Changes Of Reticulocyte Maturation Parameters In Patients With Multiple Myeloma Treated With Bortezomib Combination Regimen And Their Correlation With Immune And Clinical Indexes

Background: Multiple myeloma(MM)is a malignant disease of the hematologic system with an increasing incidence in recent years.Immunotherapy represented by bortezomib and immunomodulators has greatly improved the efficacy of MM,and the disorder of immune microenvironment in MM has also attracted widespread attention.Bortezomib combined regimen is the most commonly used regimen among many treatments,but it is easy to cause bone marrow suppression,infection,bleeding and other side effects during treatment.The changes of reticulocyte and maturation parameters can better reflect the hematopoietic condition of bone marrow.It is of great significance to monitor the changes during MM therapy.The correlation and significance of changes in reticulocytes and maturation parameters with immune and clinical indexes in MM patients have not been reported,which is the focus of this study.Objective: By observing the changes of reticulocyte and maturation parameters of Newly diagnosed multiple myeloma(NDMM)patients after bortezomib combined treatment,and studying its correlation with immune indicators,disease characteristics and prognostic indicators,To investigate the changes of reticulotic maturation parameters in patients with multiple myeloma treated with bortezomib combination regimen and its correlation and significance with immune and clinical indexes,in order to provide reference for clinical intervention.Methods: Thirty-one patients with NDMM admitted to the Second Hospital of Lanzhou University from December 2021 to January 2023 were selected as the experimental group,and 20 healthy volunteers from the physical examination center during the same period were included as the control group.Blood routine,reticulocyte and maturation parameters were determined by automatic blood cell analyzer,and IL-6,TNF-α,IFN-γ and other cytokines were detected by fluidic microsphere capture chip technology.ALB,LDH,β2-MG and CRP were determined by conventional biochemical analyzer,and plasma cell proportion was determined by bone marrow smear.Results: 1.Absolute value of reticulocyte(RET#),percentage of reticulocyte(RET%),immature reticulocyte(IRF),medium fluorescence intensity reticulocyte(MFR%),high fluorescence intensity reticulocyte(HFR%),white blood cell(WBC)and absolute neutrophil count(ANC)decreased first and then increased,and RET#decreased to the lowest on the 4th day after treatment,and recovered on the 7th day.RET% and IRF fell to the lowest on the 7th day and recovered from the 10 th day.MFR%,HFR%,WBC,ANC decreased to the lowest level on the 10 th day of treatment,and began to recover on the 13 th day.Low fluorescence intensity reticulocyte(LFR)increased gradually after treatment,reached the highest on day 7,and began to decline on day 10.By the 16 th day after observation,reticulotexin,maturation parameters,WBC and ANC had not recovered to the level before treatment.2.Correlation analysis showed that reticulocyte and maturation parameters were correlated with plasma cell ratio,β2-MG,CAR(CRP/ALB),MM risk stratification and LDH in NDMM patients before treatment(P<0.05).Plasma cell ratio,CAR and MM stratification were negatively correlated with LFR%(P<0.05).MM stratification,CAR and HFR%;MM stratification,β2-MG and MFR%;MM layering,CAR and IRF;CAR and RET%;LDH was positively correlated with RET#(P<0.05);There was no significant correlation between IL-6,TNF-α,IFN-γ and reticulocytes and maturation parameters before treatment(P>0.05).3.Using LDH250U/L before treatment as the boundary to compare reticulum and maturation parameters after treatment,there were statistically significant differences in MFR% at day 7,HFR% at day 1 and day 16,and IRF at day 7 and day 10(P<0.05);Using 60%plasma cell proportion before treatment as the boundary comparison of reticulocytes and maturation parameters after treatment,IRF and LFR% on days 4 and 7 had statistical significance(P<0.05).Using β2-MG 5500ng/L before treatment as the boundary to compare reticulocyte and maturation parameters after treatment,there was statistical significance in LFR% at day 4(P<0.05).Conclusions: 1.The reticulocyte and maturation parameters of NDMM patients after treatment are more sensitive than those of WBC and ANC,which can better reflect the suppression and recovery of bone marrow,and is the best monitoring index for bone marrow reconstruction.2.Reticulocytes and maturation parameters of NDMM patients before treatment were significantly correlated with plasma cell proportion,β2-MG,CAR,MM stratification,LDH,but not with IL-6,TNF-α,IFN-γ;It is suggested that reticulocyte and maturation parameters before treatment can reflect the severity of disease to a certain extent.3.The proportion classification ofβ2-MG,LDH and plasma cells in NDMM patients before treatment showed differences in the changes of reticulocyte and maturation parameters after bortezomib combined treatment.The higher the β2-MG and LDH,the larger the proportion of plasma cells,the more obvious bone marrow suppression after treatment,so clinical intervention can be carried out in advance according to the above indicators.