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Early monoclonal protein decline pattern is an independent prognostic factor in patients with multiple myeloma

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Abstract

Patients always have different responses to the same treatment due to the heterogeneity of multiple myeloma (MM). However, the relationship between monoclonal protein (M-protein) reduction rates during treatment and survival prognosis in MM patients remains controversial. We retrospectively analyzed 198 newly diagnosed MM patients who received regular bortezomib-based chemotherapy for at least 2 cycles and subsequent autologous stem cell transplantation (ASCT) plus continuous maintenance. The relationship between the early M-protein reduction rates and survival prognosis was evaluated. This study is the first to divide patients into three patterns, namely, A, B, and C, according to the M-protein reduction rate during the first two therapy cycles. The results showed that pattern B patients with progressive reduction in M-protein had better progression-free survival (PFS) and overall survival (OS) than did pattern A or C patients with precipitating or slow M-protein reduction (75.33 ± 18.81 versus 41.23 ± 9.13 or 26.60 ± 6.67 months; P < 0.001; 117.33 ± 18.44 versus 71.00 ± 10.06 or 39.73 ± 24.10 months; P = 0.003, respectively). In addition, biological analysis showed that pattern A + C patients had higher international staging system (ISS) stage III proportions (P = 0.008) and lactate dehydrogenase (LDH) elevations (P = 0.044) than pattern B patients. Furthermore, pattern A + C was a significant independent adverse parameter for PFS and OS (HR = 2.62, P = 0.001; HR = 2.15, P = 0.022, respectively). Thus, our results demonstrate that pattern A + C indicates an inferior survival prognosis in MM.

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Abbreviations

ASCT:

autologous stem cell transplantation

FISH:

fluorescence in situ hybridization

ISS:

international staging system

IFN-a:

interferon-a

LDH:

lactate dehydrogenase

M-protein:

monoclonal protein

MM:

multiple myeloma

OS:

overall survival

PAD:

bortezomib, pegylated liposomal doxorubicin, dexamethasone

PFS:

progression-free survival

PR:

partial response

SFLC:

serum-free light chain

VD:

bortezomib, dexamethasone

VGPR:

very good partial remission

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Funding

This work was supported by the Sun Yat-sen University medical clinical trial “5010 Plan” 2017005.

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Authors and Affiliations

  1. Department of Hematology, The First Affiliated Hospital of SunYat-sen University, 58 Second Zhongshan Road, Guangzhou, 510080, China

    Limei Xu, Junru Liu, Meilan Chen, Lifen Kuang, Beihui Huang, Jingli Gu & Juan Li

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  1. Limei Xu
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  2. Junru Liu
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  3. Meilan Chen
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Correspondence to Juan Li.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Informed consent was obtained from all patients for being included in the study.

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Xu, L., Liu, J., Chen, M. et al. Early monoclonal protein decline pattern is an independent prognostic factor in patients with multiple myeloma. Ann Hematol 99, 581–589 (2020). https://doi.org/10.1007/s00277-020-03915-9

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  • DOI: https://doi.org/10.1007/s00277-020-03915-9

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