The combination of serum calcium levels, neutrophil‑to‑lymphocyte ratio and platelet count in the prognosis of multiple myeloma: A retrospective cohort study and review of the literature

Vu,Minh Phuong; Han,Viet Trung; Pham,Phuong Thao; Vu,Hoang

doi:10.3892/wasj.2022.165

The combination of serum calcium levels, neutrophil‑to‑lymphocyte ratio and platelet count in the prognosis of multiple myeloma: A retrospective cohort study and review of the literature

Authors:
- Minh Phuong Vu
- Viet Trung Han
- Phuong Thao Pham
- Hoang Vu
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Affiliations: Department of Hematology, Hanoi Medical University, Hanoi, Vietnam, Clinical Department, Center of Hematology and Blood Transfusion, Bach Mai Hospital, Hanoi, Vietnam
Published online on: July 14, 2022 https://doi.org/10.3892/wasj.2022.165
Article Number: 30
Copyright: © Vu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The prognosis of multiple myeloma (MM) can be determined by the serum calcium levels, the neutrophil‑to‑lymphocyte ratio (NLR) and the platelet count (PLT). The objective of the present study was to determine the influence of the combined prognostic index (CPI), which included the aforementioned three indices (serum calcium levels, NLR and PLT), on the survival rates of patients with MM. A total of 111 patients newly diagnosed with MM undergoing treatment were analyzed. The prognostic values for the survival times were determined at the time of pre‑treatment. The patients with high serum calcium levels (2.665 mmol/l), a high NLR (2.245) and a low PLT (<150x10⁹/l) received a score of 1. Based on the scores obtained, the CPI was formed, in which the patients were grouped into a low‑risk group (0‑1 points), an intermediate‑risk group (2 points) and a high‑risk group (3 points). Univariate analysis demonstrated significant differences between the three CPI groups (P<0.001). Multivariate analysis indicated that the CPI was an independent prognostic factor for overall survival [intermediate‑risk group: Hazard ratio (HR), 3.244; 95% confidence interval (CI), 1.213‑8.679; high‑risk group: HR, 4.290; 95% CI, 2.180‑8.443; P<0.001]. This level of significance was also observed in the subgroups, which were divided according to the percentage of bone marrow plasma cells (≥30 or <30%) and age (≥65 or <65 years). On the whole, the present study demonstrates that the CPI determined by the high serum calcium levels, high NLR and low PLT may be used as an independent prognostic indicator for patients with MM.

