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Multiple myeloma (MM) is a neoplasm of the B lymphocytes characterized by the uncontrolled proliferation of a plasmocyte clone. Magnetic resonance imaging (MRI) remains the most sensitive and specific imaging method for the detection of bone marrow infiltration, before macroscopic bone changes are visible, with evidence that the detection rate and overall performance of MRI could be enhanced by applying diffusion-weighted imaging (DWI). The aim of our research was to evaluate whether measuring apparent diffusion coefficient (ADC) values in newly diagnosed patients with MM could be a prognostic factor for the course of the disease and to ascertain whether there is any correlation with other prognostic factors in MM. A retrospective study was performed on a group of 32 patients with newly diagnosed MM that underwent at least two whole-body (WB)-MRIs; one before and one after induction therapy. Patients with advanced stage of disease showed an increased ADC value: Stage 2 vs. stage 1 (1.162 vs. 0.289, P=0.033), respectively, stage 3 vs. stage 1 (0.867 vs. 0.289, P=0.041). In addition, ADC values were inversely correlated with survival time: r=-0.641, P<0.001. According to the multivariate linear regression model, we observed that for every point of ADC value (before treatment) the survival was decreased/reduced by 14.5 months. Moreover, bortezomib therapy predicted an increase in the survival length/duration by 7.9 months. Our regression equation proved to be a good fit for the model, explaining 57.8% of survival duration (adjusted R 2 =0.578). In conclusion, the negative prognostic factors associated with WB-MRI are represented by high ADC values before treatment (for every point of ADC the survival was decreased by 14.5 months) and focal/diffuse marrow involvement.

Vitamin D deficiency has been correlated with various conditions, including the risk of developing lymphoid malignancies. This systematic review aimed to assess the association between vitamin D levels at diagnosis of lymphoid malignancies, patient outcomes, and survival. A systematic review was conducted, encompassing 15 studies published until January 2023, involving 4503 patients, examining the relationship between vitamin D and lymphoid cancers. The median age of the patients was 56.5 years, with a median follow-up duration of approximately 36 months across studies. The overall median vitamin D level at initial measurement was 20.4 ng/mL, while a <20 ng/mL threshold was used to define vitamin D insufficiency. The results demonstrated significant associations between vitamin D levels and patient outcomes in several lymphoid malignancies, with a pooled risk in disease progression of 1.93 and a pooled hazard ratio of 2.06 for overall survival in patients with 25-(OH)D levels below the normal threshold of 20 ng/mL. Among findings, it was demonstrated that supplemental vitamin D improves the chemosensitivity of tumors by reducing the rate of tumor growth compared with vitamin D or chemotherapy alone. Vitamin D had a protective effect for patients with DLBCL under R-CHOP treatment, while vitamin D insufficiency was associated with the impairment of rituximab treatment and showed worse clinical outcomes in chimeric antigen receptor T-cell (CAR-T) recipients. Although one study found no association between vitamin D deficiency and the cause of death, most associated vitamin D insufficiency with early clinical failure and lower survival probability. In conclusion, his systematic review highlights the importance of vitamin D levels in the prognosis and survival of patients with lymphoid malignancies. Further research is needed to better understand the underlying mechanisms and explore the potential benefits of vitamin D supplementation in managing these cancers.

Multiple myeloma (MM) is typically sensitive to a range of cytotoxic agents, both as initial therapy and as relapsed disease treatment. Unfortunately, the responses are transient, and MM is not considered curable with the current approaches. This paper aims to assess the response to first line treatment of patients included in the study and their correlation with the negative prognostic factors in multiple myeloma: age over 60 years, male gender, anemia, hypercalcemia, elevated levels of creatinine, Beta 2 microglobulin, hypoalbuminemia and Bence-Jones proteins type. The study was conducted on a group of 105 patients admitted to the Hematology Department of the Municipal Emergency Clinical Hospital of Timisoara from 01 January 2013 until 31 December 2017. Twenty-seven patients received VAD regimen, while 78 underwent Bortezomib + Dexamethasone regimen as fist line therapy. When analyzing anthropometrical data, different gender distribution in the two groups of patients is seen, while a higher percentage of patients over 60 years is observed in both groups, with 77.7% in the VAD group (21 out of 27 patients) and 56.4% in the group treated with Bortezomib + Dexamethasone (44 out of 78 patients). Only some of the factors analyzed in our study statistically significantly influenced the response to treatment and the duration of survival, i.e.: age over 60 years, hemoglobin [10g/dL, platelets under 150000/mm3, creatinine ]2mg/dL, serum calcium ]10mg / dL, increased C-reactive protein, low serum albumin levels, high levels of Beta 2 microglobulin, total serum protein, as well as presence of cells in the peripheral smear. Defining a panel of negative prognostic factors that influence the evolution and response to multiple myeloma treatment would allow for tailoring of personalized therapies for each patient.

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