The identification of independent prognostic factors for elderly patients with relapsed and/or refractory multiple myeloma

Abstract

Introduction: Multiple myeloma (MM) is a malignant plasma cell disorder. It is regarded as an incurable disease with typical complications which in particular are anemia, kidney failure and congestive heart failure (CHF). Cardiac natriuretic peptides BNP and NT-proBNP can be used to screen for left ventricular systolic dysfunction in patients with symptoms suggestive of heart failure. The aim of the present study was to examine if the levels of BNP and NT-pro-BNP predicts mortality in patients with MM and concomitant CHF. Material and method: The study population included 45 (m -16, f-30) adult patients (pts) with refractory or relapsed/refractory MM. The subjects satisfy the following criteria to be enrolled in this study: (1) availability of proven CHF with New York Heart Association (NYHA) grades I-III; (2) must be documented diagnosis of MM and estimated about its chemotherapy; (3) the presence of anemia with Hb less than 8.0 mg /dL (4) ECOG performance status score not more than 2; (5) basic therapy for CHF (inhibitor APF ± diuretic) was spent not less than within last 2 weeks. Ihe study did not include pts with NYHA grade IV, the constant form of atrial fibrillation, heart diseases and/or a heavy arterial pathology. For the treatment of MM 28 (62 %) pts have received “salvage” chemotherapy with bortezomib, 15 (33 %) - alkylate drug therapy and 2 (5 %) - high doses of dexamethasone. Levels of NT-proBNP and a BNP-fragment in blood serum have been defined by ELIZA at the moment of enrolling in the study. ROC-curves were used to calculate the threshold concentrations of BNP and NT-proBNP. Overall survival (OS) was estimated using Kaplan-Mayer method. Results and discussion: The age median of patients at the enrollment was 66 (range 42-83) years. 3 (7 %) pts had IIA stage on Salmon-Durie, 22 (49 %) - IIIA and 20 (44 %) - IIIB. 33 (73 %) pts had evidence of CFH grade I, 9 (20 %) - II and 3 (7 %) - III. An objective response on MM treatment was reached 26 (58 %) pts, including complete response (CR) and very good partial response (VGPR) -7 (1 6 %) pts. 33 (73 %) pts were alive with a median follow 11 months. The predictive values of BNP-fragment levels on OS were not detected. Analysis of the activity of NT-proBNP allows detecting of a significant correlation with grades of CFH and OS (p < 0.05). The levels of NT-proBNP more than 0.93 ng/ml (sensitivity 82%, specificity 62%) was identified as a predictor of the likely risk of mortality. 1-year OS of pts with proBNP levels in the blood above 0.93 was 53% versus 78% (p < 0.05) for subjects with a lower level of this peptide. Conclusion: NT-proBNP levels in blood serum > 0.93 ng/ml were identified as the adverse factor for patients with MM and concomitant CHF. BNP-fragment levels in this clinical situation have not predictive value.