Circulating peripheral blood plasma cells as a prognostic indicator in patients with primary systemic amyloidosis.

Abstract:

:This study examined the prognostic value of circulating peripheral blood plasma cells (PBPCs) in patients with primary systemic amyloidosis (AL). A sensitive slide-based immunofluorescence technique was used to assess 147 patients for circulating PBPCs. Circulating monoclonal plasma cells were quantified as a percentage of circulating cytoplasmic immunoglobulin-positive cells (PBPC%). The absolute circulating plasma cell count was also determined. When analyzed retrospectively, 24 (16%) of 147 patients were found to have detectable circulating PBPCs. Overall survival for patients with high PBPC%'s (> 1%) was poorer (median survival, 10 vs 29 months; P =.002). Similarly, overall survival for patients with high PBPC counts (> 0.5 x 10(6)/L) was significantly poorer (median, 13 vs 31 months; P =.003). Increased percentages of bone marrow plasma cells (BMPC%; P =.0004), increased levels of serum beta(2)-microglobulin (P =.04), and dominant cardiac amyloid involvement (P =.03) also predicted poorer survival. The combined consideration of circulating PBPCs and BMPC% identified low-, intermediate-, and high-risk groups with median survivals of 37.5, 15.5, and 10 months, respectively (P =.0003). Multivariate analysis revealed circulating PBPCs and BMPC% to be independent prognostic factors for survival. Patients with PBPC%'s of 2% or higher were significantly more likely to have a coexisting clinical diagnosis of multiple myeloma (50% vs 12%, P =.008). The prognostic value of circulating PBPCs may help select treatment for patients with AL.

journal_name

Blood

journal_title

Blood

authors

Pardanani A,Witzig TE,Schroeder G,McElroy EA,Fonseca R,Dispenzieri A,Lacy MQ,Lust JA,Kyle RA,Greipp PR,Gertz MA,Rajkumar SV

doi

10.1182/blood-2002-06-1698

subject

Has Abstract

pub_date

2003-02-01 00:00:00

pages

827-30

issue

3

eissn

0006-4971

issn

1528-0020

pii

2002-06-1698

journal_volume

101

pub_type

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