Prognostic Significance Of The Inflammatory Index-Based Scoring System In Patients Preliminarily Diagnosed With Multiple Myeloma In The Bortezomib-Based Chemotherapy Era

Figures & data

Table 1 Patients’ Baseline Characteristics

Characteristic	Total	NLR			RDW			PLT
		NLR≤2	NLR>2	P value	RDW≤14	RDW>14	P Value	PLT≤150	PLT>150	P Value
Age, yrs.	61.29±9.38	60.31±7.99	62.22±10.49	0.174	60.95±8.58	61.54±9.95	0.681	62.51±10.74	60.42±8.22	0.166
Gender
Male	95 (54.30%)	40 (47.10%)	55 (61.10%)	0.062	42 (57.50%)	53 (52.00%)	0.466	38 (52.10%)	57 (55.90%)	0.616
Female	80 (45.70%)	45 (52.90%)	35 (38.90%)		31 (42.50%)	49 (48.00%)		35 (47.90%)	45 (44.10%)
BM plasma cells, %
≤40	95 (54.30%)	47 (55.30%)	48 (55.30%)	0.795	45 (61.60%)	50 (49.00%)	0.098	32 (43.80%)	63 (61.80%)	0.019
>40	80 (45.70%)	38 (44.70%)	42 (46.70%)		28 (38.40%)	52 (51.00%)		41 (56.20%)	39 (38.20%)
International Staging System
ISS I	23 (13.10%)	19 (22.40%)	4 (4.40%)	<0.001	14 (19.20%)	9 (8.80%)	0.106	4 (5.50%)	19 (18.60%)	0.004
ISS II	44 (25.10%)	24 (28.20%)	20 (22.20%)		19 (26.00%)	25 (24.50%)		14 (19.20%)	30 (29.40%)
ISS III	108 (61.70%)	42 (49.40%)	66 (73.30%)		40 (54.80%)	68 (66.70%)		55 (75.30%)	53 (52.00%)
Monoclonal protein
IgA	57 (32.60%)	34 (40.00%)	23 (25.60%)	0.150	28 (38.40%)	29 (28.40%)	0.496	27 (37.00%)	30 (29.40%)	0.649
IgD	23 (13.10%)	11 (12.90%)	12 (13.30%)		8 (11.00%)	15 (14.70%)		10 (13.70%)	13 (12.70%)
IgG	60 (34.30%)	23 (27.10%)	37 (41.01%)		22 (30.10%)	38 (37.30%)		24 (32.90%)	36 (35.30%)
Light chain disease	35 (20.00%)	17 (20.00%)	18 (20.00%)		15 (20.50%)	20 (19.60%)		12 (16.40%)	23 (22.50%)
Hemoglobin,g/L	84.05±22.20	81.48±21.44	86.48±22.74	0.137	90.85±22.91	79.19±20.43	0.001	76.97±20.59	89.12±22.02	<0.001
Serum calcium, mmol/L
≤2.65	133 (76.00%)	71 (83.50%)	62 (68.90%)	0.023	55 (75.30%)	78 (76.50%)	0.863	48 (65.80%)	85 (83.30%)	0.007
>2.65	42 (24.00)	14 (16.50%)	28 (31.10%)		18 (24.70%)	24 (23.50%)		25 (34.20%)	17 (16.70%)
Serum creatinine, μmol/L
≤177	113 (64.60%)	63 (74.10%)	50 (55.60%)	0.010	47 (64.40%)	66 (64.70%)	0.965	45 (61.60%)	68 (66.70%)	0.493
>177	62 (35.40%)	22 (25.90%)	40 (44.40%)		26 (35.60%)	36 (35.30%)		28 (38.40%)	34 (33.30%)
Serum LDH, U/L
≤250	148 (84.60%)	78 (91.80%)	70 (77.80%)	0.010	66 (90.40%)	82 (80.40%)	0.070	59 (80.80%)	89 (87.30%)	0.245
>250	27 (15.40%)	7 (8.20%)	20 (22.20%)		7 (9.60%)	20 (19.60%)		14 (19.20%)	13 (12.70%)
Serum β2-microglobulin, mg/L
<5.5	67 (38.30%)	43 (50.60%)	24 (26.70%)	0.001	33 (45.20%)	34 (33.30%)	0.111	18 (24.70%)	49 (48.00%)	0.002
≥5.5	108 (61.70%)	42 (49.40%)	66 (73.30%)		40 (54.80%)	68 (66.70%)		55 (75.30%)	53 (52.00%)
Maintenance therapy
Immunomodulator	61 (34.90%)	40 (47.10%)	21 (23.30%)	0.001	29 (39.70%)	32 (31.40%)	0.253	17 (23.30%)	44 (43.10%)	0.007
BD	114 (65.1%)	45 (52.90%)	69 (76.70%)		44 (60.30%)	70 (68.60%)		56 (76.70%)	58 (56.90%)

Notes: 1.3 mg/m², subcutaneous injection at days 1, 8, 15, and 22; dexamethasone, 40 mg, PO at days 1, 8, 15, and 22.

