TY - JOUR
T1 - Staging multiple myeloma patients with active disease using serum levels of β2m-free HLA class I heavy chain together with IgM or platelet count
AU - Perosa, Federico
AU - Minoia, Carla
AU - Favoino, Elvira
AU - Prete, Marcella
AU - Dammacco, Franco
PY - 2009/1
Y1 - 2009/1
N2 - Purpose: In multiple myeloma (MM), serum beta-2-microglobulin (β2m)-free heavy chains (FHC) of HLA class I has been shown to reflect disease activity. We investigated the possibility of stratifying patients with active disease according to FHC and other clinical parameters. Experimental design: We studied 146 patients with MM, including 100 at diagnosis, 31 in relapse and 15 unresponsive to therapy. Univariate and multivariate analyses were used to assess the prognostic significance of FHC together with continuous variables (age, albumin, creatinine, hemoglobin, erythrocyte sedimentation rate, β2m, calcium, IgM, platelet count) and categorical variables (Durie-Salmon disease stage, gender, bone lesion burden, heavy and light chain isotypes of M-component, clinical status). Survival tree analysis on significant variables was used to develop an MM staging system. Results: FHC, IgM, platelet count and hemoglobin were independent predictors of prognosis. Survival tree analysis of these variables defined 2 three-risk-group staging systems involving FHC and either IgM or platelet count. Median survival for FHC/IgM stages II and III was 41.5 and 27.8 months, whereas it was not reached for stage I patients (p <0.0001). In the FHC/platelets system, median survival was 93.2 (stage I), 44.1 (stage II) or 27.8 (stage III) months (p <0.0001). Similar results were obtained for the 117 MM patients without renal insufficiency (FHC/IgM p <0.0001; FHC/platelets p = 0.001). For the 100 patients at diagnosis, FHC/IgM (p = 0.001) was more effective than FHC/platelets (p = 0.04). Conclusions: The independent prognostic markers FHC, IgM and platelets provide two staging systems unaffected by renal insufficiency. Both are effective in evaluating MM patients with active disease.
AB - Purpose: In multiple myeloma (MM), serum beta-2-microglobulin (β2m)-free heavy chains (FHC) of HLA class I has been shown to reflect disease activity. We investigated the possibility of stratifying patients with active disease according to FHC and other clinical parameters. Experimental design: We studied 146 patients with MM, including 100 at diagnosis, 31 in relapse and 15 unresponsive to therapy. Univariate and multivariate analyses were used to assess the prognostic significance of FHC together with continuous variables (age, albumin, creatinine, hemoglobin, erythrocyte sedimentation rate, β2m, calcium, IgM, platelet count) and categorical variables (Durie-Salmon disease stage, gender, bone lesion burden, heavy and light chain isotypes of M-component, clinical status). Survival tree analysis on significant variables was used to develop an MM staging system. Results: FHC, IgM, platelet count and hemoglobin were independent predictors of prognosis. Survival tree analysis of these variables defined 2 three-risk-group staging systems involving FHC and either IgM or platelet count. Median survival for FHC/IgM stages II and III was 41.5 and 27.8 months, whereas it was not reached for stage I patients (p <0.0001). In the FHC/platelets system, median survival was 93.2 (stage I), 44.1 (stage II) or 27.8 (stage III) months (p <0.0001). Similar results were obtained for the 117 MM patients without renal insufficiency (FHC/IgM p <0.0001; FHC/platelets p = 0.001). For the 100 patients at diagnosis, FHC/IgM (p = 0.001) was more effective than FHC/platelets (p = 0.04). Conclusions: The independent prognostic markers FHC, IgM and platelets provide two staging systems unaffected by renal insufficiency. Both are effective in evaluating MM patients with active disease.
KW - Beta2-microglobulin
KW - FHC
KW - HLA class I heavy chain
KW - IgM
KW - Multiple myeloma
KW - Platelets
KW - Prognostic markers
KW - Staging
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U2 - 10.1016/j.bcmd.2008.09.003
DO - 10.1016/j.bcmd.2008.09.003
M3 - Article
C2 - 18996035
AN - SCOPUS:57949103908
VL - 42
SP - 71
EP - 76
JO - Blood Cells, Molecules, and Diseases
JF - Blood Cells, Molecules, and Diseases
SN - 1079-9796
IS - 1
ER -