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Blood, 1 July 2001, Vol. 98, No. 1, pp. 23-28
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Blood levels of immune cells predict survival in myeloma
patients: results of an Eastern Cooperative Oncology Group phase 3 trial for newly diagnosed multiple myeloma patients
Neil E. Kay,
Tracy L. Leong,
Nancy Bone,
David H. Vesole,
Philip R. Greipp,
Brian Van Ness,
Martin M. Oken, and
Robert A. Kyle
From the Mayo Clinic, Rochester, MN; the Dana Farber
Cancer Institute, Boston, MA; the Medical College of Wisconsin,
Milwaukee, WI; the Institute of Human Genetics, University of
Minnesota, and the Virginia Piper Cancer Institute, Minneapolis, MN.
Previously, it was reported that patients with multiple
myeloma (MM) who have higher baseline levels of blood CD4+
or CD19+ cells have longer survival. This article extends
the analysis of immune cell levels and survival in a large
cohort (N = 504) of patients with MM entered on Eastern
Cooperative Oncology Group (ECOG) phase 3 trial (9486). Newly diagnosed
patients with MM received 2 cycles of vincristine,
bischloroethylnitrosourea, melphalan, cytoxan, prednisone
(VBMCP) and were treated on one of 3 randomized arms: VBMCP with either
interferon or high-dose cyclophosphamide, or VBMCP alone. Blood immune
cell levels were studied at trial entry (baseline), after 2 cycles of chemotherapy, after 2 years of therapy, and at relapse.
Baseline CD3+, CD4+, CD8+,
CD19+, and CD4+ subset cell levels were all
positively associated with survival (P = .0087 to
P < .0001). A multivariate analysis incorporating CD4+ and CD19+ cell levels defined 3 separate
groups of patients with MM to survival outcome. Higher
CD19+ blood levels were positively associated with
MM-patient survival at entry to the study, at year 2, and at relapse
(P < .0001 at all 3 timepoints). Patients with MM had
evidence of immune cell reconstitution after 2 years of therapy, but
the rate and extent of recovery was greater for
CD8+, which was greater than CD4+, which was
greater than CD19+. This latter data affirms the positive
relationship between the quantitative status of the blood immune system
in MM and survival. In addition, the importance of the
CD19+ blood cells to survival is evident throughout the
course of MM. Therapeutic efforts to maintain an intact immune system
may be crucial in maximizing chemotherapeutic and/or immunotherapy
efforts in this disease.
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