The Prognostic Significance Of Lactate Dehydrogenase,Serum Ferritin And Combined Detection In Newly Diagnosed Multiple Myeloma

Multiple myeloma(MM)is a malignant proliferative disease of plasma cells.At present,the incidence of multiple myeloma in China is about 2-3 per 100,000,the male to female ratio is 1.6: 1,and most patients are over 40 years old.The emergence of new drugs in recent years has improved the prognosis of patients,but it is still an incurable disease.Due to the high heterogeneity of the disease,the establishment of an early prognostic judgment system is of great significance for improving patient survival [1-3].Lactate dehydrogenase(LDH)is an important metabolic enzyme in the physiological pathway of glycolysis.Chou T et al [4] found that the serum LDH level of patients with multiple myeloma was significantly lower than that before treatment.Serum Ferritin(SF),as an intracellular protein,is the main protein that stores iron in the body.Jekarl DW et al [5] found that ferritin can be used to assess the prognosis of patients with multiple myeloma.LDH and SF,as traditional testing indicators,have the advantages of mature testing process,high sensitivity and strong repeatability,and are good indicators for blood tumor research.The joint detection of SF and LDH levels may be helpful for early assessment of the prognosis of MM.Objective:By analyzing the expression of LDH and SF in MM patients,the relationship between LDH,SF and ISS stage and the relationship between LDH,SF,L-SF and the survival of MM patients were studied to clarify the prognostic value of LDH,SF and L-SF in MM.Clinical prognosis assessment provides relatively early guidance.Methods:1.Using a retrospective analysis method,taking 97 patients with MM diagnosed in Baoding First Central Hospital from May 2013 to October 2018 as the research objects,collecting the gender,age,LDH,SF,LDH-SF combination(L-SF)and ISS stage were followed up by telephone and outpatients.2.Determine the best cutoff value of LDH and SF according to the ROC curve,and group LDH and SF according to the best cutoff value.The independent samplet test and chi-square test were used to compare the gender,age,and ISS stage of patients in different LDH,SF groups and Survival analysis.In addition,the joint expression of LDH and SF(L-SF)is scored.Two indicators are set as 2 points,one indicator is set as 1 point,no indicator is set as 0 points,and L-SF is 2 points.Survival analysis for L-SF 2 points,1 point and 0 points;Kaplan-Meier method and Log-rank test were used for survival analysis,and Cox proportional hazard regression model was used for risk factor analysis.Results:1.According to the ROC curve,the optimal cutoff value of LDH is 327.5U/L,and the optimal cutoff value of SF is 408.5ng/ml.2.There was no statistically significant difference in age,gender and ISS stage between different LDH groups(P>0.05).There were no sig nificant differences in age,gender,and ISS stage between different groups of SF(P>0.05).3.Univariate analysis showed different ISS stages(40VS22.18 months;P=0.027),SF(45.25VS19.30 months;P=0.001),LDH(44.60VS25.21 months;P<0.001),both Joint detection(L-SF)(46.59 VS 30.08 VS 15.32 months;P<0.001)OS difference was statistically significant..different SF(18.18VS12 months;P<0.001),LDH(16.13VS15.15 months;P=0.004),combined detection of both(L-SF)(15.88 VS 16.70 VS 11.50 months;P<0.001)PFS differences are statistically significant.Multivariate analysis showed that ISS stages,LDH and L-SF regression coefficients were all positive values,indicating that ISS(HR=0.177,95%CI 0.046-0.675,P=0.011),LDH(HR=7.127,95%CI 2.166-23.456,P=0.001),combined detection(L-SF)(HR=6.621,95%CI 2.694-16.237,P<0.001)may be a prognostic risk factors for patients with MM.4.The difference between LDH and SF combined detection(L-SF),the OS with L-SF scores of 0,1,and 2(46.59 VS 30.08 VS 15.32 months)and PFS(15.88 VS 16.70 VS 11.50 months)Statistically signific ant,OS and PFS with L-SF score of 2 were significantly shortened and the prognosis was poor(P<0.05).Conclusion:1.The prognosis of patients with LDH327.5U/L,SF408.5ng/ml or MM can be evaluated,and the prognosis of patients with LDH≥327.5U/L,SF≥408.5ng/ml is poor.2.The combination of LDH and SF(L-SF),the L-SF score is 2 points than 0,1 point prognosis is poor,suggesting that the combination of LDH and SF(L-SF)compared with a single index for the prognosis of newly diagnosed MM patients Stronger evaluation value.3.ISS stage,LDH,L-SF may be prognostic risk factors for MM patients..