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Blood, 1 October 2007, Vol. 110, No. 7, pp. 2586-2592.
Prepublished online as a Blood First Edition Paper on June 18, 2007; DOI 10.1182/blood-2007-05-088443.
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NEOPLASIA
New criteria to identify risk of progression in monoclonal gammopathy of uncertain significance and smoldering multiple myeloma based on multiparameter flow cytometry analysis of bone marrow plasma cells
Ernesto Pérez-Persona1,
María-Belén Vidriales1,2,
Gema Mateo1,
Ramón García-Sanz1,2,
Maria-Victoria Mateos1,
Alfonso García de Coca3,
Josefina Galende4,
Guillermo Martín-Nuñez5,
José M. Alonso6,
Natalia de las Heras7,
José M. Hernández8,
Alejandro Martín9,
Consuelo López-Berges1,
Alberto Orfao2,10, and
Jesús F. San Miguel1,2
1 Department of Hematology, University Hospital, Salamanca;
2 Centro de Investigación del Cancer, Universidad de Salamanca/Consejo Superior de Investigaciones Cientificas (CSIC), Salamanca;
3 Department of Hematology, University Hospital, Valladolid;
4 Department of Hematology, Hospital Comarcal del Bierzo, Ponferrada, León;
5 Department of Hematology, Hospital Nuestra Señora del Puerto de Plasencia, Cáceres;
6 Department of Hematology, Hospital Río Carrión, Palencia, Caceres;
7 Department of Hematology, Complejo Hospitalario, León;
8 Department of Hematology, General Hospital, Segovia;
9 Department of Hematology, Hospital Virgen de la Concha, Zamora; and
10 Department of Cytometry, University of Salamanca, Salamanca, Spain
Monoclonal gammopathy of uncertain significance (MGUS) and smoldering multiple myeloma (SMM) are plasma cell disorders with a risk of progression of approximately 1% and 10% per year, respectively. We have previously shown that the proportion of bone marrow (BM) aberrant plasma cells (aPCs) within the BMPC compartment (aPC/BMPC) as assessed by flow cytometry (FC) contributes to differential diagnosis between MGUS and multiple myloma (MM). The goal of the present study was to investigate this parameter as a marker for risk of progression in MGUS (n = 407) and SMM (n = 93). Patients with a marked predominance of aPCs/BMPC ( 95%) at diagnosis displayed a significantly higher risk of progression both in MGUS and SMM (P< .001). Multivariate analysis for progression-free survival (PFS) selected the percentage aPC/BMPC ( 95%) as the most important independent variable, together with DNA aneuploidy and immunoparesis, for MGUS and SMM, respectively. Using these independent variables, we have identified 3 risk categories in MGUS (PFS at 5 years of 2%, 10%, and 46%, respectively; P< .001) and SMM patients (PFS at 5 years of 4%, 46%, and 72%, respectively; P < .001). Our results show that multiparameter FC evaluation of BMPC at diagnosis is a valuable tool that could help to individualize the follow-up strategy for MGUS and SMM patients.
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