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1	Fairfield H, Falank C, Avery L and Reagan MR: Multiple myeloma in the marrow: Pathogenesis and treatments. Ann N Y Acad Sci. 1364:32–51. 2016.PubMed/NCBI View Article : Google Scholar
2	Wallington-Beddoe CT and Mynott RL: Prognostic and predictive biomarker developments in multiple myeloma. J Hematol Oncol. 14(151)2021.PubMed/NCBI View Article : Google Scholar
3	Bustoros M, Mouhieddine TH, Detappe A and Ghobrial IM: Established and novel prognostic biomarkers in multiple myeloma. Am Soc Clin Oncol Educ Book. 37:548–560. 2017.PubMed/NCBI View Article : Google Scholar
4	Afram G, Gran C, Borg Bruchfeld J, Wagner AK, Hussein A, Alici E and Nahi H: Impact of performance status on overall survival in patients with relapsed and/or refractory multiple myeloma: Real-life outcomes of daratumumab treatment. Eur J Haematol. 105:196–202. 2020.PubMed/NCBI View Article : Google Scholar
5	Cai Y, Zhao Y, Dai Q, Xu M, Xu X and Xia W: Prognostic value of the albumin-globulin ratio and albumin-globulin score in patients with multiple myeloma. J Int Med Res. 49(300060521997736)2021.PubMed/NCBI View Article : Google Scholar
6	Qian J, Jin J, Luo H, Jin C, Wang L, Qian W and Meng H: Analysis of clinical characteristics and prognostic factors of multiple myeloma: A retrospective single-center study of 787 cases. Hematology. 22:472–476. 2017.PubMed/NCBI View Article : Google Scholar
7	Chen R, Zhang X, Gao C, Luan C, Wang Y and Chen B: Treatment and prognostic factors for survival in newly diagnosed multiple myeloma patients with bortezomib and dexamethasone regimen: A single Chinese center retrospective study. Cancer Manag Res. 9:373–380. 2017.PubMed/NCBI View Article : Google Scholar
8	Zhang X, Duan J, Wen Z, Xiong H, Chen X, Liu Y, Liao K and Huang C: Are the derived indexes of peripheral whole blood cell counts (NLR, PLR, LMR/MLR) clinically significant prognostic biomarkers in multiple myeloma? A systematic review and meta-analysis. Front Oncol. 11(766672)2021.PubMed/NCBI View Article : Google Scholar
9	Liu S, Shi J, Guo H, Xu F, Wei M, Sun K and Chen Y: Prognostic significance of the inflammatory index-based scoring system in patients preliminarily diagnosed with multiple myeloma in the bortezomib-based chemotherapy era. Cancer Manag Res. 11:9409–9420. 2019.PubMed/NCBI View Article : Google Scholar
10	Kim DS, Yu ES, Kang KW, Lee SR, Park Y, Sung HJ, Choi CW and Kim BS: Myeloma prognostic index at diagnosis might be a prognostic marker in patients newly diagnosed with multiple myeloma. Korean J Intern Med. 32:711–721. 2017.PubMed/NCBI View Article : Google Scholar
11	Szudy-Szczyrek A, Mlak R, Mielnik M, Szczyrek M, Nowaczyńska A, Homa-Mlak I, Zmorzyński S, Kuśmierczuk K, Sompor J, Filip A, et al: Prognostic value of pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in multiple myeloma patients treated with thalidomide-based regimen. Ann Hematol. 99:2881–2891. 2020.PubMed/NCBI View Article : Google Scholar
12	Zuo H, Zhai L, Liu X, Gao H and Xu P: Prognostic significance of neutrophil-lymphocyte ratio in multiple myeloma patients. Transl Cancer Res. 7:88–96. 2018.
13	Gui L, Wang F, Shi J and Chen B: The significance of inflammatory markers in the prognosis of newly diagnosed multiple myeloma patients. Blood. 136 (Suppl 1)(S15)2020.
14	Solmaz S, Uzun O, Acar C, Sevindik OG, Piskin O, Ozsan HG, Demirkan F, Undar B, Alacacioglu A, Ozcan MA and Alacacioglu I: Is the platelet-to-lymphocyte ratio a new prognostic marker in multiple myeloma? J Lab Physicians. 10:363–369. 2018.PubMed/NCBI View Article : Google Scholar
15	Greipp PR, San Miguel J, Durie BG, Crowley JJ, Barlogie B, Bladé J, Boccadoro M, Child JA, Avet-Loiseau H, Kyle RA, et al: International staging system for multiple myeloma. J Clin Oncol. 23:3412–3420. 2005.PubMed/NCBI View Article : Google Scholar
16	Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L, Richardson P, Caltagirone S, Lahuerta JJ, Facon T, et al: Revised international staging system for multiple myeloma: A report from international myeloma working group. J Clin Oncol. 33:2863–2869. 2015.PubMed/NCBI View Article : Google Scholar
17	Rajkumar SV: Multiple myeloma: 2016 Update on diagnosis, risk-stratification, and management. Am J Hematol. 91:719–734. 2016.PubMed/NCBI View Article : Google Scholar
18	Azam F, Latif MF, Farooq A, Tirmazy SH, AlShahrani S, Bashir S and Bukhari N: Performance status assessment by using ECOG (eastern cooperative oncology group) score for cancer patients by oncology healthcare professionals. Case Rep Oncol. 12:728–736. 2019.PubMed/NCBI View Article : Google Scholar
19	Garderet L, D'Souza A, Jacobs P, van Biezen A, Schönland S, Kroeger N, Morris C and Hari P: Response assessment in myeloma: Practical manual on consistent reporting in an era of dramatic therapeutic advances. Biol Blood Marrow Transplant. 23:1193–1202. 2017.PubMed/NCBI View Article : Google Scholar
20	Jung SH, Cho MS, Kim HK, Kim SJ, Kim K, Cheong JW, Kim SJ, Kim JS, Ahn JS, Kim YK, et al: Risk factors associated with early mortality in patients with multiple myeloma who were treated upfront with a novel agents containing regimen. BMC Cancer. 16(613)2016.PubMed/NCBI View Article : Google Scholar
21	Deftos LJ: Hypercalcemia in malignant and inflammatory diseases. Endocrinol Metab Clin North Am. 31:141–158. 2002.PubMed/NCBI View Article : Google Scholar
22	Oyajobi BO: Multiple myeloma/hypercalcemia. Arthritis Res Ther. 9 (Suppl 1)(S4)2007.PubMed/NCBI View Article : Google Scholar
23	Zagouri F, Kastritis E, Zomas A, Terpos E, Katodritou E, Symeonidis A, Delimpasi S, Pouli A, Vassilakopoulos TP, Michalis E, et al: Hypercalcemia remains an adverse prognostic factor for newly diagnosed multiple myeloma patients in the era of novel antimyeloma therapies. Eur J Haematol. 99:409–414. 2017.PubMed/NCBI View Article : Google Scholar
24	Cheng J, Zhang W, Zhao Y, Li X, Lv R, Li H and Chen J: Association of serum calcium levels with renal impairment and all-cause death in Chinese patients with newly diagnosed multiple myeloma: A cross-sectional, longitudinal study. Nutr Metab (Lond). 18(19)2021.PubMed/NCBI View Article : Google Scholar
25	Greten FR and Grivennikov SI: Inflammation and cancer: Triggers, mechanisms and consequences. Immunity. 51:27–41. 2019.PubMed/NCBI View Article : Google Scholar
26	Arman M, Payne H, Ponomaryov T and Brill A: Role of Platelets in Inflammation. Intechopen, 2015. https://www.intechopen.com/chapters/48530.
27	Karachaliou N, Pilotto S, Bria E and Rosell R: Platelets and their role in cancer evolution and immune system. Transl Lung Cancer Res. 4:713–720. 2015.PubMed/NCBI View Article : Google Scholar
28	Mellors P, Binder M, Buadi FK, Lacy MQ, Gertz MA, Dispenzieri A, Hayman SR, Kapoor P, Gonsalves WI, Hwa Y, et al: Development of thrombocytopenia and survival outcomes in newly diagnosed multiple myeloma. Blood. 132 (Suppl 1)(S1902)2018.