Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4234
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
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.
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.
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.
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.
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.
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.
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.