Plasmablastic morphology--an independent prognostic factor with clinical and laboratory correlates: Eastern Cooperative Oncology Group (ECOG) myeloma trial E9486 report by the ECOG Myeloma Laboratory Group.

摘要: We studied the prognostic significance of plasmablastic (PB) multiple myeloma (MM) in Eastern Cooperative Oncology Group Phase III trial E9486. Two reviewers independently reviewed 453 cases. They agreed on 37 PB (8.2%) cases and 416 non-PB cases, achieving an 85% concordance (P < .0001). These had significantly lower hemoglobin serum albumin levels, higher calcium beta 2-microglobuin percentage BM plasma cells (PC) by immunofluorescence. bone marrow PC labeling indices, soluble interleukin-6 receptor (sIL-6R) a probability ras mutations. Three treatment regimens were used: vincristine, bis-chloro-ethyl nitrosourea (BCNU) melphalan, cyclophosphamide, prednisone (VBMCP) alone; VBMCP with added cyclophosphamide (HiCy); or recombinant interferon alpha 2 (rIFNalpha2). Although numbers are low, patients response rate versus MM when treated (treated, 47.1% v nontreated, 66.5% [P = .015]). Patients nonresponding progression than (30.6% 11.8% .0001]), especially alone (35.3% 15.8% .002]), HiCy (37.5% 9.8% but not rIFNalpha2. Event-free overall survival was shorter (median years, 1.1 2.7 1.9 3.7, respectively .0001 for both]). In multivariate analysis, classification also highly prognostic. There is no difference between who classified as both only one reviewer. conclude that discrete entity associated more aggressive disease shortened survival. Tumor cell mutations increased sIL-6R may contribute to proliferation reduced significant improvements addition rIFNalpha2 VBMCP, small improved could be shown.