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Prognostic relevance of cellular morphology in multiple myeloma
E Fritz, H Ludwig and M Kundi
Morphological characteristics of tumor cells have been employed in the
prognosis of lymphomas and solid tumors. This report documents an attempt
to predict survival from the known cytologic heterogeneity in multiple
myeloma. Myeloma cells in bone marrow smears from patients at diagnosis
were evaluated by assigning them to morphologically defined categories.
Cox's multivariate regression model for censored survival data was used to
generate optimal weights, which served as coefficients in two regression
equations to estimate death risk from cellular morphology. Step-wise
procedures excluded redundant parameters. "Myeloma morphology score" (MMS)
discriminates significantly (p less than 0.0001) among 3 stages, with
median survival times of 42.5, 30.7, and 9.1 mo. For clinical routine
application, "myeloma progression score" (MPS), the weight sum of the
proportion of plasmablasts and the extent of bone marrow plasma cell
infiltration, is suggested as a simple prognostic tool. Its discriminative
power is very high [p less than 10(-9)]. Median survival times of greater
than 71.5, 23.4, and 6.1 mo were found for good, moderate, and poor risk
groups, respectively. However, staging is not confined to three subgroups,
grouping is flexible, and pairs of data can be matched. This fact may prove
to be valuable in designing prognosis-controlled clinical trials or
theoretical studies on cellular differentiation. Preliminary results
suggest changes in morphology due to disease progression and/or the effect
of therapy on tumor kinetics. Most importantly, staging according to MPS or
MMS may facilitate the adaption of therapy to the current state of the
disease in patients with multiple myeloma.
Volume 63,
Issue 5,
pp. 1072-1079,
05/01/1984
Copyright © 1984 by The American Society of Hematology
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