Proliferation and Angiogenesis Using Immunohistochemistry in Prognosticating Multiple Myeloma

Multiple myeloma is a neoplasm of plasma cells characterised by the presence of M protein in serum and urine. Angiogenesis and proliferation play a major role in the pathogenesis of various neoplasms. The study evaluated proliferation and angiogenesis in 48 cases of myeloma, and correlated it with morphological and clinical parameters. The histomorphological features like plasma cell morphology, percentage of plasma cells and pattern of infiltration were studied in the bone marrow aspirate and trephine biopsy. Angiogenesis was assessed by calculating the microvessel density (MVD) using immunohistochemistry for CD34. Proliferation was assessed using Ki67 and CD38 highlighted the plasma cells. The mean Ki67 % was found to be significantly higher (19.6 % range 2-40 %) in poorly differentiated morphology compared to well differentiated morphology (4.06 % range 0.2-20 %) (p = 0.003). The mean MVD in the well differentiated morphology was 10.6 (range 1.2-47.4) compared to 20.3 (range 6.9-39.6) in the poorly differentiated morphology (p = 0.04). The mean MVD was 5.7 (range 1.2-12.8) in the interstitial pattern of infiltration compared to 20.04 (2.9-47.4) in the diffuse pattern (p < 0.0001). The mean MVD was 6.4 in cases with serum albumin >3.5 gm/dl compared to 13.3 in cases with serum albumin <3.5 gm/dl (p = 0.009). Both the Ki67 and MVD showed an increasing trend with the clinical staging. Thus the study of proliferation and angiogenesis in bone marrow biopsy is useful for prognosticating patients with multiple myeloma.