Skip to main content
SpringerLink
Log in

N-Terminal pro-brain natriuretic peptide (NTproBNP) in patients with symptomatic multiple myeloma: report from a single institution

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

Elevated levels of serum cardiovascular markers including natriuretic peptides (NPs) such as amino terminal pro-brain natriuretic peptide (NTproBNP) have been associated with disease severity and survival in cancer patients and more recently in multiple myeloma (MM). In the present study, we retrospectively reviewed 87 consecutive symptomatic TEMM (transplant-eligible) and 126 TIMM (transplant-ineligible) patients treated at our institution that did undergo NTproBNP testing from 2017 to 2020. Median age at diagnosis was 59.3 years and 75.4 years for the TEMM and TIMM groups, respectively (p = 0.0001). NTproBNP ≥ 300 ng/L was used to assess survival outcomes in the group of symptomatic MM. Patients with AL amyloidosis and symptomatic MM were excluded from the study. Median OS for patients with NTproBNP ≥ 300 ng/L was shorter (45.9 months) as compared to those with NTproBNP of < 300 ng/L (non-reached) (p = 0.0001). In addition, OS was shorter for those with CCI > 2, ISS2–3, and high-risk cytogenetics by FISH and ≥ 70 years of age. Multivariate analysis showed that HR cytogenetics and ISS2–3 were independent predictors for OS in the entire cohort of MM patients. When restricted to TIMM, age ≥ 80 years and NTproBNP ≥ 800 ng/L were predictors for OS in univariate and multivariate analyses. In conclusion, NTproBNP appears to be an independent predictor factor for OS in symptomatic TIMM patients. The use of NTproBNP as a frailty marker remains to be elucidated. However, NTproBNP could potentially be used to guide treatment decisions aimed to minimize cardiovascular and renal toxicity for myeloma therapies that potentially do have cardio-renal implications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Goetze JP, Bruneau BG, Ramos HR, Ogawa T, de Bold MK, de Bold AJ (2020) Cardiac natriuretic peptides. Nat Rev Cardiol 17(11):698–717. https://doi.org/10.1038/s41569-020-0381-0

    Article  CAS  PubMed  Google Scholar 

  2. Maisel A, Hollander JE, Guss D et al (2004) Primary results of the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT) A multicenter study of B-type natriuretic peptide levels, emergency department decision making, and outcomes in patients presenting with shortness of breath. J Am Coll Cardiol 44(6):1328–33. https://doi.org/10.1016/j.jacc.2004.06.015

    Article  PubMed  Google Scholar 

  3. Mueller C, Laule-Kilian K, Scholer A et al (2004) Use of B-type natriuretic peptide for the management of women with dyspnea. Am J Cardiol 94(12):1510–1514. https://doi.org/10.1016/j.amjcard.2004.08.029

    Article  CAS  PubMed  Google Scholar 

  4. Kwan G, Isakson SR, Beede J, Clopton P, Maisel AS, Fitzgerald RL (2007) Short-term serial sampling of natriuretic peptides in patients presenting with chest pain. J Am Coll Cardiol 49(11):1186–1192. https://doi.org/10.1016/j.jacc.2006.11.031

    Article  CAS  PubMed  Google Scholar 

  5. Binder L, Pieske B, Olschewski M et al (2005) N-terminal pro-brain natriuretic peptide or troponin testing followed by echocardiography for risk stratification of acute pulmonary embolism. Circulation 112(11):1573–1579. https://doi.org/10.1161/CIRCULATIONAHA.105.552216

    Article  CAS  PubMed  Google Scholar 

  6. Murakami T, Shiraishi M, Murakami T (2020) Significance of NT-proBNP as prognostic marker in patients with hypertension. J Hypertens 38(5):975. https://doi.org/10.1097/HJH.0000000000002401

    Article  CAS  PubMed  Google Scholar 

  7. Popat J, Rivero A, Pratap P, Guglin M (2013) What is causing extremely elevated amino terminal brain natriuretic peptide in cancer patients? Congest Heart Fail 19(3):143–148. https://doi.org/10.1111/chf.12018

