Multiple myelom hastalarında PD-1/PD-L1 ekspresyonunun değerlendirilmesi
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Tarih
2024
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Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Multipl miyelom; anemi, kemik ağrısı ve kırıklar ile sonuçlanan kemik iliği infiltrasyonu ve yaygın iskelet destrüksiyonu ile karakterize plazma hücre malignitesidir. MM tedavisinde çeşitli ajanlar mevcuttur. Fakat tüm tedavilere rağmen hala kür olan bir hastalık değildir. Biz de çalışmamızda MM hastalarında yeni bir tedavi hedefi olabilecek PD-1/PD-L1 ekspresyonunu değerlendirmeyi amaçladık.
Gereç ve Yöntem: Çalışmaya Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Hematoloji Kliniğinde 2015–2024 yılları arasında de takip edilmekte olan kemoterapi almış ve kemoterapi sonrası yanıt değerlendirilmesi yapılmış 50 MM olgusu dahil edildi. İmmün histokimyasal boyama için Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Tıbbi Patoloji Anabilim Dalı arşivinde bulunan 18-80 yaş arası MM tanısı alan, tanı anında ve kemoterapi sonrası kontrol biyopsiye ait parafin bloklar kullanıldı. Bu çalışma Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi İlaç ve Tıbbi Cihaz Dışı Klinik Araştırmalar Etik Kurulu tarafından onaylanmıştır (Karar no:4422, Tarih: 07.07.2023). Çalışmamız için gerekli maddi kaynak Necmettin Erbakan Üniversitesi 23TU18017 numaralı proje ile Bilimsel Araştırma Projesi (BAP) biriminden alınmıştır.
Bulgular: Olguların tanı anında yaş ortalaması 64,94±10,02 yıl olarak saptanmıştır. Bu hastaların %54’ü (n=27) erkek, %46’sı (n=23) ise kadındır. Vakaların %48’i (n=24) IgG kappa, %18’si (n=9) IgG lambda, %12’si (n=6) IgA lambda tipi multiple myelom bulunmuştur. Tanıda hastaların %48’inde (n=24) PD-1, %40’ında (n=20) PD-L1 pozitif belirlenmiştir. Tedavi sonrası bakılan patoloji preparatlarında hastaların %44’ünde (n=22) PD-1, %44’ünde (n=22) PD-L1 pozitif belirlenmiştir. Tanı anında PD-1 pozitif olan hastalarda Beta2 mikroglobulin düzeyi negatif hastalara göre anlamlı düzeyde yüksek belirlenmiştir (p=0,018). Tanı anında PD-L1 pozitif olan hastalarda kappa düzeyi negatif hastalara göre anlamlı düzeyde yüksek, lambda düzeyi düşük olarak belirlenmiştir (p değerleri; p=0,040; p=0,006). Tanı anında PD-1 ve PD-L1 pozitifliğinin progresyonsuz sağkalım (PFS) ve ortalama sağkalım (OS) süresi üzerine etkisi tespit edilmemiştir.
Sonuç: Multiple Myelom hastalarında tanı anında PD-1 ve PD-L1 pozitifliğinin progresyonsuz sağkalım (PFS) ve ortalama sağ kalım (OS) süresi üzerine etkisi gösterilememiştir. Solid organ tümörlerinde (akciğer kanseri, meme kanseri vs) PD-1 ve PD-L1 çalışmaları literatürde fazlaca mevcuttur. Ancak hematolojik malignitelerde nispeten daha az çalışma olup daha geniş hasta sayıları ile daha geniş çalışmalara ihtiyaç duyulmaktadır
Objective: Multiple myeloma; It is a plasma cell malignancy characterized by bone marrow infiltration and widespread skeletal destruction resulting in anemia, bone pain and fractures. Various agents are available for the treatment of MM. However, despite all the treatments, it is still not a curable disease. In our study, we aimed to evaluate PD-1/PD-L1 expression, which may be a new treatment target in MM patients. Materials and Methods: The study included 50 MM cases who were followed up in the Hematology Clinic of Necmettin Erbakan University Meram Medical Faculty between 2015 and 2024, who had received chemotherapy and who underwent post-chemotherapy response evaluation. For immunohistochemical staining, paraffin blocks from the archive of the Department of Medical Pathology, Necmettin Erbakan University Meram Faculty of Medicine, were used from MM patients aged 18-80 years at the time of diagnosis. This study was approved by Necmettin Erbakan University Meram Medical Faculty Non-Drug and Medical Device Clinical Research Ethics Committee (Decision no: 4422, Date: 07.07.2023). The financial resources required for our study were received from Necmettin Erbakan University Scientific Research Project (BAP) unit with project number 23TU18017. Results: The mean age of the patients at the time of diagnosis was 64.94±10.02 years. Of these patients, 54% (n=27) were male and 46% (n=23) were female. Ig G kappa multiple myeloma was the type of multiple myeloma in 48% (n=24), Ig