Identification of High Serum Apolipoprotein A1 as a Favorable Prognostic Indicator in Patients with Multiple Myeloma

Abstract

This study is to explore the prognostic significance of serum lipid profiles in patients with multiple myeloma (MM). The study retrospectively enrolled 307 MM patients in Zhongshan Hospital, Shanghai, China, from 2007 to 2016. We evaluated the prognostic significance of the pre-diagnostic serum lipid profile [cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL), Apolipoprotein A1 (Apo A1) and Apolipoprotein B (Apo B)]. Prognostic factors identified through univariate and multivariate analysis were used to construct a new model based on Lasso Cox regression. Results indicated that lipid levels showed significant difference between ISS stages: Apo A1, Apo B, Cholesterol and LDL levels were lower in late ISS stage. However, only Apo A1 showed statistically significance in overall survival (OS), progression free survival (PFS) and cause specific survival (CSS) (P=0.038, P=0.028, P=0.011) in univariate Cox regression. Patients with higher Apo A1 displayed longer OS (median OS, 67 months vs. 30 months; P<0.001). Also, Apo A1 was revealed to be an independent prognostic indicator through multivariate analysis. Combining the Apo A1 level, Zhongshan Score model was constructed with Lasso regression for prognosis prediction. This model exhibited higher accuracy than International Staging System (ISS) and Durie and Salmon (DS) system. In conclusion, among all the serum lipid profiles, serum Apo A1 is a powerful prognostic indicator for patients with MM.

Metabolic Disorders in Multiple Myeloma

“…LDL may prevent myeloma cell apoptosis and promote myeloma cell survival [ 133 ]. Interestingly, patients with MM and high APOA1 serum levels, which is the major component of high density lipoprotein (HDL), present superior survival outcomes compared with patients with low APOA1 levels [ 134 , 135 ]. Patients with MM have lower levels of HDL-C and higher levels of triglycerides at diagnosis and when myeloma is active, as compared with healthy individuals [ 136 ].…”

“…Patients with MM have lower levels of HDL-C and higher levels of triglycerides at diagnosis and when myeloma is active, as compared with healthy individuals [ 136 ]. Furthermore, patients with favorable disease traits (international staging system, ISS-1) may present with higher HDL levels compared with those with adverse prognostic characteristics (ISS-3) [ 134 , 135 , 137 ]. Dyslipidemia in patients with MM may be relatively refractory to conventional lipid lowering medications, but it seems responsive when MM is successfully treated [ 100 , 138 ].…”

The Lipoprotein Transport System in the Pathogenesis of Multiple Myeloma: Advances and Challenges

“…Other parameters of lipid metabolism, such as APOB levels, total cholesterol, and LDL levels were lower in the late ISS stage, but showed no statistically significant correlation with either overall survival or progression-free survival. Lastly, no differences were observed in serum triglyceride levels between the different ISS stages ( 74 ).…”

Long non‐coding RNA NEAT1 serves as a novel biomarker for treatment response and survival profiles via microRNA‐125a in multiple myeloma

“…According to the global statistics report, MM is the third most commonly occurred hematological malignancy, accounting for approximately 1% of all cancer cases, and its incidence has undergone an increment in recent decades 2 . The common treatment approaches for MM consist of chemotherapy, autologous stem cell transplants, targeted therapy, and immunotherapy; however, the treatment efficacy is limited and the drug resistance is increasing due to the various chromosomal abnormalities, contributing to poor treatment response and undesirable survival profiles in MM patients 3‐6 . Therefore, discovering novel prognostic biomarker is a necessity for MM management, which can help to estimate treatment response and predict prognosis in MM patients.…”