Cyclin D1: A Prognostic Marker in Multiple Myeloma and its Association with CRP and beta 2-Microglobulin Level

Introduction: Cyclin D1 is a protein encoded by the CCND1 (bcl-1) gene on chromosome 11q13 and it is an important regulator of G1 to S phase progression. Over expression of cyclin D1 protein releases cells from their normal controls when they need to exit from the cell cycle. This obstructs their maturation, and promotes transformation into a malignant phenotype. Aim: To study the role of cyclin D1 expression in trephine biopsies of multiple myeloma patients and its association with C-Reactive Protein (CRP), beta 2-microglobulin level and treatment response rate. Materials and Methods: This prospective observational study was conducted at Department of Pathology in collaboration with Department of Clinical Hematology, King George's Medical University Lucknow, India, from September 2018 to August 2019. Total 40 cases of multiple myeloma fulfilling inclusion and exclusion criteria were enrolled. Bone marrow aspiration and biopsy was done in all the cases. Immunohistochemical expression of cyclin D1 on trephine biopsy was associated with CRP levels and beta 2-microglobulin expression. All investigations were repeated at six months follow-up and response was compared with expression of cyclin D1. The statistical tests applied were Chi-square test, student t-test and paired t-test. Results: On comparison of two groups cyclin D1 positive and cyclin D1 negative cases it was found that cyclin D1 positive cases had an early age of onset, more than 50% plasma cells on marrow aspirate and were associated with plasmablastic morphology. These cases also had increased CRP levels as compared to another group. Similarly, serum calcium, serum creatinine beta 2-microglobulin levels were more in cyclin D1 positive group. The age of cases ranged between 44 to 78 years, the mean age being 64.40 +/- 7.13 years. Total 67.5% of patients were males. Out of eight cases with weak cyclin D1 expression, five cases achieved partial response and two cases achieved complete response. One case was lost to follow-up. Among nine patients with strong cyclin D1 expression, six patients expired on six months followup and three patients achieved partial response. Conclusion: Cases who have strong cyclin D1 expression at time of diagnosis show poor response to treatment. This also associated with increased serum CRP and beta 2-microglobulin levels. Hence, cyclin D1 can be used as a prognostic marker in multiple myeloma.