The Study Of Prognostic Significance Of The Inflammatory Scoring System In Patients Preliminarily Diagnosed With Multiple Myeloma

Background:Multiple myeloma（MM）is a malignant plasmocyte disease,common in the elderly,characterized by the malignant proliferation and extensive infiltration of monoclonal plasmocyte in bone marrow,and accompanied by the secretion of vast monoclonal immunoglobulin or light chains in blood or urine.Because of the high heterogeneity of multiple myeloma,overall survival of patients various.The median survival of patients with advanced multiple myeloma was only 6 months.The effective rate of conventional chemotherapy was 40%-60%,the complete remission rate was less than 5%,and the median survival was less than 3 years.About 25 percent of patients survive more than 5 years,whereas less than 5 percent survive 10 years.Therefore,using simple and easy available indicators to make accurate risk stratification of patients with newly diagnosed multiple myeloma is essential for prognostic assessment and individualized treatment.Inflammation associated indicators such as red blood cell distribution width（RDW）,neutrophil-to-lymphocyte ratio（NLR）,and platelet count（PLT）have been reported to be associated with the prognosis of malignancies.Meanwhile,they also have certain clinical significance in the prognosis of multiple myeloma patients.Objective:This study aimed to evaluate the prognostic significance of the inflammatory prognostic scoring index（IPSI）,comprised of RDW,NLR,and PLT for overall survival（OS）in newly diagnosed multiple myeloma patients in the bortezomib-based chemotherapy era.Methods:Using retrospective analysis,this study has collected 175 newly diagnosed MM patients from October2012 to February 2019 in Henan Provincial People’s Hospital,Kaifeng Central Hospital,and Xinxiang Central Hospital.The patients were divided into high RDW group（RDW>14%）and low RDW group（RDW≤14%）,high NLR group（NLR>2）,and low NLR group（NLR≤2）,high PLT group（PLT>150×10⁹/L）,and low PLT group（PLT≤150×10⁹/L）.The cut-off values of RDW,NLR,and PLT were obtained from references.The t test and chi-square test were used to analyze the baseline characteristics of patients.Using univariate and multivariate analysis to explore prognostic indicators of overall survival.RDW,NLR and PLT,which had prognostic significance for OS in both univariate and multivariate analysis,were included to form the inflammatory prognostic scoring index（IPSI）.Patients with high RDW（RDW>14%）were given a score of 1,patients with high NLR（NLR>2）or low PLT（PLT≤150×10⁹/L）were given a score of 2.According to the obtained scores,the inflammatory prognostic scoring index（IPSI）was formed,in which patients were grouped into high-risk group（4-5 points）,intermediate-risk group（3 points）and low-risk group（0-2 points）.Results:1.Patients’baseline characterastics:A total of 175 patients with newly diagnosed multiple myeloma were included in this study,of which95（54.29%）were men and 80（45.71%）were women.The average age was 61 years（61.29±9.38）.There were 60（34.29%）monoclonal immunoglobulin subtype Ig G patients,57（32.57%）Ig A patients,23（13.14%）Ig D patients,and 35（20.00%）light chain patients.There were 23（13.14%）cases of ISS stage I,44（25.14%）cases of stage II,and 108（61.71%）cases of stage III.Patients were divided into two groups according to RDW≤14%and RDW>14%.And in the high RDW group（（RDW>14%））,the hemoglobin level was significantly lower than that in the low RDW group（RDW≤14%）（79.19±20.43 vs 90.85±22.91,P=0.001）.Patients were divided into two groups according to NLR≤2 and NLR>2.And in the high NLR group（NLR>2）,significantly more patients presented with ISS III,serum calcium>2.65 mmol/L,serum creatinine>177μmol/L,serum LDH>250 U/L,andβ₂microglobulin≥5.5 mg/L than in the low NLR group（NLR≤2）（73.30%vs 49.40%,P<0.001;31.10%vs 16.50%,P=0.023;44.40%vs 25.90%,P=0.010;22.20%vs 8.20%,P=0.010;73.70%vs 49.40%,P=0.001）.Patients were divided into two groups according to PLT≤150×10⁹/L and PLT>150×10⁹/L.The proportion of patients in the low PLT group（PLT≤150×10⁹/L）who presented with ISS III,bone marrow plasma cell count>40%,serum calcium>2.65 mmol/L,andβ₂microglobulin≥5.5 mg/L was significantly larger than that of the high PLT group（PLT>150×10⁹/L）（75.30%vs 52.00%,P=0.004;56.20%vs 38.20%,P=0.019;34.20%vs 16.70%,P=0.007;75.30%vs 52.00%,P=0.002）.The hemoglobin level in the low PLT group was significantly lower than that in the high PLT group（76.97±20.59 vs 89.12±22.02,P<0.001）.2.Prognostic factor analysis for OS with univariate and multivariate analysis:The univariate analysis indicated that significant OS prognostic factors were age（P=0.020）,number of bone marrow plasma cells（P=0.005）,serum calcium（P=0.002）,serum creatinine（P=0.048）,serum LDH（P<0.001）,β₂microglobulin（P<0.001）,RDW（P<0.001）,NLR（P<0.001）,PLT（P<0.001）,ISS stage（P<0.001）,and maintenance therapy（P<0.001）.The multivariate analysis showed that serum LDH（P=0.004）,RDW（P=0.016）,NLR（P<0.001）,PLT（P<0.001）,and ISS stage（P=0.008）were independent prognostic factors for OS.3.Inflammatory prognostic scoring index（IPSI）and subgroup analysis:The univariate analysis showed OS varied significantly in different IPSI groups（P<0.001）.On multivariate analysis,the IPSI was an independent prognostic factor for OS（intermediate-risk group HR 2.89,95%CI 1.60-5.22,high risk-group HR 14.50,95%CI 7.26-28.93,P<0.001）.Importantly,with IPSI as a supplement to the International Staging System（ISS）,a significant difference in OS was observed among IPSI subgroups with different ISS stages（ISS I,P<0.001;ISS II,P=0.008;ISS III,P<0.001）.Conclusions:The IPSI,comprised of RDW,NLR,and PLT,played a specific role in the prognosis of patients preliminarily diagnosed with multiple myeloma in the bortezomib-based chemotherapy era and could be a beneficial supplement for ISS staging.