title: Blood levels of immune cells predict survival in myeloma patients: results of an Eastern Cooperative Oncology Group phase 3 trial for newly diagnosed multiple myeloma patients.
abstract: Previously, it was reported that patients with multiple myeloma (MM) who have higher baseline levels of blood CD4(+) or CD19(+) cells have longer survival. This article extends the analysis of immune cell levels and survival in a large cohort (N = 504) of patients with MM entered on Eastern Cooperative Oncology Group (ECOG) phase 3 trial (9486). Newly diagnosed patients with MM received 2 cycles of vincristine, bischloroethylnitrosourea, melphalan, cytoxan, prednisone (VBMCP) and were treated on one of 3 randomized arms: VBMCP with either interferon or high-dose cyclophosphamide, or VBMCP alone. Blood immune cell levels were studied at trial entry (baseline), after 2 cycles of chemotherapy, after 2 years of therapy, and at relapse. Baseline CD3(+), CD4(+), CD8(+), CD19(+), and CD4(+) subset cell levels were all positively associated with survival (P =.0087 to P <.0001). A multivariate analysis incorporating CD4(+) and CD19(+) cell levels defined 3 separate groups of patients with MM to survival outcome. Higher CD19(+) blood levels were positively associated with MM-patient survival at entry to the study, at year 2, and at relapse (P <.0001 at all 3 timepoints). Patients with MM had evidence of immune cell reconstitution after 2 years of therapy, but the rate and extent of recovery was greater for CD8(+), which was greater than CD4(+), which was greater than CD19(+). This latter data affirms the positive relationship between the quantitative status of the blood immune system in MM and survival. In addition, the importance of the CD19(+) blood cells to survival is evident throughout the course of MM. Therapeutic efforts to maintain an intact immune system may be crucial in maximizing chemotherapeutic and/or immunotherapy efforts in this disease.
authors: Mayo Clinic, Rochester, MN 55905, USA. kay.neil@mayo.edu
authors: N E
authors: NE
authors: Kay
authors: T L
authors: TL
authors: Leong
authors: N
authors: N
authors: Bone
authors: D H
authors: DH
authors: Vesole
authors: P R
authors: PR
authors: Greipp
authors: B
authors: B
authors: Van Ness
authors: M M
authors: MM
authors: Oken
authors: R A
authors: RA
authors: Kyle
mesh_terms: D000206:Actuarial Analysis; D018941:Antigens, CD19 / Q000097:blood; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D001772:Blood Cell Count; D017252:CD3 Complex / Q000097:blood; D015496:CD4-Positive T-Lymphocytes; D018414:CD8-Positive T-Lymphocytes; D005500:Follow-Up Studies; D006801:Humans; D007107:Immune System / Q000166:cytology*; D016130:Immunophenotyping; D009101:Multiple Myeloma / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D015999:Multivariate Analysis; D011379:Prognosis; D017452:Receptors, IgG / Q000097:blood; D012008:Recurrence; D015996:Survival Rate
chemical_list: D018941:Antigens, CD19; D017252:CD3 Complex; D017452:Receptors, IgG