Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2019; 7(24): 4234-4244
Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4234
Expression of interleukin-32 in bone marrow of patients with myeloma and its prognostic significance
Gang Wang, Fang-Ying Ning, Jia-Heng Wang, Hai-Meng Yan, Hong-Wei Kong, Yu-Ting Zhang, Qiang Shen
Gang Wang, Jia-Heng Wang, Hong-Wei Kong, Department of Hematology, Quzhou People’s Hospital, Quzhou 324000, Zhejiang Province, China
Fang-Ying Ning, Department of Hematology, People’s Hospital of Hangzhou Medical College, Zhejiang Provincial People’s Hospital, Hangzhou 310000, Zhejiang Province, China
Hai-Meng Yan, Qiang Shen, Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Yu-Ting Zhang, Adicon Clinical Laboratories Inc., Hangzhou 310023, Zhejiang Province, China
Author contributions: Wang G and Ning FY contributed equally to this study; Wang G and Ning FY designed the research; Wang G, Ning FY, Kong HW, Zhang YT and Shen Q performed the research; Yan HM, Kong HW and Zhang YT analyzed the data; Wang G, Ning FY, Wang JH, Yan HM, Kong HW, Zhang YT and Shen Q wrote and revised the paper.
Supported by Foundation for Excellent Young Medical Talents from the Quzhou People's Hospital.
Institutional review board statement: The study was approved by the Ethics Committee of People’s Hospital of Hangzhou Medical College.
Informed consent statement: All patients included in this study gave informed consent.
Conflict-of-interest statement: There is no conflict of interest to declare.
Data sharing statement: No additional data are available.
STROBE statement: The manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fang-Ying Ning, MD, Doctor, Department of Hematology, People’s Hospital of Hangzhou Medical College, Zhejiang Provincial People’s Hospital, No. 158 Shangtang Road, Xiacheng District, Hangzhou 310000, Zhejiang Province, China. nfy182110@aliyun.com
Received: September 8, 2019
Peer-review started: September 8, 2019
First decision: November 11, 2019
Revised: October 14, 2019
Accepted: November 27, 2019
Article in press: November 27, 2019
Published online: December 26, 2019
Processing time: 108 Days and 6.1 Hours
ARTICLE HIGHLIGHTS
Research background

Multiple myeloma (MM) is a malignant disease in which clonal plasma cells proliferate abnormally, and ranks second in common malignant tumors of the blood system. It often occurs in the elderly and is still incurable. Studies have found that the development of MM is closely related to the secretion of interleukin-6 (IL-6) by bone marrow stromal cells. As a pro-inflammatory factor, IL-32 can increase the secretion of inflammatory factors such as IL-6, IL-1β and tumor necrosis factor, thus inducing an inflammation cascade amplification effect, which suggests that it also plays an important role in MM.

Research motivation

MM has obvious biological and clinical heterogeneity, which results in marked differences in efficacy and prognosis. National and international scholars have proposed a series of new staging systems and related indicators, but the ability of a single factor to predict prognosis was unsatisfactory, and there are many other prognostic factors being investigated. This suggests that the prognosis analysis of MM should be updated from time to time. Several studies have shown that MM is closely associated with inflammation, and the change in IL-32 level indicates the progress of the patient's condition. Furthermore, minimal residual disease (MRD) has also been confirmed to predict prognosis. However, the relationship between the above indicators and development of the disease is not clear, and their ability to assess the prognosis and survival of patients requires further research.

Research objectives

We conducted a follow-up and prognostic analysis of 67 patients with MM diagnosed in our hospital from 2012 to 2017, and analyzed the relationship between both IL-32 level and MRD and prognosis of the disease, in order to identify the relevant factors and the applicable prognostic indicators.

Research methods

The clinical data of 67 primary MM patients from 2012 to 2017 were collected and grouped according to the patient's IL-32 level using receiver operating characteristic curve. The baseline data of the patients were analyzed, and the follow-up outcomes and treatment effects in the two groups were compared. Cox regression was used to perform univariate and multivariate prognostic analysis, and further determine the factors affecting the prognosis of patients.

Research results

The cutoff value of IL-32 equal to 856.4 pg/mL significantly impacted the OS and PFS of patients. According to the IL-32 level, 38 patients were classified in the IL-32 ≥ 856.4 group and 29 in the IL-32 < 856.4, with a 3-year overall survival (OS) rate of 65.8% and 80%, respectively. The results showed that when the IL-32 level was < 856.4, OS and progression-free survival (PFS) were significantly better than those in patients with an IL-32 level ≥ 856.4. In multivariate analysis, IL-32 ≥ 856.4 and MRD positive were risk factors for poor prognosis.

Research conclusions

Different cutoff levels of IL-32 may have different effects on the prognoses of patients with newly diagnosed MM, which is valuable for assessing MM prognosis. IL-32 level and MRD could better predict OS and PFS in unselected nonclinical trial myeloma patients.

Research perspectives

In recent years, with the wide application of targeted new drugs and autologous hematopoietic stem cell transplantation, the prognosis of MM patients has greatly improved, but the prognosis and outcome varies greatly in different patients. The International Staging System has not fully met the current clinical needs during the new drug period. Therefore, this study analyzed several factors that may influence the prognosis of patients with MM, especially IL-32, a pro-inflammatory factor closely related to the development of MM. The results confirmed the clinical value of IL-32 and MRD in evaluating the prognosis of patients with MM.