| Objective: Retrospective analysis of immune phenotype characteristicsand its relationship with clinical stage, immunoglobulin type, treatmentresponse and prognosis about97cases of multiple myeloma (MM) patients.Methods: Retrospective analysis newly diagnosed patients with MMadmitted in our hospital and followed-up in recent eight years from January2005to June2013,97cases of whom had more completed data on immunephenotype, statistically analyzed clinical characteristics such as myeloma cellsof immune phenotype and its relationship with MM type, stage, age,treatment response,prognosis and so on.Measuring myeloma cell surfacedifferentiation antigen CD38, CD138, CD56, CD117, CD19, CD20byFACSCantoII flow cytometer. Positive criteria: myeloma cell surface antigenexpression>20%. Treatment:50cases of MM patients received3courses ofVAD-based regimen treatment(vincristine,doxorubicin/pirarubicin/epirubicin,dexamethasone),and19cases received2courses of BD-basedtreatment(bortezomib,dexamethasone).Overall survival (overallsurvival, OS)was defined as the diagnosis until death or the last follow-up inspection date.Event-free survival (event-freesurvival EFS) was defined as the the time fromdiagnosis to recurrence and death time, without the above incident calculationto the date of the last follow-up examination. However, the EFS of less thanCR ’s patients commences from the date of diagnosis to disease progression ordeath so far.The overall response rate (0RR):(CR+VGPR+PR)/totalcases.Clinical staging using ISS staging criteria. MM treatment evaluationaccording to efficacy standards of the International Multiple MyelomaWorking Group (IMWG) in2006.MM diagnostic criteria and classification,staging line with " blood disease diagnosis and treatment standards".Application SPSS20.0software for statistical analysis of research data Results:1General information:(1)age features:97MM patients, male61cases,female36cases, male:female=1.69:1.Median age61years(27-81years old)，27-50years old，21cases(21.65%),51-65years old，46cases(47.42%), over66years old，30cases(30.93%);(2)clinical characteristics of MM cells and Mprotein: IgG type46cases (47.42%), IgG levels62.39±36.83g/L、IgA type25cases(25.77%),IgA levels55.60±25.65g/L、light chain18cases(18.56%)、IgD8cases(8.25%);(3)Clinical stage at diagnosis:most of stage III,71cases(73.20%)、 stage I,8cases(8.25%)、 stage II，18cases(18.56%);(4)Theproportion of bone marrow plasma:The proportion of plasma cells was35.73±21.42%,there was no significant difference in different stages and types(P＞0.05);(5)myeloma cell phenotype analysis and genetics:CD38positive MM95cases(95/97,97.94%),CD138positive MM95cases(95/97,97.94%), CD19positive MM6cases(6/93,6.45%),CD20positive MM2cases(2/91,2.20%),CD56positive MM58patients(58/87,66.67%),CD117positive MM21cases(21/67,31.34%).Chromosome and FISH examination25cases(25.77%),2cases of deleting P53(2/25,8.00%),IgH rearrangement3cases(3/25,12.00%),1case of deleting RB1(1/25,4.00%), complex karyotype3cases(3/25,12.00%).2Myeloma cell phenotype and other clinical features:(1) MM patients ofdifferent types of M protein had different CD56positive expression rate (P=0.034), IgG type74.42%(32/43) the highest,IgA type70.83%(17/24) and thelight chain57.14%(8/14) followed,IgD type16.67%(1/6) minimum.Thatshowed the highest CD56positive expression rate in IgG type;(2)There wereno significant differences between different stages、types、age groups and Mprotein in CD38,CD138,CD19,CD20,CD117(P＞0.05).3Myeloma cell phenotype and treatment:(1) VAD-based treatment:①CD56and treatment:There was statistical difference in ORR between CD56positive and negative patients (59.26%vs27.78%, respectively, P＜0.05),while there was no significant difference in CR and PR rate between thetwo groups(P＞0.05);②CD117and treatment:There was no significantdifference in ORR between CD117positive and negative patients(P＞0.05). The above results suggested the ORR of VAD-based treatment was associatedwith CD56expression,had nothing to do with CD117expression.(2)BD-basedtreatment: There was no significant difference in ORR between CD56positiveand negative、CD117positive and negative patients(P＞0.05). That showtedthe ORR of BD-based treatment had nothing to do with CD56and CD117expression, may be associated with less cases.4Myeloma cell CD56expression and Survival analysis:(1)The follow-updeadline:December1,2013,median follow-up time was29months(4-78months).45patients with MM of detecting CD56, median OS was30.87months, median EFS was24.05months,3-year OS rate was49%,3-years EFSrate was38%.There was statistical difference in3-year OS rate、3-years EFSrate between CD56positive and negative patients (60.7%、45.1%vs25.2%、15.2%,respectively, P＜0.05).The above showed CD56positive had afavorable outcome.(2)There was statistical difference in3-year OS ratebetween CD56positive and negative patients of over60years old (60.9%vs20%, respectively, P＜0.05). There was no significant difference in3-year OSrate between CD56positive and negative patients of under60years old (P＞0.05).The results showed that CD56positive was good indicator in over60years old patients.(3)There was statistical difference in3-year OS ratebetween CD56positive and negative patients of stage III (48.3%vs18.3%,respectively, P＜0.05),however, there was no significant difference in stageII(P＞0.05).The results showed CD56positive was good indicator for patientswith higher stages.(4)There was statistical difference in IgG level betweenCD56positive and negative patients (45.06±47.95g/L vs20.66±31.84g/L，respectively, P＜0.05), while there was no statistical difference in theproportion of plasma cells, the level of IgA, IgM, WBC, Hb, PLT, β2-MG,albumin.5Myeloma cell CD117expression and Survival analysis:(1)Thefollow-up deadline:December1,2013,median follow-up time was23months(2-84months).32patients with MM of detecting CD117, median OS was34.2months, median EFS was18.31months,3-year OS rate was44%,3-years EFS rate was21%.There was statistical difference in3-year OS rate、3-years EFSrate between CD117positive and negative patients (65.2%、44.4%vs25.3%、10.6%, respectively, P＜0.05).(2) There was statistical difference in β2-MGlevel between CD117positive and negative patients (10.55±8.59mg/L vs4.13±1.83mg/L,respectively,P＜0.05),while there was no statistical differencein the proportion of plasma cells, the level of IgG, IgA, IgM, WBC, Hb, PLT,albumin.That showed CD117positive had a favorable prognosis.Conclusion:1B-cell antigen could express in small number of MM patients.2IgG type MM patients had the highest CD56positive expression rate.myeloma cell phenotype was unrelated with clinical stage and age.3On the whole,CD56positive had a better prognosis.CD56positive wasgood indicator for patients over60years old and with higher stages.4CD117positive patients had a favorable outcome with high OS rate. |
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