Abbreviations: BM, bone marrow; LDH, lactic dehydrogenase; BD, bortezomib.

Table 2 Univariate Analysis And Multivariate Analysis For Overall Survival

Factor	Univariate	Analysis	Multivariate	Analysis	P Value
	Median OS, Mon	P Value	HR	95% CI
Age, yrs.		0.020			0.349
≤65	33.97		1
>65	17.70		1.26	0.77–2.06
BM plasma cells, %		0.005			0.137
≤40	40.87		1
>40	25.47		1.42	0.90–2.25
Hemoglobin, g/L		0.740
>85	29.33
≤85	26.57
Serum calcium, mmol/L		0.002			0.292
≤2.65	33.97		1
>2.65	17.80		1.30	0.80–2.11
Serum creatinine, μmol/L		0.048			0.635
≤177	33.60		1
>177	19.87		0.88	0.53–1.48
Serum LDH, U/L		<0.001			0.004
≤250	31.03		1
>250	13.77		2.24	1.29–3.88
Serum β2-microglobulin, mg/L		<0.001
<5.5	46.13
≥5.5	20.63
NLR		<0.001			<0.001
NLR≤2	38.07		1
NLR>2	17.00		3.80	2.27–6.36
RDW		<0.001			0.016
RDW≤14	43.70		1
RDW>14	25.47		1.85	1.12–3.04
PLT, 10^9/L		<0.001			<0.001
PLT>150	43.70		1
PLT≤150	17.70		3.99	2.42–6.57
ISS		<0.001			0.008
ISS I	50.57		1
ISS II	38.07		1.94	0.74–5.06
ISS III	20.63		3.66	1.44–9.27
Maintenance therapy		<0.001
Immunomodulator	50.57
BD	20.63

Notes: 1.3 mg/m², subcutaneous injection at days 1, 8, 15, and 22; dexamethasone, 40 mg, PO at days 1, 8, 15, and 22.

Abbreviations: BM, bone marrow; LDH, lactic dehydrogenase; NLR, neutrophil-to-lymphocyte ratio; RDW, red blood cell distribution width; PLT, platelet count; ISS, International Staging System; BD, bortezomib.

Table 3 Multivariate Analysis For Overall Survival Including IPSI

Multivariate Analysis Factor	HR	95% CI	P Valve
Age, yrs.			0.834
≤65	1
>65	1.06	0.64–1.74
BM plasma cells, %			0.025
≤40	1
>40	1.75	1.07–2.85
Hemoglobin, g/L			0.320
>85	1
≤85	0.78	0.48–1.27
Serum calcium, mmol/L			0.225
≤2.65	1
>2.65	1.34	0.84–2.15
Serum creatinine, μmol/L			0.230
≤177	1
>177	0.73	0.44–1.22
Serum LDH, U/L			0.001
≤250	1
>250	2.75	1.55–4.86
ISS			0.001
ISS 1	1
ISS II	1.93	0.74–5.02
ISS III	4.28	1.69–10.88
IPSI			<0.001
IPSI low risk	1
IPSI intermediate risk	2.89	1.60–5.22
IPSI high risk	14.50	7.26–28.93

Abbreviations: BM, bone marrow; LDH, lactic dehydrogenase; IPSS, inflammatory prognostic scoring system.

Figure 1 Survival curve according to IPSI in all patients.

Figure 2 (A) Survival curve of IPSI in patients with ISS I. (B) Survival curve of IPSI in patients with ISS II. (C) Survival curve of IPSI in patients with ISS III.

Figure 3 (A) Survival curve of IPSI in patients with young age (age≤65 years). (B) Survival curve of IPSI in patients with old age (age>65 years).

Figure 4 (A) Survival curve of IPSI in patients with normal renal function (serum creatinine ≤117μmol/L). (B) Survival curve of IPSI in patients with Abnormal renal function (serum creatinine >117μmol/L).

Figure 5 (A) Survival curve of IPSI in patients with low serum calcium (calcium ≤2.65mmol/L). (B) Survival curve of IPSI in patients with high serum calcium (calcium>2.65mmol/L).

Figure 6 (A) Survival curve of IPSI in patients with bortezomib-based maintenance therapy. (B) Survival curve of IPSI in patients with immunomodulator-based maintenance therapy.