Rauf HAZNEDAR, Türköz Gülsan SUCAK, Kadir ACAR, Münci YAĞCI

Procalcitonin in multiple myeloma

Dayanak: Bir akut faz reaktam olan C-reaktif protein (CRP) multipl myelomda (MM) prognostik öneme sahiptir. Prokalsitonin de (PCT) akut faz reaktanıdır. PCT düzeyleri şiddetli sistemik enfeksiyonlar ve sepsisde yüksek bulunmuştur. Amaç: Bu çalışmada MM'lu hastalarda PCT düzeylerinin hastalığın evresi ve aktivitesiyle ilişkisi araştırılmıştır. MM'lu olgularda enfeksiyonların ayırımında PCT'in öneminin değerlendirilmesi de çalışmanın diğer amacıdır. Hastalar ve Metodlar: Altmışaltı MM'lu hastadan alınan 69 kan örneği ve 25 sağlıklı kontrolda PCT, CRP, interlökin-6 (IL-6), ve interlökin-lp (İL-1 P) düzeyleri ölçüldü. Enfeksiyon tanısı hastanın kliniği, radyolojik bulgular ve enfeksiyon etkeninin mikrobiyolojik olarak izolasyonuyla kondu. İstatiksel Analiz: İstatiksel değerlendirme Mann-Whitney-U ve Spearman korelasyon testleriyle yapıldı. 0.05'den küçük p değerleri İstatiksel olarak anlamlı kabul edildi. Sonuçlar: MM5da PCT'in hastalığın aktivitesi ve evresiyle ilişkisini değerlendirmek için eşlik eden inflamatuvar veya enfeksiyöz hastalığı olanlar değerlendirmeye alınmadı. MM'lu hastaların tümünde PCT düzeyleri 0.5 ng/ml'den düşük bulundu. MM ve enfeksiyonu olan; sadece MM'lu olgular ve kontrol grubunda PCT düzeyleri sırasıyla 1.4210.36,0.38±0.15 and 0.09±0.02 olarak bulundu. Enfeksiyonu olan ve olmayan MM'lu olguların PCT düzeyleri arasındaki fark anlamlı bulunmadı. Enfeksiyonların tespitinde PCT'in duyarlılığı % 64, özgünlüğü % 82 olarak bulundu. Sonuç: MM'lu olgularda, PCT düzeyini yükseltebilecek enfeksiyon dışı nedenler klinik veya laboratuvar araştırmalarıyla dışlanabilirse, PCT düzeyleri sistemik bakteriyel enfeksiyonların tanısı ve enfeksiyonun şiddetini değerlendirmek için faydalı bir tanı yöntemi olarak görünmektedir.

Multipl myelomda prokalsitonin

Background: C-reactive protein (CRP) is an acute phase protein (APP) and has prognostic significance in multiple myeloma (MM). Procalcitonin (PCT) is also an APP and has been reported to be elevated in patients with severe systemic infection and sepsis. Aims: We investigated PCT level in patients with MM and its relationship with the stage and activity of the disease. The discriminatory value of PCT level in myeloma patients with and without infection was also assessed. Patients and methods: PCT, CRP, interleukin-6 (IL-6) and IL-ip levels were determined in 69 blood samples from 66 myeloma patients with various disease activity and 25 controls. Infections were verified by microbiological identification of an infectious specimen together with clinical presentation and radiological findings. Statistical analysis: The Mann-Whitney U test and Spearman's rank correlation test were performed. P values lower than 0.05 were considered significant. Results: Patients with known infections and inflammatory diseases that might elevate PCT levels were excluded from the data in order to evaluate PCT merely in MM. None of the patients with MM had a PCT level higher than 0.5 ng/mL. Mean PCT level in myeloma patients with infection, without infection and controls were 1.42±0.36, 0.38±0.15 and 0.09±0.02, respectively. The difference between mean PCT levels in myeloma patients with and without infection was insignificant (p>0.05). The sensitivity of PCT for the detection of infection was 64%, and the specificity 82%. Conclusion: PCT level seems to be a,good parameter to identify systemic bacterial infections and is a useful marker of the severity of infection in patients with MM if coexistent non-infectious conditions that may contribute to PCT elevation are excluded by appropriate clinical and laboratory investigations.

