Serum prohepcidin levels are potential prognostic markers in patients with multiple myeloma

Prognostic value of semi-quantitative parameters of 18F-FDG PET/CT in newly diagnosed multiple myeloma patients

OBJECTIVE

To investigate the prognostic value of fluroine-18 fluorodexyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) semi-quantitative parameter in newly diagnosed multiple myeloma (NDMM) and to design a new staging system including ¹⁸F-FDG PET/CT semi-quantitative parameters for NDMM.

METHODS

A total of 38 NDMM patients who underwent ¹⁸F-FDG PET/CT examination in Yichang Central People's Hospital from February 2014 to April 2021 were collected. The relationship between the characteristics of ¹⁸F-FDG PET/CT (metabolic tumor volume of all lesions (aMTV), total lesion glycolysis of all lesions (aTLG), maximum standardized uptake values (SUVmax) of the lesion with largest MTV (mSUVmax), extramedullary disease (EMD), focal lesions (FLs)), the laboratory parameters, and prognostic parameters (progression-free survival (PFS) and overall survival (OS)) were analyzed retrospectively. SPSS 25.0 statistical software was used for statistical processing, Kaplan-Meier method was used for survival analysis, Log-rank method was used for univariate analysis, and Cox proportional risk model was used for multivariate analysis.

RESULTS

Univariate analysis showed that aMTV ≥ 90.97cm³, aTLG ≥ 283.31 g, hemoglobin (Hb) < 100 g/L, focal lesions (FLs) ≥ 10, (percentage of circulating plasma cells (CPC%) ≥ 30%, creatinine (Cr) ≥ 177umol/L, lactic dehydrogenase (LDH) ≥ 250 g/L might be the adverse prognostic factors of PFS in patients with NDMM, all p < 0.05; aMTV ≥ 90.97 cm³, aTLG ≥ 283.31 g, Hb < 100 g/L, FLs ≥ 10, mSUVmax ≥ 5.8, the presence of extramedullary disease (EMD) and PCPs ≥ 30% may be adverse prognostic factors for OS in patients with NDMM, all p < 0.05. Multivariate regression analysis showed that aMTV ≥ 90.97 cm³ was an independent risk factor for PFS in NDMM patients, p < 0.05; aMTV ≥ 90.97 cm³, mSUVmax ≥ 5.8, and the presence of EMD were independent risk factors for OS in the NDMM patients, all p < 0.05. According to the multivariate analysis results of OS, the New stage (NS) was performed. The 3-year OS rates of stage I, stage II, and stage III in NDMM patients were 100.0, 53.5, and 32.1%, respectively, p = 0.000.

CONCLUSION

aMTV can predict PFS and OS of NDMM patients better than other parameters. NS which combined with aMTV can predict OS of NDMM patients better and can provide an accurate and simple method for risk stratification of NDMM patients.

New Biomarkers of Ferric Management in Multiple Myeloma and Kidney Disease-Associated Anemia

Multiple myeloma (MM) is a malignancy of clonal plasma cells accounting for approximately 10% of haematological malignancies. MM mainly affects older patients, more often males and is more frequently seen in African Americans. The most frequent manifestations of MM are anaemia, osteolytic bone lesions, kidney failure and hypercalcemia. The anaemia develops secondary to suppression of erythropoiesis by cytokine networks, similarly to the mechanism of anaemia of chronic disease. The concomitant presence of kidney failure, especially chronic kidney disease (CKD) and MM per se, leading to anaemia of chronic disease (ACD) in combination, provoked us to pose the question about their reciprocal dependence and relationship with specific biomarkers; namely, soluble transferrin receptor (sTfR), growth differentiation factor 15 (GDF15), hepcidin 25 and zonulin. One or more of these are new biomarkers of ferric management may be utilized in the near future as prognostic predictors for patients with MM and kidney failure.

Predictive value of 18 F-FDG PET/CT scanning in combination with clinical parameters in patients with newly diagnosed multiple myeloma

OBJECTIVE

To evaluate the association of ¹⁸ F-2'-deoxy 2'-fluorodeoxyglucose (¹⁸ F-FDG) PET/CT with clinical parameters in predicting patients with newly diagnosed multiple myeloma (MM).

