title: Prognostic value of bone marrow angiogenesis in patients with multiple myeloma undergoing high-dose therapy.
abstract: Bone marrow (BM) angiogenesis is increased in multiple myeloma and is an important prognostic factor. However, prior studies were mainly done on patients receiving conventional chemotherapy and there is limited data on its prognostic value in patients undergoing high-dose therapy (HDT) as initial therapy. We studied BM angiogenesis in terms of microvessel density (MVD) in 88 newly diagnosed patients, who were uniformly treated, with 3-4 cycles of induction chemotherapy followed by HDT. We examined if MVD at diagnosis was predictive of response to induction therapy or to subsequent HDT. In addition, we also examined its prognostic value in these patients. The median MVD for primary refractory patients was 28 (range, 2-84) compared to 27 (range, 2-99) for responding patients (P=0.7). The median progression-free survival (PFS) was 21 months for those with high-grade angiogenesis compared to 42 months for those with low-grade angiogenesis, P=0.017. The median overall-survival (OS) from diagnosis was 40 months for those with high-grade angiogenesis and not yet reached, for those with low-grade angiogenesis, P=0.007. BM MVD at the time of initial diagnosis is an important prognostic factor for OS and PFS in patients undergoing autologous transplantation as frontline therapy for myeloma.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.forename: M A
authors.initials: MA
authors.lastname: Gertz
authors.forename: A
authors.initials: A
authors.lastname: Dispenzieri
authors.forename: M Q
authors.initials: MQ
authors.lastname: Lacy
authors.forename: L A
authors.initials: LA
authors.lastname: Wellik
authors.forename: R
authors.initials: R
authors.lastname: Fonseca
authors.forename: J A
authors.initials: JA
authors.lastname: Lust
authors.forename: T E
authors.initials: TE
authors.lastname: Witzig
authors.forename: R A
authors.initials: RA
authors.lastname: Kyle
authors.forename: P R
authors.initials: PR
authors.lastname: Greipp
authors.forename: S V
authors.initials: SV
authors.lastname: Rajkumar
mesh_terms: D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000032:analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001706:Biopsy; D001853:Bone Marrow / Q000098:blood supply*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008833:Microcirculation / Q000473:pathology; D008875:Middle Aged; D009101:Multiple Myeloma / Q000098:blood supply* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D009389:Neovascularization, Pathologic / Q000473:pathology*; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D018952:Antigens, CD34