Myeloma prognostic index at diagnosis might be a prognostic marker in patients newly diagnosed with multiple myeloma

Abstract

Background/AimsThe aims of this study were to identify the value of inflammatory markers as pretreatment prognostic factors for patients with multiple myeloma (MM) and to estimate the value of a prognostic index including these markers at diagnosis.MethodsA total of 273 newly diagnosed MM patients undergoing active treatment were analyzed in this study. The prognostic values for survival of the pretreatment inflammatory markers were investigated. A myeloma prognostic index (MPI) was derived using prognostic factors determined to be independently significant on multivariate analysis.ResultsA high pretreatment neutrophil-lymphocyte ratio (NLR), low platelet count, and high C-reactive protein (CRP) level had independently unfavorable significance for overall survival (OS). The MPI was derived based on these factors. Per the MPI, 1 point each was assigned to high NLR, low platelet count, and high CRP. Risk categories were stratified into low- (score 0), intermediate- (score 1), and high-risk (score 2 or 3) groups. The MPI demonstrated independent statistical significance for OS on multivariate analysis ([intermediate: hazard ratio (HR), 1.91; 95% confidence interval (CI), 1.12 to 3.24] and [high: HR, 3.37; 95% CI, 2.00 to 5.69]; p < 0.001). Moreover, this significance could be observed regardless of age, renal function, and exposure to novel agents. In addition, the International Staging System risk group could be further significantly stratified using the MPI.ConclusionsThe MPI, consisting of pretreatment inflammatory markers, NLR, platelet count, and CRP, might be effective in predicting the survival of newly diagnosed MM patients undergoing active treatment.

Association of CD117 and HLA‑DR expression with shorter overall survival and/or progression‑free survival in patients with multiple myeloma treated with bortezomib and thalidomide combination treatment without transplantation

“…Treatment with lenalidomide provides an alternative choice for elderly patients and those unable to tolerate chemotherapy ( 16 , 17 ). In addition, prognostic factors, including peripheral lymphocytes and CRP, have been reported and were demonstrated to have a varying prognostic significance in traditional chemotherapy and novel drug protocols ( 4 , 5 , 18 , 19 ). This highlights the importance of discovering and identifying prognostic markers in MM for novel treatment approaches.…”

“…The mean age of affected individuals is 72 years for men (75% >70 years) and 71 years for women (79% >70 years) ( 3 ). In addition to genetic markers, there are further prognostic factors, including lymphocyte counts and C-reactive protein (CRP) expression level, which have been evaluated in recent years ( 4 , 5 ). Immunophenotyping, including the analysis of CD19, CD45, CD56 and CD117, is of great value to the prognosis and diagnosis of MM according to recent reports ( 6 , 7 ).…”

Can Neutrophil‐to‐Lymphocyte Ratio, Monocyte‐to‐Lymphocyte Ratio, and Platelet‐to‐Lymphocyte Ratio at Day +100 be used as a prognostic marker in Multiple Myeloma patients with autologous transplantation?

“…The studies have examined its impact on MM as well. High NLRs in patients with MM are associated with negative prognosis in these studies . The specific mechanism involved in the interaction between increased NLR and poor prognosis of multiple myeloma patients is incompletely understood.…”

“…Lihui and Shi calculated the cutoff value of NLR as 4. In other studies, NLR cutoff values were given as 2, 2.25, and it was obtained as 2.78 . The cutoff values for NLR were calculated as 3.19 on day −5 prior ASCT and 1.46 on day +100 after ASCT in our study.…”

The Prognostic Value of the Derived Neutrophil-to-Lymphocyte Ratio in Transplantation-Ineligible Patients with Multiple Myeloma

“…Kim et al [5] have very recently evaluated the prognostic value of baseline NLR in 273 newly diagnosed MM patients. Multivariate analysis revealed that poor performance status (≥2), a high percentage of plasma cells in the bone marrow, a high cytogenetic risk, a high NLR, a low platelet count, elevated C-reactive protein, the use of novel agents (bortezomib, thalidomide, and lenalidomide), and stem cell transplantation were independent and significant prognosticators of OS.…”