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Objective:To investigate the clinical characteristics of patients with multiple myeloma (MM) combined with kidney injury and the risk factors associated with the occurrence of kidney injury.Methods:The clinical data of 96 newly treated MM patients in Heze Municipal Hospital from January 2017 to June 2021 were retrospectively analyzed, and the patients were divided into the kidney injury group (33 cases) and the non-kidney injury group (63 cases) based on whether the blood creatinine was >177 μmol/L at the time of diagnosis. The general data and laboratory results of the two groups were compared. The risk factors for kidney injury in MM patients were analyzed by logistic regression method, and the receiver operating characteristic (ROC) curve was drawn to assess the predictive value of each risk factor for the occurrence of kidney injury in MM patients.Results:Compared with the non-kidney injury group, hemoglobin was lower in the kidney injury group, and white blood cell count, blood uric acid, urea nitrogen, β 2-microglobulin (β 2-MG), cystatin C, the proportion of patients with light chain type, and the proportion of patients with international staging system (ISS) stage Ⅲ were higher in the kidney injury group, and the differences were statistically significant (all P < 0.05). Thirty-four patients underwent fluorescence in situ hybridization (FISH) test, and 22 cases (64.7%) had abnormal results. In the non-kidney injury group, genetic testing were performed in 26 cases, and the results were abnormal in 14 cases, including 11 cases (42.3%) of IgH rearrangement, 4 cases (15.4%) of RB1 deletion, 4 cases (15.4%) of 1q21 amplification, and 1 case (3.8%) of P53 deletion; in the kidney injury group, 8 cases underwent genetic testing, and all results were abnormal, including 6 cases (75.0%) of IgH rearrangement, 5 cases (40.0%) of RB1 deletion, and 2 cases (25.0%) of 1q21 amplification. The rate of RB1 mutation in the kidney injury group was higher than that in the non-kidney injury group, and the difference was statistically significant ( χ2 = 4.43, P = 0.035). Logistic regression analysis showed that elevated blood uric acid ( OR = 1.009, 95% CI 1.002-1.016, P = 0.015) and ISS stage Ⅲ ( OR = 16.401, 95% CI 1.174-229.164, P = 0.038), elevated white blood cell count ( OR = 1.833, 95% CI 1.020-3.294, P = 0.043), elevated β 2-MG ( OR = 1.320, 95% CI 1.009-1.728, P = 0.043), and decreased hemoglobin ( OR = 0.900, 95% CI 0.832-0.922, P = 0.008) were independent risk factors for the development of kidney injury in MM patients. According to the area under the ROC curve (AUC), blood uric acid (AUC = 0.775, 95% CI 0.675-0.875, P < 0.001), white blood cell count (AUC = 0.696, 95% CI 0.583-0.809, P = 0.002), β 2-MG (AUC = 0.822, 95% CI 0.732-0.911, P < 0.001), hemoglobin (AUC = 0.755, 95% CI 0.652-0.857, P < 0.001), and ISS stage Ⅲ (AUC = 0.763, 95% CI 0.669-0.856, P < 0.001) had predictive value for kidney injury in MM. Conclusions:MM patients have a high incidence of combined kidney injury, and active monitoring and control of risk factors may improve the outcome and prognosis of patients.
