四色流式细胞术分析多发性骨髓瘤的免疫表型与临床特征及预后关系

Four-color flow cytometric analysis of multiple myeloma and the correlation with its clinical features and prognosis

目的:利用四色流式术探讨多发性骨髓瘤(MM)免疫表型与临床特征的相关性及其预后价值。方法:分别用四色流式细胞术、间期荧光原位杂交技术检测50例初诊MM患者的瘤细胞表面免疫表型以及细胞遗传学异常,并收集患者的临床和实验室指标。结果:共检测不同组合的四色CD抗原:CD38-PE/CD45-Percp/CD19-FITC/CD56-APC;CD38-FITC/CD138-Percp/CD117-PE/CD28-APC;CD38-PE/CD138-Percp/CD27-APC/CD20-FITC,其中CD28的表达多与ISS高分期相关,多易骨髓浸润,出现贫血、高钙、肾功能损害、低白蛋白、β2-微球蛋白高水平,以及IGH易位等不良预后因素,而CD117则为较佳预后因素,其表达缺失患者多易出现骨髓浸润,低白蛋白,且易出现del(13q14),IGH易位,进一步分析发现del(13q14)与IGH易位之间存在相关性(r=0.378,P<0.05);分别根据CD28和CD117的联合表达以及FISH预后风险分组,流式高危组(CD28+CD117-)与FISH预后风险分组中的高危组(13q14缺失)之间差异有统计学意义(P<0.05)。结论:CD28和CD117对MM患者的临床预后具有重要的价值,且其联合评估能够帮助MM患者识别预后因素,指导临床治疗。

Objective：This study was purposed to investigate the relation between the immunophenotype and clinical features or prognosis in multiple myeloma（MM）.Method：The immunophenotype and cytogenetic abnormalities of myeloma cell of 50 cases of newly diagnosed MM patients were detected with multiparameter flow cytometry（MFC） and interphase fluorescence in situ hybridization（I-FISH）respectively.The clinical and laboratory parameters of the patients were colleted and analyzed as well.Result：In this study,different antigen combinations were detected： CD38-PE/CD45-Percp/CD19-FITC/CD56-APC,CD38-FITC/CD138-Percp/CD117-PE/CD28-APC,CD38-PE/CD-138-Percp/CD27-APC/CD20-FITC.Expression of CD28 was associated with a significant higher frequency of advanced International staging system（ISS） stages,higher levels of BM infiltration（PC≥30%）and β2-microglobulin（β2-MG≥0.2 g/L）,greater frequencies of anemia（Hemoglobin≤100 g/L）,hypercalcemia（calcium≥2.75 mmol/L）,renal impairment（creatinine≥0.2 g/L）,low albumin（albumin≤30 g/L）,and IGH translocations.In turn,lack of CD117 expression was associated with higher levels of BM infiltration,greater frequencies of low albumin,del（13q14） and IgH translocations.Further analysis revealed that there was correlation between del（13q14） and IGH translocation（r=0.378,P〈0.05）.Grouped according to the joint expression of CD28 and CD117 or the risk stratification of FISH,we found that there was significant difference between the CD28＋CD117-group and del（13q14） group（P〈0.05）.Conclusion：The expression of CD28 and CD117 has important clinical prognosis value for MM patients,which helps for identifying the prognostic factors and guiding clinical treatment in MM.