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. 2005 Oct 1;106(7):2276-9.
doi: 10.1182/blood-2005-05-1858. Epub 2005 Jun 16.

Circulating plasma cells detected by flow cytometry as a predictor of survival in 302 patients with newly diagnosed multiple myeloma

Grzegorz S Nowakowski  1 , Thomas E Witzig, David Dingli, Michal J Tracz, Morie A Gertz, Martha Q Lacy, John A Lust, Angela Dispenzieri, Philip R Greipp, Robert A Kyle, S Vincent Rajkumar
Affiliations

Circulating plasma cells detected by flow cytometry as a predictor of survival in 302 patients with newly diagnosed multiple myeloma

Grzegorz S Nowakowski et al. Blood. .

Abstract

We detected circulating plasma cells (PCs) by flow cytometry in 302 patients with newly diagnosed multiple myeloma (MM) by gating on CD38+CD45- cells. The number of circulating PCs per 50 000 mononuclear cells was reported. In 80 (27%) patients, no circulating PC were seen; 106 (35%) patients had 1 to 10 and 115 (38%) patients had more than 10 circulating PCs. Median overall survival for the 302 patients was 47 months. Patients with 10 or fewer circulating PCs had a median survival of 58.7 months, whereas patients with more than 10 circulating PCs had a median survival of 37.3 months (P = .001). On multivariate analysis, the prognostic value of circulating PCs was independent of beta2-microglobulin, albumin, and C-reactive protein. There was only a weak correlation between tumor mass and circulating PCs, suggesting that the appearance of circulating PCs may be a reflection of tumor biology. We conclude that the number of circulating PCs measured by flow cytometry in patients with newly diagnosed MM is an independent predictor of survival.

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Figures

Figure 1.
Figure 1.
Flow cytometric analysis of peripheral blood in 3 patients with MM. (A) Patient with no circulating PCs (R2). (B) Patient with 7 circulating PCs per 50 000 events (R2). (C) Patient with high number of circulating PCs (R2; 2946 per 50 000 events).
Figure 2.
Figure 2.
Distribution of circulating PCs in 302 study patients. Patients were divided into 5 groups based on the number of PCs.
Figure 3.
Figure 3.
Kaplan-Meier estimates of OS. (A) Survival by ISS (ISS 1-I, ISS 2-II, ISS 3-III). (B) Survival by number of circulating PCs (A, 10 or less; B, more than 10).
Figure 4.
Figure 4.
Kaplan-Meier estimates of OS in the risk stratification model using B2M, albumin levels, and circulating PCs. L indicates low-risk group; LI, low-intermediate risk group; HI, high-intermediate risk group; H, high-risk group.
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References

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    1. Greipp PR, San Miguel J, Durie BG, et al. International Staging System for Multiple Myeloma. J Clin Oncol. 2005;23: 3412-3420. - PubMed

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