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document
Circulating blood B cells in multiple myeloma : analysis and relationship to circulating clonal cells and clinical parameters in a cohort of patients entered on the Eastern Cooperative Oncology Group phase III E9486 clinical trial . Recent analyses of circulating blood B cells in myeloma have generated controversy concerning the exact levels of these cells and whether they may represent circulating clonal tumor B cells . Previous reports suggested that CD19+ B cells are markedly increased in myeloma patients and that this population shares clonotypic rearrangements with the malignant plasma cell . We studied the numbers of CD19+ B cells by flow cytometry in previously untreated newly diagnosed myeloma patients in Eastern Cooperative Oncology Group ( ECOG ) phase III trial E9486 . There were 628 patients who were eligible for the clinical protocol E9486 , but of these 521 were also entered on the companion laboratory study ( E9487 ) and had CD19 data . In comparison with normal controls , the myeloma patients exhibited a marked heterogeneity in the number of circulating CD19+ B cells as detected by flow cytometry . Approximately 20 % of patients had significantly increased levels of circulating CD19+ B cells . However , the total CD19+ blood population from myeloma was not significantly different from the median of age-matched , normal controls . Analysis of CD19+ blood cells in relationship to circulating clonal cells was done in 13 myeloma patients using a clonotypic , quantitative allele-specific oligonucleotide-polymerase chain reaction ( PCR ) assay . No correlation was found between the numbers of CD19+ B cells ( range , 5 % to 51 % ) and PCR estimates of the number of clonal cells in the peripheral blood ( range , .009 % to 3.6 % ) . Low CD19+ B-cell level ( < 125 microL ) was associated with clinical stage III ( P = .033 ) . A significant relationship exists between higher levels ( > or = 125/microL ) of CD19 cells and longer overall survival ( P < .0001 ) . In addition , high CD19 levels also predicted a clinical response and longer event-free survival . There was a strong inverse association between the level of CD19 values at diagnosis and infections within the first 2 months of diagnosis . Importantly , the number of deaths related to infections was significantly greater in the low versus high CD19 group ( P < .0202 ) . Also , CD19 is an independent prognostic factor in addition to plasma cell labeling indices , beta2-microglobulin , hemoglobin , and plasmablastic morphology . Patients with infections were more likely to have low levels of CD19+ cells . In summary , higher CD19+ cell levels are a favorable prognostic sign with no apparent relationship to circulating tumor cells . In addition , this analysis strongly suggests that low peripheral blood levels of CD19+ cells are an adverse prognostic sign in myeloma . The CD19+ cell levels in myeloma patients is an important parameter in the overall assessment of these patients .
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Intervention_Physical
Circulating blood B cells
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Intervention_Physical
CD19+ B cells
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Intervention_Physical
flow cytometry
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Intervention_Physical
PCR
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Intervention_Physical
CD19 values
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Intervention_Physical
CD19+
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Outcome_Physical
CD19+ B cells
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Outcome_Physical
CD19+ B cells
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Outcome_Physical
CD19+ B cells
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Outcome_Physical
levels of circulating CD19+ B cells
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Outcome_Physical
total CD19+ blood population
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Outcome_Physical
CD19+ blood cells
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Outcome_Physical
CD19+ B cells
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Outcome_Physical
CD19+ B-cell level
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Outcome_Physical
clinical stage III
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Outcome_Physical
CD19 cells
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Outcome_Mortality
longer overall survival
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Outcome_Physical
CD19 levels
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Outcome_Mortality
event-free survival
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Outcome_Physical
CD19 values
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Outcome_Mortality
number of deaths related to infections
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Outcome_Physical
levels of CD19+ cells
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Outcome_Physical
CD19+ cell levels
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Outcome_Physical
blood levels of CD19+
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Outcome_Physical
CD19+ cell
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Participant_Condition
Eastern Cooperative Oncology Group phase III E9486 clinical trial
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Participant_Condition
myeloma patients
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Participant_Sample-size
628 patients
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Participant_Sample-size
521