Correlation between argyrophilic nucleolar organizer region counts and labelling index in multiple myeloma

The correlation between the bromodeoxyuridine (BrdU)-labelling index (LI) of plasma cells and a new proliferation marker, the Argyrophilic Nucleolar Organizer Regions (AgNORs), was investigated in 44 myeloma patients at diagnosis. A preliminary analysis was made to verify the reproducibility of the assessment of plasma cell infiltration (PC%) in bone marrow aspirates, used to collect cells for LI determination, and in bone marrow biopsies, used for AgNORs evaluation. Although an overall good correlation was observed between PC% in biopsies and aspirates (r = 0.58, p = 0.001), the ratio between PC% in biopsies and in aspirates ranged from 0.35 to 7.5. Only 17 patients (38.6%) were within the 0.5-1.5 range. A positive correlation between LI and AgNORs was observed in these patients (r = 0.68, p = 0.003), whereas the correlation was lost in patients with higher ratio between PC% in biopsies and in aspirates (r = 0.08, p = 0.69). The prognostic significance of AgNORs was confirmed by survival analysis, showing a reduced survival for patients with high (> 4.4) AgNOR counts (14 months vs 35 months, p = 0.004). The AgNORs analysis therefore allows the simultaneous evaluation of myeloma cell infiltration, degree of differentiation and kinetics of growth in bone marrow biopsies. AgNOR counts deserve to be included in the procedures for diagnosis and prognostic evaluation of myeloma patients.