다발성골수종 환자에서 질병 진행 예측인자로서 혈청 Thrombopoietin과 임상지표 분석 = The Analysis of Thrombopoietin and Clinical Parameters as a Marker for Disease Progression in Patients with Multiple Myeloma

다국어 초록 (Multilingual Abstract)

Background : Multiple myeloma (MM) causes the suppression of hematopoiesis because of malignant cells in the bone marrow. Thrombopoietin (TPO) is regulated by a feedback mechanism with
platelets. Recently, it was suggested that an elevated TPO without thrombocytopenia was associated with impaired hematopoiesis. We evaluated whether TPO levels could be a marker for disease progression in MM.
Methods : The TPO levels were measured in 70 blood samples from 27 patients (newly/previously- diagnosed patients=13/14). We analyzed the TPO and clinical parameters, WBC, hemoglobin, creatinine, calcium, M-protein, protein, albumin, and β2-microglobulin. The TPO in 20 healthy controls
ranged from 6 to 69 pg/mL.
Results : The TPO levels were significantly higher in MM patients with thrombocytopenia than in patients without thrombocytopenia and the healthy controls (median TPO: 293.0 pg/mL vs 59.6 pg/mL and 35.6 pg/mL, P<0.0001). There was a negative correlation between the TPO levels and the
blood cells, i.e., leukocytes (r=-0.293), hemoglobin (r=-0.378) and platelets (r=-0.508) (P<0.05). Elevated TPO were found in association with normal platelet counts (N=20). Among the samples without thrombocytopenia, especially one year after the diagnosis, the hemoglobin (10.3 vs 12.9
g/dL, P=0.025) and albumin (3.3 vs 4.0 g/dL, P=0.085) were lower and the M-protein and protein tended to be higher in patients with elevated TPO compared to those with normal TPO.
Conclusions : Serum TPO was elevated with thrombocytopenia and related to impaired hematopoiesis. The elevated TPO without thrombocytopenia might be considered as impaired hematopoiesis and a marker for disease progression in patients with MM.

국문 초록 (Abstract)

배경 : 다발성골수종은 골수 내 악성 세포의 증식으로 인해 조
혈 기능의 저하를 초래하는 질환이다. 최근 혈소판이 정상이지만
thrombopoietin (TPO)의 증가는 부적절한 조혈작용의 지표이
며 조혈작용을 유지하려는 보상기전이라는 연구결과가 있었다.
저자들은 다발성 골수종 환자에서 TPO와 임상지표와의 분석을
통해 질병진행인자로 고려할 수 있는지를 알아보고자 하였다.
방법 : 27명의 환자로부터 채취한 70개의 혈액을 통해 혈청
TPO를 측정하였다. 13명은 새롭게 다발성골수종으로 진단받은
환자였으며, 14명은 이전에 진단받고 추적관찰 중인 환자였다.
혈청 TPO 및 혈소판 수에 따른 백혈구, 혈색소치, 크레아티닌,
칼슘, M-단백, 단백질, 알부민 그리고 β2-micoglobulin 등의
임상 지표에 대해 비교 분석하였다. 정상 대조군 20명의 혈청
TPO 농도범위는 6-69 pg/mL이었다.
결과 : 혈청 TPO 농도는 정상 대조군 및 정상 혈소판 수를 보
이는 다발성골수종 환자와 비교해 혈소판 수 저하를 보이는 다발
성골수종 환자에서 통계적으로 의미 있게 높았다(median TPO:
293.0 pg/mL vs 59.6 pg/mL and 35.6 pg/mL, P<0.0001).
혈청 TPO가 높을수록 백혈구(r=-0.293), 혈색소치(r=-0.378)
및 혈소판 수(r=-0.508)는 저하되는 음의 상관관계를 보였다
(P<0.05). TPO 증가는 정상 혈소판을 보이는 검체에서도 관찰
되었다(N=20). 혈소판 수가 정상이면서 혈청 TPO가 증가되어
있는 군은 혈청 TPO가 정상인 군에 비해 질병이환기간이 1년
이상인 환자가 많았으며, 이러한 군은 혈색소치(10.3 vs 12.9 g/
dL, P=0.025) 및 알부민(3.3 vs 4.0 g/dL, P=0.085)이 낮았
으며, M-단백 및 단백질의 수치가 높은 경향을 보였다.
결론 : 다발성골수종에서 혈청 TPO 농도는 혈소판 저하 시 증
가되어 있었으며, 부적절한 조혈작용과 관련성을 보였다. 혈소
판 저하 없이 TPO가 증가되어 있는 경우, 부적절한 조혈기능이
진행되고 있음을 예측할 수 있으며 질병 예측 인자로 고려해 볼
수 있겠다.

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