METHODS

A total of 120 MM patients undergoing ¹⁸ F-FDG PET/CT scanning were analyzed in a retrospective cohort study.

RESULTS

Based on multivariate analysis, β2M, LDH, number of focal lesions (FLs), and SUVmax were significantly correlated with OS. These 4 variables were used to construct a new staging system (NSS) based on the number of risk factors. NSS provided a better discrimination of risk between stages III and II than International staging system (ISS) (P < .001 vs P = .086). For OS, there was no significant difference among risk groups in Durie-Salmon (DS) stage (P > .05). Based on Spearman correlation analysis, the presence of lesions in appendicular skeleton, number of FLs, and SUVmax appeared to indicate advanced stage of MM. ROC curves which showed the combination of β2M with calcium got a specificity of 96.3% for lesions in appendicular skeleton, and LDH alone had 100% specificity in predicting the number of FLs, although the sensitivity was only 50%.

CONCLUSIONS

¹⁸ F-FDG PET/CT in combination with clinical parameters provided an accurate and simple method for risk stratification of patients with newly diagnosed MM.

Dilemma: Correlation Between Serum Level of Hepcidin and IL-6 in Anemic Myeloma Patients

Introduction:

Anemia occurs in 60% to 80 % of patients with newly diagnosed myeloma multiplex (MM). The cause of anemia in MM is probably multi factorial and involved among the others hepcidin and some cytokines, especially interleukine-6. Anemia in MM is one of the risk factor used in Durie-Salmon classification for staging and prognostic score. Treatment options are set according to this score with most significant impact on survival.

Aim:

To estimate baseline level of serum hepcidin, IL-6 and iron metabolism markers in anemic MM patients, possible role of hepcidin and its interaction with IL-6.

Methods:

27 patients with newly diagnosed MM were enrolled in this observational, prospective study and age, gender matched 60 healthy controls. Erythrocyte count, hemoglobin, serum hepcidin, interleukin-6, iron, ferritin and transferrin were measured.

Results:

Anemia was diagnosed in 70% of MM patients. Serum hepcidin was significantly higher in MM group (55.5 ng/mL) than in control 5.9 ng/mL (p=0000). In myeloma patients serum IL-6 was 3.59 pg/mL, anemic 3.80 pg/mL, non-anemic 0.33 pg/mL, without significant difference. It was not found significant correlation between hepcidin and IL-6 in anemic myeloma patients.

Conclusion:

High level of hepcidin probably causes anemia in MM but its high expression is not due only to IL-6.

Study of the correlation between serum ferritin levels and the aggregation of metabolic disorders in non-diabetic elderly patients

The present study aimed to explore the correlation between serum ferritin (SF) levels and the aggregation of metabolic disorders in non-diabetic elderly patients. A total of 2,600 patients were enrolled in the study. Various parameters, including blood pressure (BP), height, weight, lipid profiles, blood glucose (BG), body mass index (BMI), fasting insulin (FINS), serum uric acid (SUA), the urinary albumin/creatinine ratio (UACR) and SF levels were measured. A homeostatic model was used to evaluate insulin resistance (HOMA-IR) and β-cell function (HOMA-β). The quantitative insulin sensitivity check index (QUICKI) and disposition index (DI) were calculated. The QUICKI and DI decreased significantly and other parameters increased significantly when the number of metabolic disorders increased. Patients with high triglycerides (TG), high total cholesterol (TC), high SUA and obesity demonstrated higher SF levels than those with normal TG, normal TC, normal SUA and normal weight, respectively (P<0.01). Male patients with metabolic disorders (high TG, high TC, high BP, high SUA and obesity) had higher SF levels than female patients with the corresponding disorders (P<0.01). BG, FINS, BMI, TC, TG, SUA, HOMA-IR and HOMA-β were positively correlated with SF, while DI and QUICKI were negatively correlated with SF (P<0.01). Stepwise regression analysis showed that HOMA-IR, BMI, TC, TG and SUA were risk factors for elevated SF levels. In conclusion, the SF levels in non-diabetic, elderly individuals with metabolic disorders may be significantly related to the clustering of the metabolic disorders. Dyslipidemia, obesity, disorders of purine metabolism and insulin resistance may be important risk factors for higher SF levels in the elderly.