1 Prediction of survival using absolute lymphocyte count for newly diagnosed patients with multiple myeloma:a retrospective study Hilmi Ege, Morie A.Gertz, Svetomir N.Markovic Div. of Hematology/Dep.of medicine Mayo Clinic College of Medicine, MN, USA British journal of Haematology,vol 141,June 2008

2 Introduction  Absolute lymphocyte count(ALC) recovery after autologous stem cell transplantation - prognostic factor for survival in multiple haematological malignancies  Quantitative numbers of CD 19+ cells at the time of MM diagnosis - survival  Failed to compare the prognostic ability of CD 19+ cell against chromosome analysis and ISS  ALC at diagnosis was analyed in newly diagnosed MM to assess whether ALC, marker of host immune status, is associated with survival at diagnosis of MM

3 Patients and methods  Patient population 1835 Multiple myeloma patients at the Mayo Clinic,1994~2002,originally diagnosed,followed and treated at the Mayo Clinic ->537 MM Pts. Excluded- concomitant malignant diagnosis,other plasma proliferative disorder,amyloidosis  End point Primary end point - to assess the impact on overall survival (OS) based on ALC at diagnosis in newly diagnosed MM Pts Secondary end point - whether the ALC at diagnosis was an independent prognostic factor for OS in MM Pts  Prognostic factors ISS,age,albumin ( 3.5mg/l),BM plasma cell(BMPC>40%),circulating plasma cells,LDH,plsama cell labelling index

4 Results

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10 Discussion  First report linking ALC at diagnosis to prognosis newly diagnosed MM – strong independent predictor of treatment outcome in MM Pts  Previous studies – quantitative numbers of CD19 or development of T cell clones associated survival but failed to analysis against cytogenetics or ISS  Human studies – T cell has suppressive effect on immunoglobulin production, lymphocyte has antimyeloma activity ->host immune system to MM

11 Limitations  First - none of the Pts had their lymphocyte subset analysed at diagnosis  Second - 57% of cohort has chromosomes studies performed by conventional cytogenetics,false negative results so conventional karyotyping was not included  Third - Choice of standard Tx versus ASCT biased by physicians’s preferance based on Pt’s characteristics but higher ALC better OS regardless of their Tx

12 Conclusion  In newly diagnosed MM, ALC is independent prognostic factor for OS, suggesting significant role of host immune status in survival of MM