| Multiple myeloma（MM）is a plasma cell malignant proliferative disease accounting for about 1%of neoplastic disease and 10%of hematological malignancies.Although the use of new drugs and hematopoietic stem cell transplantation has prolonged the survival of patients with myeloma and improved the quality life of patients,multiple myeloma is still an incurable disease.The interaction between different components of myeloma cells and the bone marrow microenvironment plays an important role in the treatment of MM,minimal residual disease and clinical manifestations and prognosis.Macrophages are extensively infiltrated in the tumor microenvironment and are now considered to be type M2 macrophages,which is called tumor associated macrophage（TAM）.In solid tumors such as cervical cancer,endometrial cancer,bladder cancer,breast cancer,pancreatic cancer and glioma,TAM can promote tumor angiogenesis by secreting various cytokines,chemokines and metalloproteinases,Inhibit immune regulation and enhance tumor invasion and metastasis and many other ways to promote tumor progression,but TAM in MM to promote tumor growth is rarely studied.ObjectiveTo investigate the clinical significance of tumor associated macrophages in multiple myeloma and its relationship with angiogenesis and immunosuppression.Method 70 cases of MM patients as the experimental group,20 cases of benign hematological diseases（13 with iron deficiency anemia and 7 with megalic anemia）patients as control group,from August 2015 to June 2017.Detecting the expression of CD163、CD34、VEGF in bone marrow by using Immunohistochemical method,and flow cytometry was used to detect the proportion of regulatory T cell（Treg cells）,ELISA was used to detect the level of IL-10,and the clinical features were analyzed.Result 1.TAM infiltration density,MVD,VEGF expression level,Treg ratio and IL-10level in bone marrow tissue of 70 cases of MM patients were significantly higher than those of 20 cases of benign hematological diseases（p<0.05）.2.In the MM group,the above indexes of the patients with disease stabilization（15cases）were lower than those the newly diagnosed group（35 cases）and the relapse refractory group（20 cases）（p<0.05）,the relapsing refractory group were higher than those of newly diagnosed group（p>0.05）.3.Of the 35 newly diagnosed MM patients,27 completed 4 courses of treatment.The effectivegroup（15cases）wassignificantlylowerthanthatbefore treatment（p<0.05）;while the ineffective group of 12 cases are higher than those before treatment（p>0.05）.4.The TAM infiltration density in MM patients was positively correlated with MVD,VEGF expression level,Treg cell ratio and IL-10 level（p<0.05）.5.There was no correlation between TAM infiltration density and LDH andβ2-MG in MM patients（p>0.05）.Conclusion The infiltration of TAMs in the microenvironment of myeloma,which may promoting angiogenesis and inhibiting immune response,is related to the occurrence,development,therapeutic effect and drug resistance of MM.This study may provide a new direction for targeted therapy of MM. |