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1. Rajkumar SV, Greipp PR. Prognostic factors in multiple myeloma. Hematol Oncol ClinN Am 1999; 13: 1295-1314.
2. Bataille R, Boccadoro M, Klein B, Durie BGM, Pileri A. C-reacti ve protein and beta-2 microglobulin produce a simple and powerful myeloma staging system. Blood 1992; 80: 733-737.
3. Pelliniemi TT, Irjala K, Mattila K, Pulkki K, Rajamaki A, Tienahara A, Laakso M, Lahtinen R.Immunoreactive interleukin-6 and acute phase proteins as prognostic factors in multiple myeloma. Blood 1995; 85: 765-771.
4. Tricot G. Multiple myeloma and other plasma cell disorders. In: Hoffman R, Benz EJ, Shattil SJ, Furie B, Cohen HJ, Silberstein LE, McGlave P, eds. Hematology. Basic principles and practice. 3rd ed. Philadelphia: Churchill Livingstone, 2000: 1399-1416.
5. Nijtsen MWN, Olinga P, The TH, de Vries EGE, Koops HS, Groo-thuis GMM, Limburg PC, ten Duis HJ, Moshage H, Hoekstra HJ, Bijzet J, Zwaveling JH. Procalcitonin behaves as a fast responding acute phase protein in vivo and in vitro. Crit Care Med 2000; 28: 458-461.
6 Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993; 341: 515-518.
7. Whicher J, Bienvenu J, Monneret G. Procalcitonin as an acute phase marker. Ann Clin BiochemN2001; 38: 483-493.
8. Ghillani PP, Motte P, Troalen F, Jullienne A, Gardet P, Le Chevalier T, Rougier P, Schlumberger M, Bohuon C, Bellet D. Identification and measurement of calcitonin precursors in serum of patients with malignant diseases. Cancer Res 1989; 49: 6845-6851.
9. Schmidt M, Burchardi C, Sitter T, Held E, Schiffl H. Procalcitonin in patients undergoing chronic hemodialysis. Nephron 2000; 84: 187-188.
10. Mimoz O, Benoist JF, Edouard AR, Assicot M, Bohuon C, Samii K. Procalcitonin and C-reactive protein during the early posttraumatic systemic inflammatory response syndrome. Int Care Med 1998; 24:185-188.
11. Meisner M, Tschaikowsky K, Hutzler A, Schick C, Schüttler J. Postoperative plasma concentrations of procalcitonin after different types of surgery. Int Care Med. 1998; 24: 680-684.
12. Eberhard OK, Haubitz M, Brunkhorst FM, Kliem V, Koch KM, Brunchorst R. Usefulness of procalcitonin for differentiation between activity of systemic autoimmune disease (systemic lupus erythematosus/systemic antineutrophil cytoplasmic antibody-associated vasculitis) and invasive bacterial infection. Arthritis Rheumatism 1997; 40: 1250-1256.
13. Durie BGM, Salmon SE. A clinical staging system for multiple myeloma. Cancer 1975; 36: 842-854.
14. Anderson KC, Lust JA. Role of cytokines in multiple myeloma. Sem Hem 1999; 36 (suppl 3): 14-20.
15. Jourdan M, Tarte K, Legouffe E, Brochier C, Rossi JF, Klein B. Tumor necrosis factor is a survival and proliferation factor for human myeloma cells. Eur Cytokine Netw 1999; 10: 65-70.
16. Moshage H. Cytokines and the hepatic acute phase response. J Patholl996; 181:257-266.
17. Ugarte H, Silva E, Mercan D, De Mendonça A, Vincent JL. Procal¬ citonin used as a marker of infection in the intensive care unit. Crit Care Med 1999; 27: 498-504.
18. Svaldi M, Hirber J, Lanthaler AI, Mayr O, Faes S, Peer E, Mitterer M. Procalcitonin-reduced sensitivity and specificity in heavily leukopenic and immunosuppressed patients. Br J Haematol 2001; 115:53-57.