Abstract
PD-L1 expression is associated with poor prognosis, although this relationship is unclear in bone marrow-derived haematologic malignancies, including multiple myeloma. We aimed to determine whether PD-L1 expression could predict the prognosis of newly diagnosed multiple myeloma (NDMM). We evaluated 126 NDMM patients (83, retrospectively; 43, prospectively) who underwent bone marrow examinations. Bone marrow aspirates were analysed for PD-L1 expression, categorized as low or high expression, using quantitative immunofluorescence. High PD-L1 expression could independently predict poor overall survival (OS) (95% CI = 1.692–8.346) in multivariate analysis. On subgroup analysis, high PD-L1 expression was associated with poor OS (95% CI = 2.283–8.761) and progression-free survival (95% CI = 1.024–3.484) in patients who did not undergo autologous stem cell transplantation (ASCT) compared with those who did. High PD-L1 expression was associated with poor OS despite frontline treatments with or without immunomodulators. Thus, PD-L1 expression can be a useful prognosis predictor in NDMM patients, whereas ASCT may be used in patients with high PD-L1 expression. We developed a prognostic nomogram and found that a combination of PD-L1 expression in bone marrow plasma cells and clinical parameters (age, cytogenetics, and lactate dehydrogenase) effectively predicted NDMM prognosis. We believe that our nomogram can help identify high-risk patients and select appropriate treatments.
Highlights
Programmed cell death ligand 1 (PD-L1) expression is associated with poor prognosis, this relationship is unclear in bone marrow-derived haematologic malignancies, including multiple myeloma
To the best of our knowledge, this is the first study to indicate that high PD-L1 expression in bone marrowaspirated plasma cells is associated with a poor prognosis in newly diagnosed multiple myeloma (NDMM)
Our subgroup analyses revealed that autologous stem cell transplantation (ASCT) was associated with an improved prognosis in the high PD-L1 expression group, it did not prevent the progression or relapse of NDMM
Summary
PD-L1 expression is associated with poor prognosis, this relationship is unclear in bone marrow-derived haematologic malignancies, including multiple myeloma. Previous studies have shown that PD-L1 is expressed in many types of malignancies, including multiple myeloma (MM)[3,4,5], and immune checkpoint blockades targeting the PD-1/ PD-L1 pathway It is a promising treatment for solid tumours and lymphomas[6,7,8]. Soluble PD-L1 levels predicted treatment response and progression-free survival (PFS) in NDMM p atients[14], and high levels of soluble PD-L1 in bone marrow plasma were associated with worse OS rates and worse responses after autologous stem cell transplantation (ASCT) in MM p atients[15]. We developed a nomogram incorporating PD-L1 expression into selected clinical parameters, and we believe that this nomogram can help identify high-risk patients with poor predicted prognoses
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