多发性骨髓瘤免疫表型分析及预后

Immunophenotype and prognosis of multiple myeloma

目的 :探讨多发性骨髓瘤 (MM )骨髓免疫表型的特点及外周血CD 38+ 细胞的表达。方法 :采用间接免疫荧光法对 4 1例MM患者进行免疫表型分析。结果 :①MM患者外周血及骨髓CD38+ 表达率均为 90 .2(37/ 4 1) %。②按三个不同病期分为初发期组、稳定期组及进展期组患者的骨髓细胞CD38及HLA DR阳性表达率分别为 88.9%、5 5 .6 % ;88.9%、6 6 .7% ;10 0 .0 %、4 0 .0 %。其外周血三个病期CD38+ 细胞表达率分别为88.9%、88.9%及 10 0 .0 % ,不管是外周血还是骨髓三组相比均差异无统计学意义 (P >0 .0 5 )。③按形态学分类将MM初诊患者分为成熟型和幼稚型 ,两个组CD38+ 及HLA DR阳性表达率分别为 83.3%、6 6 .7% ;10 0 .0 %、4 6 .7% ,两组相比差异无统计学意义 (P >0 .0 5 ) ;④B淋巴系统抗原在初发期、进展期中CD19、CD2 0呈部分表达 ,而在稳定期则全部消失 ;μ、κ、λ在三个组中均呈低表达 ,7例 μ、κ、λ阳性表达的病例中有 6例为骨髓瘤细胞 >6 0 %以上。结论 :CD38+ 对于诊断MM有独特意义 ,尤其结合外周血意义更大 ;B淋巴系统抗原CD19、CD2 0可能是一个预后不良因素 ,提示CD19+ 、CD2 0 + 患者预后差 ;认为骨髓中瘤细胞≥ 6 0 %对于轻链、重链的检出有价值。

Objective:To study the immunophenotype in bone marrow and the expression of CD38 in peripheral blood in multiple myeloma (MM).Method:Indirect immunofluorescence assay was used to determine the immunophenotype of 41 MM patients.Result: ①Both of the positive rates of CD38 in peripheral blood and bone marrow were 90.2%. ②The positive rates of CD38 and HLA-DR in three stages including prethreapy stage、stable stage and developing stage were 88.9%、 55.6%, 88.9%、 66.7%, 100.0%、 40.0% respectively. The positive rates of CD38 in three stages in peripheral blood were 88.9%、 88.9% and 100.0% respectively, but there were no statistic differences of the expressions of CD38 and HLA-DR among the three stages in both of peripheral blood and bone marrow. ③The positive rates of CD38 and HLA-DR in mature group and immature group of pretherapy patients were 83.3%、 66.7%, 100.0%、 46.7% respectively, which were not statistically different between the two groups. ④CD19 and CD20 expressed in part of patients in pretherapy and developing stages, but they disappeared in patients in stable stage. The positive rates of μ、κ、λ were vrey low in the three stages. The number of cancer cells in 6 of 7 patients with expression ofμ、κ or λ were more than 60%.Conclusion:CD38 + was of significant value in bone marrow for the diagnosis of MM, especially when it was combined with that in peripheral blood. The expression of CD19 and CD20 might predict poor prognosis. It was valuable for the detection of light chain and heavy chain while the number of cancer cells was equal to or more than 60%.