Study On The Correlation Between Glasgow Prognostic Score And Prognosis Of Multiple Myeloma

Objective:To analyze the clinical characteristics and survival time of different Glasgow prognostic score(GPS)before initial chemotherapy in patients with multiple myeloma(MM),and explored the prognostic stratification value of GPS in MM patients.Methods:This study collected clinical data from 181 patients with newly diagnosed multiple myeloma who were admitted to the Affiliated Hospital of Qingdao University between January 2015 and October 2021.The diagnostic criteria used in this study were consistent with those of the International Myeloma Working Group(IMWG).Patients with acute infection,rheumatic disease,chronic inflammatory bowel disease,autoimmune disease,liver or kidney dysfunction,other malignant tumors,or those who had received chemotherapy,hormone therapy,or immunomodulator therapy were not included in the study.Clinical data such as gender,age,hemoglobin(HB)levels,and lactate dehydrogenase(LDH),serum albumin(ALB),C-reactive protein(CRP),β2-microglobulin(β2-MG),platelet(PLT),bone marrow plasma cell ratio,creatinine(Scr),blood calcium(Ca),chromosome karyotype,immunophenotype,cytogenetics,D-S staging,ISS staging,R-ISS staging were recorded.The patients were followed up to March 31,2022 by outpatient follow-up,hospitalization,telephone follow-up,etc.,recorded the overall survival time and progression-free survival time of patients and then divided them into three groups based on their serum CRP and ALB levels: CRP≤10mg/L and ALB≥35g/L were GPS0 group;CRP>10mg/L or ALB<35g/L were GPS1 group;CRP>10mg/L and ALB<35g/L were GPS2 group.To analyze the correlation between each group and clinical data and on the prognosis of MM patients.The data between groups were analyzed by χ2 test or Fisher test.Kaplan-Meier method was used for univariate analysis and survival curve was drawn.Multivariate analysis was conducted using Cox regression analysis and P<0.05 was considered statistically significant.Results:Among the 181 patients,the age was between 30 and 83 years old,the median age of62 years old.There were 104 male patients(57.5%)and 77 female patients(42.5%).There were 62 cases(34.3%)in GPS0 group,77 cases(42.5%)in GPS1 group and 42cases(23.2%)in GPS2 group.The median follow-up time was 31 months.There were 48 cases of recurrence and 38 cases of death.143 patients survived to the end of follow-up.χ~2 test or Fisher test was used to compare the relationship between GPS and clinical data.The statistical results showed that there were significant differences between GPS and classification,D-S stage,ISS stage,R-ISS stage,HB,ALB and CRP,but not with age,bone marrow plasma cell ratio,PLT,β2-MG,LDH,Scr and Ca.Univariate analysis showed that GPS low score group had longer OS and PFS than GPS high score group.D-S stage III and increased proportion of bone marrow plasma cells were only associated with poor PFS.ISS stage III,hemoglobin decrease,PLT decrease,β2-MG increase,LDH increase,Scr increase,hypercalcemia,hypoproteinemia and CRP increase were associated with short PFS and OS.The independent factors with P<0.05 in univariate analysis were included in the Cox regression model for multivariate analysis.The results showed that GPS score,bone marrow plasma cell ratio,serum calcium and LDH were independent prognostic factors for PFS and OS.There were significant differences in survival time between different subgroups of GPS.With the increase of GPS score,the survival rate of patients decreased.Efficacy analysis: The efficacy of GPS low score group is better than that of GPS high score group,and patients with GPS low score are more likely to achieve deep remission.MM patients receiving one or more proteasome inhibitors and immunomodulator regimens had significant differences in survival between different GPS score groups(P<0.001),indicating that GPS score still has a good prognostic predictive value in the era of new drugs.Conclusion:1.The GPS score before the initial treatment is closely related to the classification,clinical stage,anemia,high CRP and hypoproteinemia of multiple myeloma.2.GPS is an independent predictor of prognosis in patients with multiple myeloma,and high GPS indicates shorter survival time.3.The therapeutic effect of low GPS group is better than that of high GPS group,and GPS scoring system still has good prognostic predictive value in the era of new drugs.