title: Circulating plasma cells in newly diagnosed symptomatic multiple myeloma as a possible prognostic marker for patients with standard-risk cytogenetics.
abstract: Detection of circulating plasma cells (PCs) in multiple myeloma (MM) patients is a well-known prognostic factor. We evaluated circulating PCs by flow cytometry (FC) in 104 patients with active MM at diagnosis by gating on CD38(+)  CD45(-) cells and examined their relationship with cytogenetic risk. Patients had an average follow-up of 36 months. By using a receiver operating characteristics analysis, we estimated the optimal cut-off of circulating PCs for defining poor prognosis to be 41. Patients with high-risk cytogenetics (n = 24) had poor prognosis, independently of circulating PC levels [PC < 41 vs. PC ≥ 41: overall survival (OS) = 0% vs. OS = 17%, P = not significant (n.s.); progression-free survival (PFS) = 0% vs. 17%, P = n.s.]. Patients with standard-risk cytogenetics (n = 65) showed a better prognosis when associated with a lower number of circulating PCs (PC < 41 vs. PC ≥ 41: OS = 62% vs. 24%, P = 0·008; PFS = 48% vs. 21%, P = 0·001). Multivariate analysis on the subgroup with standard-risk cytogenetics confirmed that the co-presence of circulating PCs ≥ 41, older age, Durie-Salmon stage >I and lack of maintenance adversely affected PFS, while OS was adversely affected only by lactate dehydrogenase, older age and lack of maintenance. Our results indicate that the quantification of circulating PCs by a simple two-colour FC analysis can provide useful prognostic information in newly diagnosed MM patients with standard-risk cytogenetics.
authors.affiliation: U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Vagnoni
authors.affiliation: U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy.
authors.forename: Fosco
authors.initials: F
authors.lastname: Travaglini
authors.affiliation: U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Pezzoni
authors.affiliation: U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy.
authors.forename: Miriana
authors.initials: M
authors.lastname: Ruggieri
authors.affiliation: U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy.
authors.forename: Catia
authors.initials: C
authors.lastname: Bigazzi
authors.affiliation: U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Dalsass
authors.affiliation: U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mestichelli
authors.affiliation: U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Troiani
authors.affiliation: U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy.
authors.forename: Sadia
authors.initials: S
authors.lastname: Falcioni
authors.affiliation: U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Mazzotta
authors.affiliation: U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Natale
authors.affiliation: U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Angelini
authors.affiliation: U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ferretti
authors.affiliation: U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Angelini
authors.affiliation: U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Galieni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D003582:Cytogenetics; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D010950:Plasma Cells / Q000378:metabolism* / Q000473:pathology; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor
keywords: circulating plasma cells; cytogenetic-risk; flow cytometry; multiple myeloma; prognostic factors