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Purpose To analyze the prognostic impact of immunophenotyping in patients with multiple myeloma (MM). Patients and Methods We have prospectively analyzed the prognostic impact of antigenic markers, assessed by multiparametric flow cytometry, in a series of 685 newly diagnosed MM patients that were uniformly treated according to the GEM 2000 protocol. Results Our results show that expression of both CD19 and CD28 as well as the absence of CD117 were associated with a significantly shorter progression free-survival (PFS) and overall survival (OS). Interestingly, the CD28 expression correlated with t(14;16) and del(17p), while CD117-negative patients were associated with t(4;14) and del(13q). Simultaneous assessment of CD28 and CD117 antigens allowed stratification of patients with MM into three risk categories: poor risk (CD28 positive CD117 negative), intermediate (either both markers negative or both positive), and good risk (CD28 negative CD117 positive), with PFS rates of 30, 37, and 45 months, respectively (P = .01), and OS rates of 45, 68, and not reached, respectively (P = .0001). Conclusion To the best of our knowledge, this is the first prospective analysis in which the prognostic impact of a relatively high number of antigenic markers has been simultaneously analyzed in a large series of uniformly treated patients, showing that the expression of several antigens (particularly CD28 and CD117) on bone marrow plasma cells from patients with MM can help to identify patients at high risk of progression.

Fluorescence in situ hybridization (FISH) has become a powerful technique for prognostic assessment in multiple myeloma (MM). However, the existence of associations between cytogenetic abnormalities compels us to re-assess the value of each abnormality. A total of 260 patients with MM at the time of diagnosis, enrolled in the GEM-2000 Spanish transplant protocol, have been analyzed by FISH in order to ascertain the independent influence on myeloma prognosis of IGH translocations, as well as RB and P53 deletions. Survival analyses showed that patients with t(4;14), RB or P53 deletions had a significantly shorter survival than patients without these abnormalities. However, patients with RB deletions without other abnormalities in FISH analysis, displayed a similar outcome to those patients without genetic changes by FISH (46 vs 54 months, P=0.3). In the multivariate analysis the presence of t(4;14), RB deletion associated with other abnormalities, age >60 years, high proportion of S-phase cells and advanced stage of the disease according to the International Staging System retained their independent prognostic influence. In summary, RB deletion as a sole abnormality does not lead to a shortening in the survival of MM patients, whereas t(4;14) confers the worst prognosis in MM patients treated with high-dose chemotherapy.

OBJECTIVE: To find the pattern of causes of mortality in the Chantrea (Navarra) Health District and the trends in main causes of death between 1987 and 1995. DESIGN: Descriptive study. SETTING: Urban primary care centre. STUDY POPULATION: Population belonging to the Chantrea Health District. INTERVENTIONS: 1986 data from the Municipal Roll of inhabitants of Chantrea were crossed with the Navarra mortality figures to find the deaths occurred between 1986 and 1995. Overall mortality and mortality for the main reasons were analysed for both sexes and for the periods 1987-1990 and 1991-1995. RESULTS: Between 1991 and 1995, Chantrea had a mortality rate close to that of the European population: 711 per 100000 inhabitants for men and 403 per 100000 for women. The main causes of death were circulatory diseases, tumours, respiratory diseases and external causes. Overall mortality rates dropped by 11.8% among men and by 8% among women from the 1987-1990 period to the 1991-1995 period. Statistically significant drops in mortality were noted for circulatory diseases and for malignant oesophageal tumours in men. AIDS as cause of death increased significantly among men. CONCLUSIONS: Low rates of overall mortality in men and women of Chantrea and, in particular, mortality rates for circulatory disease were below the figures recorded in most European countries. Other causes of death, such as traffic accidents, AIDS or malignant tobacco-related tumours had moderately high rates.