Abstract
Red blood cell distribution width (RDW) is a parameter reported in complete blood cell count tests, and has been reported as an inflammatory biomarker. Multiple myeloma (MM) is known to be associated with inflammatory microenvironments. However, the importance of RDW has been seldom studied in MM. For this study, 146 symptomatic myeloma patients with available RDW at diagnosis were retrospectively reviewed, and their characteristics were compared between two groups, those with high (>14.5%) and normal (≤14.5%) RDW. RDW was correlated to hemoglobin, MM stage, β2-microglobulin, M-protein, bone marrow plasma cells, and cellularity (P < 0.001). During induction, overall response rates of the two groups were similar (P = 0.195); however, complete response rate was higher in the normal-RDW group than it was in the high-RDW group (P = 0.005). With a median follow-up of 47 months, the normal-RDW group showed better progression-free survival (PFS) (24.2 versus 17.0 months, P = 0.029) compared to the high-RDW group. Overall survival was not different according to the RDW level (P = 0.236). In multivariate analysis, elevated RDW at diagnosis was a poor prognostic factor for PFS (HR 3.21, 95% CI 1.24–8.32) after adjustment with other myeloma-related prognostic factors. RDW would be a simple and immediately available biomarker of symptomatic MM, reflecting the systemic inflammation.
Highlights
Red blood cell distribution width (RDW) is one of the parameters routinely reported in the complete blood cell count test, and it reflects the size variability of mature erythrocytes in peripheral blood and ineffective erythropoiesis of bone marrow [1]
Multiple myeloma is the hematologic malignancy originating from plasma cells; it is characterized by increased monoclonal protein (M-protein) and specific organ injuries resulting in hypercalcemia, anemia, renal insufficiency, and osteolytic bone lesions
HighRDW group included more elderly patients compared to normal-RDW group, it was not statistically significant (P = 0.061)
Summary
Red blood cell distribution width (RDW) is one of the parameters routinely reported in the complete blood cell count test, and it reflects the size variability of mature erythrocytes in peripheral blood and ineffective erythropoiesis of bone marrow [1]. It has been used in routine practice for several decades to make a differential diagnosis for various cases of anemia, such as an iron deficiency anemia [2, 3]. The prognostic factors associated with multiple myeloma mainly reflect plasma cell burden or intrinsic characteristics of the myeloma clones. The International Staging System (ISS) and cytogenetic risk groups are well known as important prognostic models [14,15,16]
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