Case Control Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2023; 11(24): 5643-5652
Published online Aug 26, 2023. doi: 10.12998/wjcc.v11.i24.5643
Reduction rate of monoclonal protein as a useful prognostic factor in standard-risk group of newly diagnosed multiple myeloma
Min Liu, Jun-Yu Zhang
Min Liu, Jun-Yu Zhang, Department of Hematology, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
Author contributions: Zhang JY and Liu M contributed equally to this work; Zhang JY designed the research study; Liu M performed the research; Zhang JY and Liu M analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Lishui Central Hospital Institutional Review Board (Approval No. 2020.3).
Conflict-of-interest statement: Both authors have nothing to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun-Yu Zhang, MM, Chief Doctor, Department of Hematology, Lishui Municipal Central Hospital, No. 289 Kuocang Road, Lishui 323000, Zhejiang Province, China. zhangjunyu815@163.com
Received: March 17, 2023
Peer-review started: March 17, 2023
First decision: June 19, 2023
Revised: July 2, 2023
Accepted: August 1, 2023
Article in press: August 1, 2023
Published online: August 26, 2023
Processing time: 161 Days and 6 Hours
ARTICLE HIGHLIGHTS
Research background

Multiple myeloma (MM) is a common hematologic malignancy that originates from a malignant clone of plasma cells. Solitary plasmacytoma, history of diabetes, and platelet count are considered as prognostic factors for MM. But some patients are still associated with much worse outcomes without any prognostic factors.

Research motivation

To study the potential prognostic factors in MM patients.

Research objectives

This study aimed to observe the reduction rate of monoclonal protein (M protein) after the first and fourth chemotherapy cycles, which is considered as a new prognostic factor for progression-free survival (PFS) in standard-risk group of newly diagnosed MM patients.

Research methods

We retrospectively analyzed 164 patients diagnosed with standard-risk MM for the first time, and compared the PFS and overall survival (OS) between patients with a reduction rate of M protein after first chemotherapy of ≥ 50% vs < 50% and between patients with a reduction rate of M protein after the fourth chemotherapy cycle of ≥ 75% vs < 75%.

Research results

Multivariate analysis revealed age [hazard ratio (HR): 1.059, 95% confidence intervals (95%CI): 1.033-1.085, P ≤ 0.001], International Staging System stage (HR: 2.136, 95%CI: 1.500-3.041, P ≤ 0.001), autotransplantion (HR: 0.201, 95%CI: 0.069-0.583, P = 0.019), total cholesterol (HR: 0.689, 95%CI: 0.533-0.891, P = 0.019), the first cycle reduction rate (HR: 0474, 95%CI: 0.293-0.767, P = 0.019), and the fourth cycle reduction rate (HR: 0.254, 95%CI: 0.139-0.463, P = 0.019) as predictors of PFS. The Kaplan-Meier survival analysis and the log-rank tests revealed that a higher reduction rate of M protein after the first cycle (≥ 50%) and fourth cycle (≥ 75%) chemotherapy was associated with a longer PFS than the lower one.

Research conclusions

Our study have identified new prognostic factors for patients with initially diagnosed MM, and a higher reduction rate of M protein after the first chemotherapy cycle (≥ 50%) and the fourth chemotherapy cycle (≥ 75%) is associated with a longer PFS. The high reduction rate of M protein after the fourth chemotherapy cycle could is associated with the OS.

Research perspectives

To our knowledge, this is the first study to analyze the effects of the reduction rate of M protein after chemotherapy in MM patients. The new prognostic factors could help doctors to administer the treatment in time.