Mieloma múltiplo: estudo do microambiente e correlação com fatores prognósticos
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Data
2020-01-17
Autores
Duarte, Pollyanna Domeny [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Mieloma Múltiplo é uma neoplasia maligna de células plasmocitárias, cujas repercussões clínicas de interação da célula tumoral com seu microambiente e com o hospedeiro podem causar danos irreversíveis e progressivos ao doente. Estratégias terapeuticas têm tentado reunir antídotos às várias linhas de atuação da célula tumoral. Objetivou-se avaliar características clíncas e possíveis interações com o microambiente da medula óssea. Foram colhidos dados clínicos, reavaliado material histológico e confeccionado bloco de TMA com grupos de pacientes ao diagnóstico, na primeira recaída e após transplante autólogo de medula óssea. A análise estatística compreendeu descrição dos dados de distribuições de frequência para as variáveis qualitativas e calculadas as médias, desvios padrão, valores mínimo e máximo e mediana para as variáveis quantitativas. O teste de Qui-quadrado de Pearson foi empregado para variáveis qualitativas. Gráficos do tipo mosaico apresentaram os cruzamentos das variáveis discretas e técnica FAMD para verificação da contribuição das variáveis qualitativas e quantitativas simultaneamente. As curvas de sobrevida foram obtidas usando a metodologia de Kaplan & Meier e a estatística de Breslow foi empregada para testar a diferença entre as curvas observadas. Os intervalos de confiança para as curvas e testes foram feitos com nível de significância de 5%. As análises e figuras foram elaboradas com o software R (R Core Team, 2017). Concluímos que pacientes com condições clínicas para terapeuticas iniciais mais agressivas podem ter impacto em suas curvas de sobrevida; que pacientes em uso de talidomida tem risco de morte reduzido; que estádio ISS avançado reduz em até três vezes a sobrevida e que há associação negativas entre resposta terapeutica e positividade das células tumorais para ciclina-D1, CD45 e cadeia leve de imunoglobulina kappa.
Multiple Myeloma is a malignant neoplasm of plasma cells whose clinical repercussions of tumor cell interaction with its microenvironment and host may cause irreversible and progressive damage to the patient. Therapeutic strategies have attempted to gather antidotes to the various lines of action of the tumor cell. This study aimed to evaluate clinical characteristics and possible interactions with the bone marrow microenvironment. Clinical data were collected, histological material was reevaluated and an AMT block was made with patient groups at diagnosis, in the first relapse and after autologous bone marrow transplantation. Statistical analysis included description of frequency distribution data for qualitative variables and calculated means, standard deviations, minimum and maximum values and median for quantitative variables. Pearson's chi-square test was used for qualitative variables. Mosaic graphs showed the intersections of discrete variables and FAMD technique to verify the contribution of qualitative and quantitative variables simultaneously. Survival curves were obtained using the Kaplan & Meier methodology and the Breslow statistic was employed to test the difference between the observed curves. Confidence intervals for curves and tests were made at a significance level of 5%. The analyzes and figures were elaborated with the R software (R Core Team, 2017).We conclude that patients with clinical conditions for more aggressive initial therapies may impact their survival curves; whereas thalidomide patients have a reduced risk of death; which advanced ISS stage reduces survival by up to three-fold and that there is a negative association between therapeutic response and tumor cell positivity for cyclin-D1, CD45 and kappa immunoglobulin light chain.
Multiple Myeloma is a malignant neoplasm of plasma cells whose clinical repercussions of tumor cell interaction with its microenvironment and host may cause irreversible and progressive damage to the patient. Therapeutic strategies have attempted to gather antidotes to the various lines of action of the tumor cell. This study aimed to evaluate clinical characteristics and possible interactions with the bone marrow microenvironment. Clinical data were collected, histological material was reevaluated and an AMT block was made with patient groups at diagnosis, in the first relapse and after autologous bone marrow transplantation. Statistical analysis included description of frequency distribution data for qualitative variables and calculated means, standard deviations, minimum and maximum values and median for quantitative variables. Pearson's chi-square test was used for qualitative variables. Mosaic graphs showed the intersections of discrete variables and FAMD technique to verify the contribution of qualitative and quantitative variables simultaneously. Survival curves were obtained using the Kaplan & Meier methodology and the Breslow statistic was employed to test the difference between the observed curves. Confidence intervals for curves and tests were made at a significance level of 5%. The analyzes and figures were elaborated with the R software (R Core Team, 2017).We conclude that patients with clinical conditions for more aggressive initial therapies may impact their survival curves; whereas thalidomide patients have a reduced risk of death; which advanced ISS stage reduces survival by up to three-fold and that there is a negative association between therapeutic response and tumor cell positivity for cyclin-D1, CD45 and kappa immunoglobulin light chain.
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Palavras-chave
Mieloma múltiplo, Gamopatia monoclonal, Imunoglobulina, Microambiente, Multiple myeloma, Monoclonal gammopathy, Immunoglobulin, Light chains, Microenvironment