title: Plasma cell growth fraction using Ki-67 antigen expression identifies a subgroup of multiple myeloma patients displaying short survival within the ISS stage I.
abstract: The current most powerful prognostic model in Multiple Myeloma (MM) combines beta-2 microglobulin (b2m) with albumin, corresponding to the International Staging System (ISS). However, the prognosis of patients within the ISS stage I (high albumin and low b2m) may vary. Ki-67 is a nuclear protein associated with cell proliferation. We retrospectively evaluated the percentage of bone marrow plasma cells expressing Ki-67 antigen (Ki-67 index) in a series of 174 untreated MM patients at diagnosis. Median survival was 51, 41 and 20 months respectively, and median Ki-67 index was 3.0%, 6.1% and 6.5% in ISS stages I, II, and III respectively. Independently of ISS, Ki-67 index > or =4% was highly predictive of adverse prognosis. Ki-67 index correlated with markers of intrinsic malignancy and with markers of tumour burden. Within ISS stage I, median survival was of 31 months (RR of death 2.65) in patients with Ki-67 index > or =4%. Eventually, the combination of Ki-67 with b2m produced an efficient prognostic model, which appeared most effective in our series when compared with b2m and KI-67 with chromosome 13 deletion models. In this series, we demonstrated that a proliferation marker provides clear-cut additional survival prognostic information to b2m into the ISS model.
authors: Service d'Hématologie Clinique, CHU, Nantes, France.
authors: Thomas
authors: T
authors: Gastinne
authors: Xavier
authors: X
authors: Leleu
authors: Alain
authors: A
authors: Duhamel
authors: Anne-Sophie
authors: AS
authors: Moreau
authors: Genevieve
authors: G
authors: Franck
authors: Joris
authors: J
authors: Andrieux
authors: Jean-Luc
authors: JL
authors: Lai
authors: Valerie
authors: V
authors: Coiteux
authors: Ibrahim
authors: I
authors: Yakoub-Agha
authors: Francis
authors: F
authors: Bauters
authors: Jean-Luc
authors: JL
authors: Harousseau
authors: Marc
authors: M
authors: Zandecki
authors: Thierry
authors: T
authors: Facon
mesh_terms: D000368:Aged; D001854:Bone Marrow Cells / Q000378:metabolism* / Q000473:pathology; D049109:Cell Proliferation; D002872:Chromosome Deletion; D002882:Chromosomes, Human, Pair 13 / Q000378:metabolism; D018572:Disease-Free Survival; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D019394:Ki-67 Antigen / Q000096:biosynthesis*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009101:Multiple Myeloma / Q000235:genetics / Q000378:metabolism / Q000401:mortality* / Q000473:pathology; D009363:Neoplasm Proteins / Q000096:biosynthesis*; D009367:Neoplasm Staging; D010950:Plasma Cells / Q000378:metabolism* / Q000473:pathology; D012189:Retrospective Studies; D015996:Survival Rate; D001613:beta 2-Microglobulin / Q000096:biosynthesis
chemical_list: D019394:Ki-67 Antigen; D009363:Neoplasm Proteins; D001613:beta 2-Microglobulin