Clinical Significance Of Serum Bone Metabolic Markers In Multiple Myeloma Bone Disease

Purpose To explore the clinical significance of serum bone metabolic markers in patients with multiple myeloma bone disease(MBD)in the diagnosis,progression,therapeutic effect and prognosis of the disease.Method To review and summarize the clinical feature and collect the bone metabolism markers of MBD patients who were newly diagnosed,from January 2014 to June 2018.Then,compare the clinical datas of MBD patients including age,sex,blood routine,biochemical,imaging,bone marrow related examinations and bone metabolic markers.Using retrospective analysis according to the results of imaging examination(including whole body CT,MRI,PET-CT and whole body PET,etc.)among 178 patients.Then divided patients into two group according to different types of osteopathy.Group A: no osteopathy or osteoporosis;Group B: osteolytic changes and/or more serious pathological fractures.All patients took the serum bone metabolic markers at the first diagnosis.All patients were followed up until December the 31 st of 2018.There were 36 of them toke continuous multiple bone metabolic markers during following treatment.At the same time,chose the bone metabolism data of healthy people with the same number of cases in the same period and the same median age were selected as the control group.The basic characteristics,clinical data,bone metabolism markers,therapeutic effect evaluation,prognosis and survival of MDB patients with different classification groups were compared.Results 1.General data: Among 178 patients with MM,there were 167 had bone pain at the first diagnosis;37 had hypercalcemia by biochemical examination;84 had osteoporosis,155 had osteolytic destruction,and 73 had the most serious pathological fracture.The most common sites of osteopathy were spine(90 cases),rib(66 cases)and pelvis(54 cases),skull(28 cases),limb bone(16 cases),and less involved in sternum,scapula and clavicle(21 cases).2.Basis of grouping and difference of clinical data: According to the classification and diagnostic criteria of multiple myeloma bone disease established in IMWG in 2015,178 patients in this study were divided into group A(57 cases)with mild osteopathy and group B(121 cases)with relatively severe osteopathy.There were no differences in sex,median age of onset,LDH,uric acid content,serum albumin and globulin levels between group A and group B.Statistical significance(P > 0.05).However,the hemoglobin level in group B was lower,the serum calcium concentration and creatinine level increased significantly,and the bone marrow examination in group B indicated that the proportion of bone marrow plasma cells was higher(all P<0.05).3.Characteristics of bone metabolic markers in newly diagnosed MM patients: By analyzing the related indexes of bone metabolism in all newly diagnosed MBD patients,it was found that the contents of P1 NP and OCN-MID in patient group was significantly lower than those in the control group,and the contents of beta-CTX in patients group were higher than those in the control group.Statistical analysis showed that the differences were all unified.Academic significance(P < 0.05).4.Changes of bone metabolic markers in MM patients after treatment: After systematic treatment,P1 NP and OCN-MID contents in MBD patients increased significantly,while the content of beta-CTX decreased significantly.Combined with the statistical analysis results,it was indicated that there were significant differences between the two groups and the corresponding indexes before treatment,and the differences were statistically significant(P < 0.05).However,after analysis with the normal control group,the two groups were found to have significant differences(P <0.05).There was no significant statistical difference between the two groups(P > 0.05).5.Disease status of patients in different groups: Univariate analysis showed that the PFS and TTP of MBD patients in group B were significantly smaller than those in group A(P < 0.05);Survival analysis showed that there were significant differences in overall survival(OS)between group B with severe bone disease and group A with mild bone disease,and statistical analysis showed that P < 0.05.Conclusion 1.Epidemiological characteristics of MBD patients: MBD is the most common clinical manifestation of MM patients.In this study,about 94%(167/178)of MM patients had MBD at the beginning of diagnosis,slightly higher than that reported in the relevant literature at home and abroad(50-70%).Most of the MBD patients were in a later stage of diagnosis,and 67.98%(121/178)of them had three or more stages,which was higher than that reported in the other similar study(about 50%).2.The difference of clinical data between two groups of MBD patients: The proportion of plasma cells in bone marrow,hemoglobin,serum creatinine and serum calcium in patients with severe bone disease(group B)were significantly higher than those in patients with mild bone disease(group A).Combined with the relevant indicators,it is suggested that the tumor load and the impact on target organs in group B of osteopathy are greater,indicating that different grades of osteopathy may have a certain role in indicating the severity of the disease.3.Characteristics of bone metabolism markers between two groups of MBD patients: About bone metabolic markers,the later ISS stage and the severity of osteopathy in MM patients,the more significant the difference of bone metabolic markers is.After complete and standardized systemic treatment,the bone metabolic markers of MBD patients have changed significantly,suggesting that after systematic and standardized treatment,the bone metabolic markers of patients are improved significantly.The degree of destruction has a distinct decreasing process,while the level of bone synthesis has a distinct increase.4.Changes of bone metabolic markers in MBD patients before and after treatment: After systemic and complete systemic treatment,there was no significant difference in bone metabolic markers between MBD patients and normal control group,suggesting that systemic treatment has a significant impact on the improvement of bone metabolism in MBD patients.5.Disease status of MBD patients in different groups: the median time to progress(TTP)(18.11 months VS 26.62 months P = 0.036)and overall survival(OS)(21.05 months VS 30.31 months,P = 0.024)of MBD patients with different grades were significantly different.