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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: To explore the correlation between the immunophenotype and clinical features of multiple myeloma (MM) and its prognostic value by four-color flow cytometry. Methods: Immunocytochemistry and cytogenetic abnormalities of 50 cases of newly diagnosed MM patients were detected by four-color flow cytometry and interphase fluorescence in situ hybridization respectively. The clinical and laboratory parameters of the patients were collected. Results: Four color CD antigens were detected in different combinations: CD38-PE / CD45-Percp / CD19-FITC / CD56-APC; CD38-FITC / CD138-Percp / CD117- Percate / CD27-APC / CD20-FITC, in which the expression of CD28 was mostly associated with high stage of ISS, with more susceptible bone marrow infiltration, anemia, hypercalcemia, impaired renal function, low albumin, high β2-microglobulin, and IGH Translocation and other adverse prognostic factors, while CD117 is the better prognostic factor, the expression of missing patients prone to bone marrow infiltration, low albumin, and prone to del (13q14), IGH translocation, further analysis found that del (13q14) and (R = 0.378, P <0.05). According to the co-expression of CD28 and CD117 and the prognosis risk of FISH group, the high risk group (CD28 + CD117-) and the risk of FISH prognosis group were higher Group (13q14 deletion) between the difference was statistically significant (P <0.05). Conclusion: CD28 and CD117 are of great value in clinical prognosis of patients with MM, and their combined assessment can help MM patients to identify prognostic factors and guide clinical treatment.