Originally published as JCO Early Release 10.1200/JCO.2007.15.4120 on April 28 2008

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Prognostic Value of Immunophenotyping in Multiple Myeloma: A Study by the PETHEMA/GEM Cooperative Study Groups on Patients Uniformly Treated With High-Dose Therapy

Gema Mateo, M. Angeles Montalbán, Maria-Belén Vidriales, Juan J. Lahuerta, Maria V. Mateos, Norma Gutiérrez, Laura Rosiñol, Laura Montejano, Joan Bladé, Rafael Martínez, Javier de la Rubia, Joaquín Diaz-Mediavilla, Anna Sureda, José M. Ribera, José M. Ojanguren, Felipe de Arriba, Luis Palomera, Maria J. Terol, Alberto Orfao, Jesús F. San Miguel

From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain

Corresponding author: Jesús F. San Miguel, Servicio de Hematología, Hospital Universitario de Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, SPAIN; e-mail: sanmigiz{at}usal.es

Purpose To analyze the prognostic impact of immunophenotyping in patients with multiple myeloma (MM).

Patients and Methods We have prospectively analyzed the prognostic impact of antigenic markers, assessed by multiparametric flow cytometry, in a series of 685 newly diagnosed MM patients that were uniformly treated according to the GEM 2000 protocol.

Results Our results show that expression of both CD19 and CD28 as well as the absence of CD117 were associated with a significantly shorter progression free-survival (PFS) and overall survival (OS). Interestingly, the CD28 expression correlated with t(14;16) and del(17p), while CD117-negative patients were associated with t(4;14) and del(13q). Simultaneous assessment of CD28 and CD117 antigens allowed stratification of patients with MM into three risk categories: poor risk (CD28 positive CD117 negative), intermediate (either both markers negative or both positive), and good risk (CD28 negative CD117 positive), with PFS rates of 30, 37, and 45 months, respectively (P = .01), and OS rates of 45, 68, and not reached, respectively (P = .0001).

Conclusion To the best of our knowledge, this is the first prospective analysis in which the prognostic impact of a relatively high number of antigenic markers has been simultaneously analyzed in a large series of uniformly treated patients, showing that the expression of several antigens (particularly CD28 and CD117) on bone marrow plasma cells from patients with MM can help to identify patients at high risk of progression.

published online ahead of print at www.jco.org on April 28, 2008.

Supported by the Cooperative Research Thematic Network (RD06/0020/0006), MM Jevitt Foundation Grant No. QAG7, and Instituto de Salud Carlos III/Subdirección General de Investigación Sanitaria (PI060339 and 02/0905).

Presented in part at the 49th Annual Meeting of the American Society of Hematology December 8-11, 2007.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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