Correlation Analysis Between R-ISS Staging And Prognosis Of Multiple Myeloma

ObjectiveThere is significant heterogeneity among multiple myeloma(MM)patients with the survival duration varying greatly from a few months to several years.This study retrospectively analyzed serum lactate dehydrogenase(LDH)in 105 cases of newly diagnosed elderly MM patients to investigate its value for outcome prediction.MethodsSerum LDH concentrations were evaluated prior to induction therapy.Prognostic analyses were carried out based on LDH levels and patients’ other clinical data.ResultsOf all the patients,elevated serum LDH levels(≥271U/L)were observed in 13.3%(14 out of 105)elderly MM patients at diagnosis.Compared with normal LDH group,high LDH group had significantly shorter overall sirvival(OS)(15.5 vs.52.5 months,P=0.002)and median progression free survival(PFS)(12.0 vs.24 months,P=0.030).There were also significant differences in 2-year OS rate(81%20%,P<0.001)and PFS rate(44%22%,P=0.005)between the normal and high LDH groups.A multivariate analysis identified high LDH as a unique independent adverse prognostic parameter for both OS and PFS in elderly MM patients.Furthermore,high LDH was a unique independent adverse indicator for overall response rate(ORR)and early death in elderly MM patients.ConclusionsThese results identified LDH as an unfavorable prediction for the outcome of elderly patients with MM.It is convient to be applied in the clincal practise in order to design risk stratification of elderly MM patients.ObjectiveMultiple myeloma(MM)is a highly heterogeneous plasma cell malignant tumor.The survival time of patients with multiple myeloma is very different.The R-ISS staging and ISS staging of 189 patients with newly diagnosed MM were analyzed retrospectively,and the correlation between these two staging methods and the prognosis was analyzed.MethodsThe subjects were 189 patients with newly diagnosed multiple myeloma in our hospital from January 2009 to December 2016,including 109 males and 80 females,with a median age of 60(34-87)years,and a median follow-up time of 21(2-99)months.The karyotypes abnormalities of 3 loci t(4,14),t(14,16)and del(17p)were measured by interphase FISH on CD138 purified bone marrow plasma cells using magnetic cell sorting system or clg-FISH methods,and on this basis,R-ISS staging was performed on all the patients.The study was intended to analyze the correlation between ISS staging and R-ISS staging and the prognosis of newly diagnosed MM patients.Results1.Ⅰ,Ⅱ,Ⅲ stage patients in ISS staging were 23,77 and 89 cases(12.2%,40.7%and 47.1%),1-year cumulative survival rate(OS)were 90%,88%and 83%(P=0.239),the 1-year progression free survival rate(PFS)were 72%,73%and 74%(P=0.672)Ⅰ,Ⅱ,Ⅲ stage patients in R-ISS staging were 16,142 and 31 cases(8.5%,75.1%andl6.4%),1-year OS were 100%,89%and 65%(P<0.001),1-year PFS were 86%,77%and 52%(P=0.002),the results showed statistically significant difference.2.t(4;14)positive patients were 24 cases,accounting for 13.5%,compared with negative patients,the median OS was 42 months and 68 months(P=0.144)respectively,1-year OS were 75%and 87%(P=0.171)respectively;the median PFS were 10 months and 24 months P=0.030)respectively,1-year PFS were 41%and 77%(P=0.015);del(17p)positive patients were 20 cases,accounting for 10.7%,compared with negative patients,the median OS was 30 months and 72 months(P=0.071)respectively,1-year OS were 66%and 88%(P=0.091),the median PFS was 12 months and 24 months(P=0.005),1-year PFS were 47%and 76%(P=0.003);only 5 cases were t(14;16)positive patients,a separate analysis was not performed.3.COX proportional hazard model to assess OS:age,LDH,platelet,beta 2-macroglobulin was statistically significant in univariate analysis(P<0.05).The hemoglobin,del(17p)and t(4;14),were also included in the multivariate analysis because of K-M curves in different trends(P<0.20).The results showed the age,LDH and del(17p)were independent prognostic factors for OS assessment(P<0.05).COX proportional hazard model to assess PFS:LDH,del(17p),t(4;14)had statistical significance in univariate analysis(P<0.05).The albumin and ferritin were included in the multivariate analysis because of K-M curves in different trend(P<0.20).The results showed that LDH,del(17p)and t(4;14)were.independent prognostic factors for PFS assessment(r<0.05).ConclusionCytogenetic abnormalities and LDH are predictive factors for poor prognosis;R-ISS staging based on LDH and cytogenetic abnormalities is superior to the ISS staging system in the prognostic evaluation of newly diagnosed MM patients.