The Study Of Newly Diagnosed Multiple Myeloma Applying SFLC And WB-DWI

PartⅠ The roles of the measurement of serum free light chain in the diagnosis and prognosis of newly diagnosed multiple myelomaObjective The data were analyzed for the roles of the measurement of serum free light chain(s FLC) in the diagnosis and prognosis of newly diagnosed multiple myeloma(NDMM) patients,in order to enhance the value of the measurement of serum free light chain.Methods The clinical data was retrospectively analyzed for 96 newly diagnosed multiple myeloma(NDMM) patients at hematology department of the first affiliated hospital of Soochow’s University from September 28,2012 to December 30,2105,the serum free light chain levels were measured and κ/λ ratios were calculated,so we could analyze the roles of s FLC and s FLCR in the diagnosis and prognosis of newly diagnosed multiple myeloma(NDMM) patients.Results It was 82.3%(79/96) positive by the serum protein electrophoresis(SFE) and 93.7%(90/96) was determined as positive by the serum immunofixation electrophoresis(IFE).Both the percentage of positive results obtained using s FLC and s FLCR calculations were 95.8%(92/96).Among the patients withλ light-chain MM, the λlight-chain levels showed a significant positive correlation with serum creatinine,β 2-mg and numbers of bone marrow plasma cells and it was negatively associated with levels of serum total protein.At the same time,the patients with k light-chain MM,the k light-chain levels was not showed statistically correlation with those levels above.The morbidity of renal insufficiency in theλ light-chain MM groups was 25.5%(13/51),it was 6.7%(3/45) in the k light-chain MM groups. The morbidity of renal insufficiency was more higher in theλ light-chain MM groups(P=0.009).The difference about the progression-free survival(PFS) and overall survival(OS) between the two groups was not statistically significant.Compared with the low s FLCR group(0.01﹤s FLCR﹤100,45 cases),the high s FLCR group(s FLCR≥100 or ≤0.01,51 cases)had elevated serum creatinine,bone marrow plasma cells, β2-mg,Ca2+; lower hemoglobin;a higher proportion of patients with renal dysfunction and selecting hemodialysis;more patients of DS stage Ⅲ B,ISS stage Ⅲ and R-ISS stage Ⅲ;more increased people of abnormal chromosome,fluorescence in situ hybridization(FISH) and λ chain isotype. The low risk group had a rise of κ chain isotype(all P﹤0.05). And the difference was not statistically significant when compared with the age,sex,total protein(TP),albumin(ALB),C-reactive protein(CRP),lactate dehydrogenase(LDH) and M protein.After 4-5 courses of induction chemotherapy,basing on the response criteria formulated by the IMWG for patients who could reach the Very Good Remission or better(≥VGPR),the high s FLCR group and the low were 62.2%(28/45) VS 84.4%(38/45),respectively. And the difference was statistically significant(P=0.017).The median PFS was 15.1 months for the high free light chain ratio group(s FLCR≥100 or ≤0.01) and 29.1 months for the low free light chain ratio group(0.01﹤s FLCR﹤100), respectively. And the difference was statistically significant(P<0.01).The mean of OS between the high free light chain ratio group and the low free light chain ratio group was 45.9 monthes and 47.5 monthes, respectively. And the difference was statistically significant(P=0.0047).Log-rank univariate analysis showed that elevated LDH levels and obvious abnormally s FLCR were independent prognostic factors of MM patients.Cox multi-factor analysis discovered that the LDH levels was the only poor-prognosis factor.The s FLCR(≥100 or ≤0.01) and LDH≧225U/L could serve as two risk factors.The patients who had one or more risk factor had poor prognosis than the patients who had none of them.The median progression-free survival between the two groups were 15.1 months versus 29.1 months,respectively(P=0.001).The mean of overall survival(OS) between the two groups were 44.5 months versus 49.4 months,respectively(P=0.01). And the difference was statistically significant. Among them,there were 16 cases(16.7%) of NDMM with renal dysfunction.The the 2-year survival between the patients with renal insufficiency and the normal renal fuction was 75% vs 87.5%(P=0.365). The mean of overall survival(OS) between the renal insufficiency group and the normal renal fuction group was 35 monthes and 51.2 monthes, respectively. And the difference was not statistically significant(P=0.149).Conclusions Baseline s FLC assay is much more sensitive than the commoly used methods,such as SPE and IFE for the diagnosis of MM. The λlight-chain can more easily lead to the renal insufficiency than the k light-chain.The patients withλlight-chain MM have higher morbidity of renal insufficiency more than the patients with k light-chain MM. The type of free light chain has no effect on the overall survival of multiple myeloma. The patients who have apparently abnormal baseline s FLCR have more tumour burden and higher aggressive.The baseline s FLCR could suggest adverse prognosis. The baseline LDH levels is the poor-prognosis factor for MM patients.We strongly recommend combine the serum free light chain ratio with the LDH levels to evaluate the prognosis of MM patients. The patients who have either the s FLCR(≥100 or ≤0.01) or LDH≧225U/L at the time of diagnosis have poor prognosis than the patients who had none of them. Renal insufficiency will not lead to patients early death if they acquire more treatment with timely and positively,such as the program including the Bortezomib.This has impoved the OS.PartⅡ The roles of Whole-body Diffusion Weighted Imaging(WB-DWI) in the clinical diagnosis and monitoring of newly diagnosed multiple myelomaObjective To analyze the practical value of Whole-body Diffusion Weighted Imaging(WB-DWI) in the diagnosis and monitoring of newly diagnosed multiple myeloma(NDMM) patients,in order to enhance the understanding of the WB-DWI and guide the clinical application.Methods The clinical data were retrospectively analyzed for 107 newly diagnosed multiple myeloma(NDMM) patients at hematology department of the first affiliated hospital of Soochow’s University from September,2012 to January,2016.The result of all the 60 patients who were performed WB-DWI before the treatment were analyzed. And the role of WB-DWI in the diagnosis and monitoring multiple myeloma was discussed.Results There were 57 patients who were checked out more or less abnormal focus of osteoclasia on the WB –DWI sequence from the 60 patients.It was the 95%(57/60) positive checking rate of WB–DWI. These osteolytic bone lesions occurred predominantly in the axial skeleton,that was rib, spine and pelvis. There were 96.5%(55/57) patients who had osteolytic rib lesions. Our results proved the rib was mostly involved. Thirteen patients who had no osteoclasia on computerized tomography(CT) were detected abnormal limited diffuse lesions on WB –DWI. Eight patients underwent more than one follow-up WB –DWI. The results of WB–DWI after the chemotherapy had a consistency of clinical therapeutic effect.Conclusions WB-DWI has an important value in the diagnosis and monitoring of newly diagnosed multiple myeloma. It has more higher sensitivity than CT. It has a nice correlation with treatment effect and could monitor the disease.