G lambda multiple myeloma in 18% (n=9) and Ig A lambda multiple myeloma in 12% (n=6). PD-1 was positive in 48% (n=24) and PD-L1 was positive in 40% (n=20) of the patients at diagnosis. In the pathology preparations examined after the diagnosis, 44% (n=22) of the patients were PD-1 positive and 44% (n=22) were PD-L1 positive. Beta2 microglobulin levels were significantly higher in PD1 positive patients compared to negative patients (p=0.018). Patients who were PD-L1 positive at the time of diagnosis had significantly higher kappa and lower lambda levels compared to negative patients (p values; p=0.040; p=0.006). It was determined that PD1 and PD-L1 positivity at the time of diagnosis did not have a statistically significant effect on progression-free survival (PFS) and mean survival (OS) in the multiple myeloma patients included in the study. Conclusion: In multiple myeloma patients, PD-1 and PD-L1 positivity at the time of diagnosis did not have a statistically significant effect on progression-free survival (PFS) and mean survival (OS). PD-1 and PD-L1 studies in solid organ tumors (lung ca, breast ca) are abundant in the literature. However, there are relatively fewer studies in hematologic malignancies and larger studies with larger patient numbers are needed.
Objective: Multiple myeloma; It is a plasma cell malignancy characterized by bone marrow infiltration and widespread skeletal destruction resulting in anemia, bone pain and fractures. Various agents are available for the treatment of MM. However, despite all the treatments, it is still not a curable disease. In our study, we aimed to evaluate PD-1/PD-L1 expression, which may be a new treatment target in MM patients. Materials and Methods: The study included 50 MM cases who were followed up in the Hematology Clinic of Necmettin Erbakan University Meram Medical Faculty between 2015 and 2024, who had received chemotherapy and who underwent post-chemotherapy response evaluation. For immunohistochemical staining, paraffin blocks from the archive of the Department of Medical Pathology, Necmettin Erbakan University Meram Faculty of Medicine, were used from MM patients aged 18-80 years at the time of diagnosis. This study was approved by Necmettin Erbakan University Meram Medical Faculty Non-Drug and Medical Device Clinical Research Ethics Committee (Decision no: 4422, Date: 07.07.2023). The financial resources required for our study were received from Necmettin Erbakan University Scientific Research Project (BAP) unit with project number 23TU18017. Results: The mean age of the patients at the time of diagnosis was 64.94±10.02 years. Of these patients, 54% (n=27) were male and 46% (n=23) were female. Ig G kappa multiple myeloma was the type of multiple myeloma in 48% (n=24), Ig G lambda multiple myeloma in 18% (n=9) and Ig A lambda multiple myeloma in 12% (n=6). PD-1 was positive in 48% (n=24) and PD-L1 was positive in 40% (n=20) of the patients at diagnosis. In the pathology preparations examined after the diagnosis, 44% (n=22) of the patients were PD-1 positive and 44% (n=22) were PD-L1 positive. Beta2 microglobulin levels were significantly higher in PD1 positive patients compared to negative patients (p=0.018). Patients who were PD-L1 positive at the time of diagnosis had significantly higher kappa and lower lambda levels compared to negative patients (p values; p=0.040; p=0.006). It was determined that PD1 and PD-L1 positivity at the time of diagnosis did not have a statistically significant effect on progression-free survival (PFS) and mean survival (OS) in the multiple myeloma patients included in the study. Conclusion: In multiple myeloma patients, PD-1 and PD-L1 positivity at the time of diagnosis did not have a statistically significant effect on progression-free survival (PFS) and mean survival (OS). PD-1 and PD-L1 studies in solid organ tumors (lung ca, breast ca) are abundant in the literature. However, there are relatively fewer studies in hematologic malignancies and larger studies with larger patient numbers are needed.
Açıklama
Anahtar Kelimeler
Multipl miyelom, Multiple miyelom, PD-1, PD-L1
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Akkabak, Y. (2024). Multiple myelom hastalarında PD-1/PD-L1 ekspresyonunun değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
