Abstract
Renal failure is a common morbidity in multiple myeloma (MM). Although proteinuria has been increasingly reported in malignancies, it is not routinely used to refine risk estimates of survival outcomes in patients with MM. Here we aimed to investigate initial serum albumin and 24-hour daily protein excretion (24-h DPE) before treatment as prognostic factors in patients with MM. We conducted a retrospective analysis of 102 patients with myeloma who were ineligible for haematopoietic stem cell transplantation between October 2000 and December 2012. Initial proteinuria was assessed before treatment by quantitative analysis of 24-hour urine samples. The demographic and laboratory characteristics, survival outcome, and significance of pre-treatment 24-h DPE and albumin in the new staging system of MM were analyzed. Pre-treatment proteinuria (>300 mg/day) was present in 66 patients (64.7%). The optimal cut-off value of 24-h DPE before treatment was 500 mg/day. Analysis of the time-dependent area under the curve showed that the serum albumin and 24-h DPE before treatment were better than 24-h creatinine clearance rate and β2-microglobulin. A subgroup analysis showed that an initial excess proteinuria (24-h DPE ≥ 500 mg) was associated with poor survival status (17.51 vs. 34.24 months, p = 0.002). Furthermore, initial serum albumin was an independent risk factor on multivariate analysis (<2.8 vs. ≥2.8, hazard ratio = 0.486, p = 0.029). Using the A-DPE staging system, there was a significant survival difference among patients with stage I, II, and III MM (p < 0.001). Initial serum albumin and 24-h DPE before treatment showed significant prognostic factors in patients with MM, and the new A-DPE staging system may be utilized instead of the International Staging System. Its efficacy should be evaluated by further large prospective studies.
Highlights
Multiple myeloma (MM) is a neoplastic disorder characterized by a single clone abundance of plasma cells occupying in the bone marrow and generating a monoclonal immunoglobulin, which sequentially results in end organ damage and related complications such as anemia, renal insufficiency, hypercalcaemia, skeletal events, and infection [1,2,3,4]
The results revealed that Eastern Cooperative Oncology Group performance status (ECOG PS), stage International Staging System (ISS), proteinuria, 24-h clearance rate (Ccr), serum blood urea nitrogen (BUN), Cr, total calcium, albumin, Table 2
In patients with MM, the significance of initial serum albumin and 24-h daily protein excretion (DPE) before treatment led to the introduction of the new A-DPE staging system, and we found a significant survival difference among the different stages (p < 0.001)
Summary
Multiple myeloma (MM) is a neoplastic disorder characterized by a single clone abundance of plasma cells occupying in the bone marrow and generating a monoclonal immunoglobulin, which sequentially results in end organ damage and related complications such as anemia, renal insufficiency, hypercalcaemia, skeletal events, and infection [1,2,3,4]. The earlier the magnitude of proteinuria is reduced, the lower the risks of renal disease progression and mortality become [11, 12]. The Durie Salmon (DS) staging system, which was primarily used 40 years previously for patients with MM, was designed with each stage divided into A and B subgroups according to renal function [16]. Whether the DS or ISS is used, renal function and albumin have been considered easy and good indicators of survival [18]. Β2M is influenced by many factors including renal function, diverse autoimmune disease, and haematological malignancies [19,20,21,22,23]. We try to introduce new parameters, including 24-h daily protein excretion (DPE) and albumin, to refine risk estimates of survival outcomes in patients with MM
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