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Objective: To analyze the influence of Revised International Staging System (RISS) on the prognosis and treatment of multiple myeloma (MM). Methods: The clinical information of two hundred and fifty-nine newly diagnosed patients with MM was retrospectively analyzed. The survival and prognosis of these MM patients was compared by using Durie-Salmon (DS) staging, International Staging System (ISS) and RISS, respectively. The influence of use of bortezomib and autologous stem cell transplantation (ASCT) on the prognosis of patients with MM according to RISS was evaluated. Results: The median age of 259 patients with MM was 58 years (range: 34-87 years). The ratio of male to female was 1.3: 1. The median follow-up time was 32 months (range: 1-188 months), and the median progression-free survival (PFS) and median survival time were 45 and 67 months, respectively. In 239 patients with MM according to DS staging, the patients with DS stage I, II and III MM were accounted for 4.2%, 16.7% and 79.1%, respectively; the median PFS were 68, 41 and 44 months, respectively (P = 0.496), and the median survival time were 99, 64 and 67 months (P = 0.478); the 5-year PFS rates were 60.0%, 38.1% and 31.3% (P = 0.208), and the 5-year overall survival (OS) rates were 60.0%, 60.9% and 53% (P = 0.533). In 236 patients with MM according to ISS, the patients with ISS stage I, II and III MM were accounted for 17.4%, 41.1% and 41.5%, respectively; the median PFS were 53, 48 and 38 months, respectively (P = 0.033), and the median survival time were 68, 92 and 57 months, respectively (P = 0.028); the 5-year PFS rates were 36.8%, 40.0% and 25.6% (P = 0.291), and the OS rates were 60.0%, 63.9% and 42.1%, respectively (P = 0.119). In 173 patients with MM according to RISS, the patients with RISS stage I, II and III MM were accounted for 9.2%, 81.6% and 9.2%, respectively; the median PFS were 68, 47 and 16 months (P = 0.022), and the median survival time were statistics not shown and 72 and 25 months, respectively (P = 0.001). The 5-year PFS rates were 55.6%, 34.7% and 11.1% (P = 0.049), and the OS rates were 80.0%, 59.2% and 22.2% (P = 0.012). The patients with RISS stage III MM had better prognosis in bortezomib-based combination chemotherapy group, and the median survival time was 30 months, which was longer than that of the routine chemotherapy group (14 months, P = 0.014). ASCT had significant difference neither in PFS nor in OS according to RISS (P > 0.05). Conclusion: The RISS is superior to DS staging and ISS in the prognostic significance. Patients with RISS stage III MM have poor prognosis, and the bortezomib can improve the prognosis.
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Objective To analyze the changes and clinical significance of C-reactive protein (CRP)、hemoglobin (Hb) and erythrocyte sedimentation rate (ESR) in different disease stage of multiple myeloma according the international staging system. Method Thirty untreated MM patients with complete clinical records were included in the stndy. The multiple myeloma patients were classified into three groups according to international staging system (ISS).Thirty megaloblastic anemia patients of similar age 、sex、hemoglobin level as the observation group.Resulets The levels of CRP (24.17±9.87 mg/L)、Hb (71.72±13.27 g/L) and ESR (105.94±27.73 mm/h) of stage Ⅲ patients were statistically different with stage Ⅰ ( CRP 8.54±1.97 mg/L; Hb 91.00±9.92g/L; ESR 73.57±20.53mm/h)、Ⅱ patients ( CRP 14.89±5.51 mg/L; Hb 91.29±8.32g/L; ESR 67.00± 15.56 mm/h) separately (P＜0.05).The levels of CRP (19.40±10.17 mg/L) and ESR (91.90±29.70 mm/h) in the MM patients were significantly higher than that in the observation group Ⅰ ( CRP 7.52±1.57mg/L; ESR 20.20±8.04mm/h) (P＜0.05 respectively).CRP and ESR level in MM patients positively correlated with myeloma cell proportion and β2-microglobulin level (P＜0.05), while Hb level negatively correlated with myeloma cell proportion and β2-microglobulin level (P＜0.05),Conclusion The levels of C-reactive protein、hemoglobin and erythrocyte sedimentation rate are closely associated with the development of multiple myeloma. C-reactive protein and hemoglobin are relatively sensitive response to disease than erythrocyte sedimentation rate. There is a clear clinical implication in detecting the patient' s condition for progress and the prognosis.
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PURPOSE: We wanted to investigate the validity of the recently introduced Southwest Oncology Group (SWOG) staging system and the International Staging System (ISS) by comparing both systems with the widely accepted Durie/Salmon (DS) system for multiple myeloma patients. MATERIALS AND METHODS: Between 1992 and 2005, 85 multiple myeloma patients (men: women 41:44, median age: 63 years (range: 36~87)) with available baseline values of albumin and beta2-microglobulin were enrolled. The clinical and laboratory data were retrospectively obtained. RESULTS: According to the ISS, 11 patients were stage I (12.9%), 30 patients stage II (35.3%) and 44 patients stage III (51.8%). The median survivals of the ISS stages I, II and III were 78.6 months, 31.8 months and 15.1 months, respectively (p=0.015). The DS staging system was not able to predict the survival. For the SWOG staging system, 14 patients were stage I (16.4%), 27 patients stage II (31.8%), 27 patients stage III (31.8%) and 17 patients were stage IV (20.0%). The median survivals of the SWOG staging system stage I, II, III and IV were 78.6 months, 31.8 months, 11.6 months and 24.8 months, respectively (p=0.0075). CONCLUSION: The ISS staging system showed better reliability, simplicity and predictability for survival than the DS and SWOG staging systems for multiple myeloma patients.