Plasma cell growth fraction using Ki-67 antigen expression identifies a subgroup of multiple myeloma patients displaying short survival within the ISS stage I.
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.
Gastinne
Thomas
T
Service d'Hématologie Clinique, CHU, Nantes, France.
Leleu
Xavier
X
Duhamel
Alain
A
Moreau
Anne-Sophie
AS
Franck
Genevieve
G
Andrieux
Joris
J
Lai
Jean-Luc
JL
Coiteux
Valerie
V
Yakoub-Agha
Ibrahim
I
Bauters
Francis
F
Harousseau
Jean-Luc
JL
Zandecki
Marc
M
Facon
Thierry
T
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
D019394:Ki-67 Antigen; D009363:Neoplasm Proteins; D001613:beta 2-Microglobulin