Plasma cell proliferation in monoclonal gammopathy: relations with other biologic variables--diagnostic and prognostic significance.
OBJECTIVE
We investigated the place of direct plasma cell proliferation analysis beside other biologic data in monoclonal gammopathy, particularly the serum level of C-reactive protein (C-RP) PATIENTS: Eighty patients were studied at the time of their diagnosis. Patients with a serum creatinine level greater than 200 mumol/L were excluded.


METHODS
Plasma cell proliferation analysis was performed after bromodeoxyuridine incorporation and double immunoenzymatic labeling on cytological smears, making determination of the plasma cell labeling index (LI) possible. The other biologic variables studied were related to tumor burden (plasmacytosis, hemoglobin, serum levels of monoclonal immunoglobulin, albumin) or to kidney function (creatinine). beta 2-microglobulin (beta 2-M), C-RP, lactic dehydrogenase (LDH), and calcemia were also assessed.


RESULTS
No correlation was found between LI and serum C-RP. LDH was the sole variable significantly correlated to C-RP (P < 0.01). Besides the biologic parameters used for the staging according to the Durie and Salmon classification, beta 2-M, albumin and LI were significantly different between stages (P < 0.0002, < 0.0004, < 0.00001). LDH and C-RP showed no significant difference. Results were similar when patients with and without bone lesions were analyzed separately. Multivariate analysis ranked these variables as follows with respect to prognostic value: beta 2-M, LI, and age.


CONCLUSIONS
Among the variables analyzed, LI is the sole true reflector of cell proliferation. We confirm its diagnostic and prognostic value.
Ffrench
M
M
Laboratoire de Cytologie Analytique, Faculté de Médecine Rockefeller, Lyon, France.
Ffrench
P
P
Remy
F
F
Chapuis-Cellier
C
C
Wolowiec
D
D
Ville
D
D
Bryon
P A
PA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001853:Bone Marrow / Q000473:pathology; D002097:C-Reactive Protein / Q000378:metabolism; D002455:Cell Division; D003404:Creatinine / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D008940:Mitotic Index; D010265:Paraproteinemias / Q000097:blood / Q000473:pathology*; D010950:Plasma Cells / Q000166:cytology*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D001613:beta 2-Microglobulin / Q000378:metabolism
D006454:Hemoglobins; D012709:Serum Albumin; D001613:beta 2-Microglobulin; D002097:C-Reactive Protein; D003404:Creatinine; D007770:L-Lactate Dehydrogenase