    Article  CAS  PubMed  Google Scholar 

  8. Andreu A, Guglin M (2012) Exaggerated NT-proBNP production in patients with hematologic malignancies: a case series. Congest Heart Fail 18(6):333–336. https://doi.org/10.1111/j.1751-7133.2011.00258.x

    Article  CAS  PubMed  Google Scholar 

  9. Milani P, Vincent Rajkumar S, Merlini G et al (2016) N-terminal fragment of the type-B natriuretic peptide (NT-proBNP) contributes to a simple new frailty score in patients with newly diagnosed multiple myeloma. Am J Hematol 91(11):1129–1134. https://doi.org/10.1002/ajh.24532

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Kumar S, Dispenzieri A, Lacy MQ et al (2012) Revised prognostic staging system for light chain amyloidosis incorporating cardiac biomarkers and serum free light chain measurements. J Clin Oncol 30(9):989–995. https://doi.org/10.1200/JCO.2011.38.5724

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Lilleness B, Ruberg FL, Mussinelli R, Doros G, Sanchorawala V (2019) Development and validation of a survival staging system incorporating BNP in patients with light chain amyloidosis. Blood 133(3):215–223. https://doi.org/10.1182/blood-2018-06-858951

    Article  CAS  PubMed  Google Scholar 

  12. Merlini G, Lousada I, Ando Y et al (2016) Rationale, application and clinical qualification for NT-proBNP as a surrogate end point in pivotal clinical trials in patients with AL amyloidosis. Leukemia 30(10):1979–1986. https://doi.org/10.1038/leu.2016.191

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Rosenthal A, Luthi J, Belohlavek M et al (2016) Carfilzomib and the cardiorenal system in myeloma: an endothelial effect? Blood Cancer J 6:e384. https://doi.org/10.1038/bcj.2015.112

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383. https://doi.org/10.1016/0021-9681(87)90171-8

    Article  CAS  PubMed  Google Scholar 

  15. Kyle RA, Gertz MA, Witzig TE et al (2003) Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 78(1):21–33. https://doi.org/10.4065/78.1.21

    Article  PubMed  Google Scholar 

  16. Bonello F, Boccadoro M, Larocca A. Diagnostic and therapeutic challenges in the management of intermediate and frail elderly multiple myeloma patients. Cancers (Basel). Oct 24 2020;12(11) https://doi.org/10.3390/cancers12113106

  17. Abe Y, Kobayashi T, Usui Y et al (2019) N-terminal pro-brain natriuretic peptide reflects both left ventricular diastolic dysfunction and myeloma-related renal insufficiency and robustly predicts mortality in patients with symptomatic multiple myeloma. Oncotarget 10(10):1160–1170. https://doi.org/10.18632/oncotarget.26647

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Oncology and Hematology, Tom Baker Cancer Center, 1331 29th St, NW, Calgary, AB, T2N 4N2, Canada

    Victor H. Jimenez-Zepeda, Holly Lee, Jason Tay, Peter Duggan, Sylvia McCulloch, Paola Neri & Nizar J. Bahlis

  2. Charbonneau Cancer Research Institute, Calgary, AB, Canada

    Victor H. Jimenez-Zepeda, Jason Tay, Paola Neri & Nizar J. Bahlis

Authors
  1. Victor H. Jimenez-Zepeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Holly Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jason Tay
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Duggan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sylvia McCulloch
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paola Neri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nizar J. Bahlis
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

VJZ and HL performed research; collected, analyzed, and interpreted data; performed statistical analysis; and wrote the manuscript; and SM, PN, PD, JT, and NB designed research, analyzed, and interpreted data, and wrote the manuscript.

Corresponding author

Correspondence to Victor H. Jimenez-Zepeda.

Ethics declarations

Ethical standards

Approval for the review of these records was obtained from the TBCC Institutional Review Board and informed consent was also obtained.

This study was performed in accordance with the ethical standards of TBCC research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from patients to participate in this project and our institutional database.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (213 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jimenez-Zepeda, V.H., Lee, H., Tay, J. et al. N-Terminal pro-brain natriuretic peptide (NTproBNP) in patients with symptomatic multiple myeloma: report from a single institution. Ann Hematol 100, 2521–2527 (2021). https://doi.org/10.1007/s00277-021-04591-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-021-04591-z

Keywords

Search

Navigation