Prognostic value of circulating plasma cells in patients with multiple myeloma: A meta-analysis

PURPOSE: The clinical significance and prognostic role of circulating plasma cells (CPCs) in multiple myeloma (MM) are still controversial. We conducted the first meta-analysis to clarify the correlation between CPCs and the clinicopathological features and prognosis of MM patients. METHODS: A comprehensive literary search for relevant studies was performed on PubMed, Embase, Medline, CNKI (Chinese) and Web of Science databases (January 1, 1950 to December 20, 2016). The associations between CPCs and survival rate and clinicopathological parameters, including International staging system (ISS) and Durie-Salm staging system (DS) stage, were evaluated. Then pooled hazard ratios (HRs) for survival with 95% confidence intervals (CIs), subgroup analysis, sensitivity analysis, and publication bias were conducted. RESULTS: 11 studies covering a total of 2943 patients were included. Pooled hazard ratios (HRs) revealed that the presence of CPCs predicted aggressive disease progression (HR = 1.78, 95% CI = 1.57–2.03) and reduced overall survival (OS) (HR = 1.82, 95% CI = 1.59–2.08). Subgroup analyses demonstrated that CPCs positive patients also had poor disease progression and OS in detection methods and sampling time subsets. Moreover, the presence of CPCs was strikingly associated with increased ISS stage (OR = 2.78% CI = 1.69–4.56), but not with DS stage(OR = 1.60; 95% CI = 0.74–3.47). CONCLUSIONS: CPCs status is associated with poorer survival outcome in multiple myeloma. Additionally, increased ISS stage could be significant risk factors for the presence of CPCs.