title: Prognostic impact of circulating plasma cells in patients with multiple myeloma: implications for plasma cell leukemia definition.
abstract: The presence of circulating plasma cells in patients with multiple myeloma is considered a marker for highly proliferative disease. In the study herein, the impact of circulating plasma cells assessed by cytology on survival of patients with multiple myeloma was analyzed. Wright-Giemsa stained peripheral blood smears of 482 patients with newly diagnosed myeloma or plasma cell leukemia were reviewed and patients were classified into 4 categories according to the percentage of circulating plasma cells: 0%, 1-4%, 5-20%, and plasma cell leukemia with the following frequencies: 382 (79.2%), 83 (17.2%), 12 (2.5%) and 5 (1.0%), respectively. Median overall survival according to the circulating plasma cells group was 47, 50, 6 and 14 months, respectively. At multivariate analysis, the presence of 5 to 20% circulating plasma cells was associated with a worse overall survival (relative risk 4.9, 95% CI 2.6-9.3) independently of age, creatinine, the Durie-Salmon system stage and the International Staging System (ISS) stage. Patients with ≥5% circulating plasma cells had lower platelet counts (median 86×109/Lvs214×109/L,P<0.0001) and higher bone marrow plasma cells (median 53%vs36%,P=0.004). The presence of ≥5% circulating plasma cells in patients with multiple myeloma has a similar adverse prognostic impact as plasma cell leukemia.
authors.affiliation: Department of Haematology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Josep Carreras Leukemia Research Institutes, Universitat Autònoma de Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Granell
authors.affiliation: Amyloidosis and Myeloma Unit, Department of Haematology, Hospital Clínic and IDIBAPS, Universitat de Barcelona, Spain.|Laboratory of Cytology. Department of Pathology, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Calvo
authors.affiliation: Department of Haematology, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Garcia-Guiñón
authors.affiliation: Department of Haematology, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Escoda
authors.affiliation: Department of Haematology. Hospital del Mar-IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Eugènia
authors.initials: E
authors.lastname: Abella
authors.affiliation: Department of Haematology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Josep Carreras Leukemia Research Institutes, Universitat Autònoma de Barcelona, Spain.
authors.forename: Clara Mª
authors.initials: CM
authors.lastname: Martínez
authors.affiliation: Department of Haematology, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Teixidó
authors.affiliation: Department of Haematology, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain.
authors.forename: Mª Teresa
authors.initials: MT
authors.lastname: Gimenez
authors.affiliation: Department of Haematology. Hospital del Mar-IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Senín
authors.affiliation: Department of Haematology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Josep Carreras Leukemia Research Institutes, Universitat Autònoma de Barcelona, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Sanz
authors.affiliation: Department of Haematology, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Spain.
authors.forename: Desirée
authors.initials: D
authors.lastname: Campoy
authors.affiliation: Department of Haematology, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Vicent
authors.affiliation: Laboratory of Cytology. Department of Pathology, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain.
authors.forename: Leonor
authors.initials: L
authors.lastname: Arenillas
authors.affiliation: Amyloidosis and Myeloma Unit, Department of Haematology, Hospital Clínic and IDIBAPS, Universitat de Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Rosiñol
authors.affiliation: Department of Haematology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Josep Carreras Leukemia Research Institutes, Universitat Autònoma de Barcelona, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Sierra
authors.affiliation: Amyloidosis and Myeloma Unit, Department of Haematology, Hospital Clínic and IDIBAPS, Universitat de Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Bladé
authors.affiliation: Amyloidosis and Myeloma Unit, Department of Haematology, Hospital Clínic and IDIBAPS, Universitat de Barcelona, Spain cfernan1@clinic.ub.es.
authors.forename: Carlos Fernández
authors.initials: CF
authors.lastname: de Larrea
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000473:pathology; D006801:Humans; D007952:Leukemia, Plasma Cell / Q000175:diagnosis / Q000401:mortality; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000473:pathology; D010950:Plasma Cells / Q000473:pathology*; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis