Effect of immune score at initial diagnosis in predicting prognosis in patients with multiple myeloma treated with bortezomib

  Objective  To investigate the effect of the lymphocyte-to-monocyte ratio (LMR), uninvolved immunoglobulin (u-Ig) levels and immune scores for newly diagnosed multiple myeloma (MM) patients treated with bortezomib.

  Methods  The clinical data of 201 newly diagnosed MM patients was retrospectively analyzed. Patients were divided into low LMR group (LMR < 3.6) and high LMR group (LMR≥3.6) according to the cutoff value of LMR related references. According to the reduced levels of u-Ig (IgG, IgA, IgM), the patients were divided into normal u-Ig group, one index of u-Ig reduced group (one index was lower than the lower limit of normal value) and two indexes of u-Ig reduced group (two or more indicators were lower than the lower limit of normal value). Immunization groups were established, including low risk group, medium risk group and high risk group. Baseline data, objective response rate (ORR) and overall survival (OS) of patients of LMR groups and u-Ig groups before treatment were analyzed. Independent factors of poor prognosis related to OS in MM patients were analyzed.

  Results  The ORR of low-risk group was significantly higher than that of medium-risk group and high-risk group(P=0.044, P=0.007). Aged 65 years and above, International Staging System (ISS) stage Ⅲ, platelet ≤100×10⁹/L, lactate dehydrogenase (LDH) >250 U/L, LMR < 3.6, u-Ig decreased by one item, u-Ig decreased by ≥2 items and immunization medium risk as well as high risk were independent adverse prognostic factors affecting the OS in MM patients.

  Conclusion  In the application of bortezomib, the immune score has a good effect on the treatment response and prognosis of MM patients, and can be used as a reference for early identification of high-risk patients.