Objective: To explore the expression of CD28 in multiple myeloma and its correlation with tumor burden and clinical prognosis.
Methods: Flow cytometry was adopted to analyze bone marrow specimens of 91 newly diagnosed patients with multiple myeloma. According to CD28 expression, the patients were divided into CD28+ group and CD28- group, and the differences between the two groups in clinical features, genetic abnormalities, and treatment response were compared. Staging was carried out in accordance with the International Staging System (ISS).
Results: Among 91 newly diagnosed patients, there were 31 cases in CD28+ group and 60 cases in CD28- group. The proportion of ISS-Ⅲ patients in the CD28+ group was 70.97%, which was higher than 50.00% in the CD28- group (P<0.05). The median of bone marrow plasma cells in the CD28+ group was 41.78(2.00-77.00), which was higher than 26.92(2.00-92.00) in the CD28- group (P<0.05). β2-microglobulin level in the CD28+ group was 6.53(2.11-36.50) mg/L, which was higher than 5.76(2.00-31.34) mg/L in the CD28- group (P<0.05). The positive rate of poor karyotype in the CD28+ group was 70.00% (21/30), which was higher than 45.00% (27/60) in the CD28- group (P=0.025). After 4 cycles of chemotherapy, the total effective rate of CD28- group was 86.27%, which was higher than 60.00% of CD28+ group (P<0.05). After a median follow-up of 10 months, the progression-free survival (PFS) time of CD28+ group was 10.7 months, which was lower than 14 months of CD28- group (P<0.05). Univariate analysis showed that age ≥ 65 years old, hemoglobin < 60 g/L, ISS-III, CD28+ expression and ≥ 2 genetic abnormalities were not risk factors for PFS, while further multivariate analysis showed that induction effect < partial response (PR) and CD28+ expression and were independent risk factors for PFS.
Conclusion: CD28+ is associated with clinical characteristics and prognosis of newly diagnosed multiple myeloma patients, and can be used as a reference index to evaluate the prognosis.
题目: CD28表达在初诊多发性骨髓瘤中的临床意义.
目的: 探讨CD28在多发性骨髓瘤中的表达及其与肿瘤负荷、临床预后的相关性。.
方法: 用流式细胞术对91例新诊断的多发性骨髓瘤患者骨髓标本进行免疫表型分析。根据CD28表达将患者分为CD28+组与CD28-组，比较两组在临床特征、遗传学异常、治疗反应等方面的差异。根据国际分期系统（ISS）进行分期。.
结果: 91例初诊患者中，CD28+组患者31例，CD28-组患者60例；CD28+组ISS-Ⅲ期患者比例为70.97%，高于CD28-组的50.00%（P<0.05）；CD28+组患者骨髓浆细胞中位数为41.78（2.00-77.00），高于CD28-组患者的26.92（2.00-92.00）（P<0.05）；CD28+组患者β2-微球蛋白水平为6.53（2.11-36.50）mg/L，高于CD28-组患者的5.76（2.00-31.34）mg/L（P<0.05）；CD28+组患者不良核型阳性率为70.00%（21/30），高于CD28-组患者的45.00%（27/60）（P=0.025）；化疗4个周期后，CD28-组总有效率为86.27%，高于CD28+组的60.00%（P<0.05）；中位随访10个月，CD28+组无进展生存期为10.7个月，低于CD28-组的14个月（P<0.05）。单因素分析显示，年龄≥65岁、血红蛋白<60 g/L、ISS Ⅲ期、CD28+表达及≥2个遗传学异常均不是影响患者PFS的危险因素；进一步的多因素分析表明，诱导效果<PR、CD28+表达是影响患者PFS的独立危险因素。.
结论: CD28+与初诊的多发性骨髓瘤患者临床特征及预后有关，可作为评估患者预后的参考指标。.
Keywords: CD28; flow cytometry; multiple myeloma; prognosis.