title: Plasmablastic morphology is an independent predictor of poor survival after autologous stem-cell transplantation for multiple myeloma.
abstract: OBJECTIVE
  To study the prognostic value of plasmablastic morphology after autologous stem-cell transplantation for relapsed or primary refractory myeloma.
  
  
  METHODS
  Seventy-five patients were studied. Investigators blinded to the clinical details of the individual cases reviewed bone marrow aspirate slides to determine plasmablastic classification. Plasmablasts were defined using strict, well-described criteria. Plasmablastic morphology was considered to be present (plasmablastic myeloma) when 2% or more plasmablasts were present in the plasma-cell population.
  
  
  RESULTS
  Patients underwent transplantation 5 to 88 months (median, 20 months) after the initial diagnosis of myeloma. Twenty-eight percent of patients had plasmablostic morphology. A significantly greater proportion of patients with plasmablastic morphology had abnormal cytogenetics compared with those with nonplasmablastic classification (73% v 31%, respectively; P = .003). The overall survival rate measured from the time of transplantation was significantly worse in patients with plasmablastic morphology compared with those without (median survival time, 5 months v 24 months, respectively; P < .001). Progression-free survival time was shortened also, with a median time of 4 months compared with 12 months, respectively (P < .001). In the multivariate analysis, plasmablastic classification was the most powerful prognostic factor after transplantation for both overall (P = .001) and progression-free survival rates (P < .001). We also identified three risk groups based on plasmablastic morphology: plasma-cell labeling index, lactate dehydrogenase, and cytogenetics. The median overall survival time was 38 months when none of these factors was abnormal, 17 months with one abnormal factor, and 8 months with two or more abnormal factors (P < .001).
  
  
  CONCLUSIONS
  Plasmablastic morphology is a powerful independent predictor of poor survival rate after autologous stem-cell transplantation for relapsed or primary refractory myeloma.
authors.affiliation: Division of Hematology and Internal Medicine and the Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
authors.forename: S V
authors.initials: SV
authors.lastname: Rajkumar
authors.forename: R
authors.initials: R
authors.lastname: Fonseca
authors.forename: M Q
authors.initials: MQ
authors.lastname: Lacy
authors.forename: T E
authors.initials: TE
authors.lastname: Witzig
authors.forename: T M
authors.initials: TM
authors.lastname: Therneau
authors.forename: R A
authors.initials: RA
authors.lastname: Kyle
authors.forename: M R
authors.initials: MR
authors.lastname: Litzow
authors.forename: M A
authors.initials: MA
authors.lastname: Gertz
authors.forename: P R
authors.initials: PR
authors.lastname: Greipp
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001856:Bone Marrow Examination; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000235:genetics / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D010950:Plasma Cells / Q000473:pathology*; D011379:Prognosis; D012008:Recurrence; D016019:Survival Analysis