摘要
目的探讨循环浆细胞(CPC)的预后意义和免疫球蛋白(IG)基因重排的关系。方法收集2017年1月至2019年12月我院新诊断的MM患者118例。采用多参数流式细胞术(MFC)进行CPC和骨髓浆细胞(BMPC)定量,并采用IGH FR1和IGK引物基于NGS进行针对IG重链(IGH)和轻链(IGK)基因的的克隆性测试,确定CPC水平与临床病理特征和IG重排的关系。结果118例患者CPC水平为0.02%(0,0.14),根据CPC水平的中位值0.02%分为低CPC组和高CPC组。CPC与改良ISS分期、R2-ISS分期、β-2微球蛋白、乳酸脱氢酶、血红蛋白和BMPC/总淋巴细胞比值有关(P<0.05)。将CPC水平进行对数转化后,CPC与BM有核细胞或总淋巴细胞中浆细胞比例呈正相关[r_(s)=0.239(P=0.009)和r_(s)=0.317(P<0.001)]。中位随访时间为39.5个月。改良ISS不能区分Ⅱ期和Ⅲ期之间的OS差异(P=0.361)。但对改良ISSⅡ期和Ⅲ期患者进一步分层,高CPC组和低CPC组患者中位OS分别为33.50个月和58.30个月,差异有统计学意义(P=0.037)。在有(+)或没有(-)克隆性IGH重排患者中,CPC比例分别为0.025%(0.00,0.17)和0.01%(0.00,0.13),P=0.027。此外,在克隆性IGH重排(+)和/或IGK重排(+)的患者中,CPC比例为0.03%(0.00,0.15),高于克隆性IGH重排(-)且IGK重排(-)的患者[0.01%(0.00,0.015),P=0.030]。结论高水平CPC可以预测高危MM,IGH重排在高CPC组患者中更常见,为改良ISS危险分层,尤其是Ⅱ~Ⅲ期MM患者提供额外的预后信息。
Objective To investigate the prognostic significance of circulating plasma cells(CPC)and the relationship between immunoglobulin(IG)gene rearrangement.Methods One hundred and eighteennewly diagnosed MM patients in our hospital from January 2017 to December 2019 were collected.Multi parameter flow cytometry(MFC)was used to quantify CPC and bone marrow plasma cells(BMPC),and IGH FR1 and IGK primers were used based on NGS to perform clonal testing of IG heavy chain(IGH)and light chain(IGK)genes,determining the relationship between CPC levels and clinical pathological features and IG rearrangement.Results CPC level of 118 patients was 0.02%(0,0.14),and they were divided into low CPC group and high CPC group based on the median CPC level of 0.02%.CPC and improved ISS staging,R2-ISS stagingβ-2.Microglobulin,lactate dehydrogenase,hemoglobin,and BMPC/total lymphocyte ratio were correlated(P<0.05).After logarithmic transformation of CPC levels,there was a positive correlation between CPC and the proportion of plasma cells in BM nucleated cells or total lymphocytes,with r_(s)=0.239(P=0.009)and r_(s)=0.317(P<0.001).The median follow-up was 39.5 months.Improved ISS cannot distinguish the OS difference between stageⅡand stageⅢ(P=0.361).However,for further_(s)tratification of patients with improved ISS stage II and III,the median OS time was 33.50 months in the high CPC group and 58.30 months in the low CPC group,respectively,with a statistically significant difference(P=0.037).In patients with(+)or without(-)clonal IGH rearrangement,the CPC ratios were 0.025%(0.00,0.17)and 0.01%(0.00,0.13),respectively,with P=0.027.In addition,among patients with clonal IGH rearrangement(+)and/or IGK rearrangement(+),the CPC ratio was 0.03%(0.00,0.15),higher than in patients with clonal IGH rearrangement(-)and IGK rearrangement(-)[0.01%(0.00,0.015),P=0.030].Conclusion High level CPC can predict high-risk MM,and IGH rearrangement is more common in patients with high CPC group,providing additional prognostic information for improving ISS risk stratification,especially for stageⅡ-ⅢMM patients.
作者
任慧娟
苏晓甜
陈秋雨
刘健
REN Huijuan;SU Xiaotian;CHEN Qiuyu;LIU Jian(Department of Hematology,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010103,China)
出处
《临床肿瘤学杂志》
2023年第10期887-892,共6页
Chinese Clinical Oncology
基金
内蒙古自治区高等学校科学研究资助项目(NJZY23149)。
关键词
多发性骨髓瘤
循环浆细胞
预后
遗传学特征
免疫球蛋白基因重排
Multiple myeloma
Circulating plasma cell
Prognosis
Genetic characteristics
Immunoglobulin gene rearrangement
