Prognostic relevance of a histologic classification system applied in bone marrow biopsies from patients with multiple myeloma: A histopathological evaluation of biopsies from 153 untreated patients*

Abstract

A total of 153 diagnostic bone marrow biopsies from patients with advanced stages of multiple myeloma corresponding to stages II and III according to the Durie/Salmon classification were evaluated prior to any treatment in a prospective therapy trial of the German Myeloma Treatment Group. Histologic sections were analyzed according to a pre‐defined system of criteria microscopically by 2 observers, determining three criteria: 1) grading by histopathology, regarding the cytologic differentiation of neoplastic cells and quantifying the percentage of plasmacytic, pleomorphic, and plasmablastic myeloma cells distributed within the sections; 2) the volume of infiltration; and 3) the pattern of neoplastic growth. Furthermore, four other criteria, namely hematopoiesis, fiber increase, osteomalacia, and micro‐osteo‐lesions, were evaluated. A cluster analysis using the three histological criteria revealed three groups of patients with significantly different survival times based on histological criteria only; the three criteria were mentioned above. It is concluded from these results that bone marrow biopsies, when evaluated histologically by grading and staging according to the three criteria, provide most valuable prognostic parameters in myeloma patients.

Prognostic significance of bone marrow histology in multiple myeloma

“…The criteria put forward by the German myeloma task force was used by us to type the plasma cell morphology into well differentiated, intermediately differentiated or poorly differentiated plasma cells. [7] Mitosis was counted in 20 high power fields showing plasma cell infiltration in the biopsy and was categorized as 0-1/ 10 hpf, 2-5/10 hpf and >5/10 hpf. Fibrosis was graded between grade 0 and 3 as per the European Consensus method.…”

“…[2] Several clinical, laboratory and histological/cytological variables help us in determining the prognosis of the disease. [1,[3][4][5][6][7] The first histological classification and staging of multiple myeloma, based on the bone marrow trephine biopsy, was put forward by Bartl et al in 1987. [3] The Durie and Salmon clinical staging system, proposed in 1977, [8] is still being used today, though it has been replaced by the ISS staging at many places.…”

“…Histological parameters that have a definitive prognostic significance in multiple myeloma are the percentage of myeloma cells in the marrow, pattern of infiltration, degree of plasma cell atypia, marrow fibrosis and mitotic index. [5][6][7] There have been very few studies from India evaluating bone marrow histology of plasma cells in myeloma. [10,11] The current study presents an approach to evaluate the histological features in the bone marrow trephine biopsy in multiple myeloma which could be of use in prognostication.…”

Expression of VEGF and microvessel density in patients with multiple myeloma: clinical and prognostic significance

“…A number of clinical variables were particularly analyzed: age, gender, clinical stage, presence and extent of bone lesions, serum immunoglobulins, serum and urine immunoelectrophoresis, albumin, C-reactive protein, b 2 -microglobulin, calcium, creatinine, 24-h proteinuria, hemoglobin concentration, and platelet count. Classification of the histological grade of plasma cell differentiation was done according to the model proposed by Sailer et al [12] and was defined as low, intermediate, and high-grade plasma cell malignancy. Classification of the histological stage (i.e., the extent of bone marrow infiltration) was done according to the model proposed by Bartl et al [13] as follows: stage I or lowgrade bone marrow infiltration (plasma cells \20% of all nucleated cells, ANC), stage II or intermediate infiltration (plasma cells 20-50% ANC), and stage III or high-grade bone marrow infiltration (plasma cells [50% ANC).…”

Plasmablastic Extramedullary Plasmacytoma Associated with Epstein-Barr Virus Arising in an Immunocompetent Patient with Multiple Myeloma

“…The proliferative rate with MIB1 labeling index was extremely high, suggesting morphologic features of PBL rather than those of plasmablastic EP because Vega et al (8) reported that PBL was characterized by a monotonous proliferation of plasmablasts and/or immunoblasts, with rare or no obvious plasmacytic cells. However, in H&E-stained sections, plasmablastic features were defined as equal to or greater than 30% of blasts (16). In fact, plasmacytic cells were frequently seen in plasmablastic MM (8).…”