Dewald et al, 1985;Bataille et al, 1992;Greipp et al, 1993), leading to the proposal of different prognostic systems. Recent studies have introduced serum HGF and serum syndecan-1 as prognostic markers for survival in myeloma patients (Seidel et al, 1998(Seidel et al, , 2000b.…”

Prognostic evaluation in multiple myeloma: an analysis of the impact of new prognostic factors

“…In some reports multivariate analysis has been used to identify independent prognostic factors and several prognostic systems were constructed several years ago (Durie & Salmon, 1975;Medical Research Council's Working Party on Leukaemia in Adults, 1980;Merlini et al, 1980;Blade  et al, 1989). The introduction of b-2-microglobulin, C-reactive protein and the plasma cell labelling index as prognostic factors allowed more powerful staging systems (Bataille et al, 1992;Greipp et al, 1993). In the last years several new prognostic factors have been reported.…”