Jimenez-Zepeda Victor H, Lee Holly, Tay Jason, Duggan Peter, McCulloch Sylvia, Neri Paola, Bahlis Nizar J
Department of Medical Oncology and Hematology, Tom Baker Cancer Center, 1331 29th St, NW, Calgary, AB, T2N 4N2, Canada.
Charbonneau Cancer Research Institute, Calgary, AB, Canada.
Ann Hematol. 2021 Oct;100(10):2521-2527. doi: 10.1007/s00277-021-04591-z. Epub 2021 Jul 21.
Elevated levels of serum cardiovascular markers including natriuretic peptides (NPs) such as amino terminal pro-brain natriuretic peptide (NTproBNP) have been associated with disease severity and survival in cancer patients and more recently in multiple myeloma (MM). In the present study, we retrospectively reviewed 87 consecutive symptomatic TEMM (transplant-eligible) and 126 TIMM (transplant-ineligible) patients treated at our institution that did undergo NTproBNP testing from 2017 to 2020. Median age at diagnosis was 59.3 years and 75.4 years for the TEMM and TIMM groups, respectively (p = 0.0001). NTproBNP ≥ 300 ng/L was used to assess survival outcomes in the group of symptomatic MM. Patients with AL amyloidosis and symptomatic MM were excluded from the study. Median OS for patients with NTproBNP ≥ 300 ng/L was shorter (45.9 months) as compared to those with NTproBNP of < 300 ng/L (non-reached) (p = 0.0001). In addition, OS was shorter for those with CCI > 2, ISS2-3, and high-risk cytogenetics by FISH and ≥ 70 years of age. Multivariate analysis showed that HR cytogenetics and ISS2-3 were independent predictors for OS in the entire cohort of MM patients. When restricted to TIMM, age ≥ 80 years and NTproBNP ≥ 800 ng/L were predictors for OS in univariate and multivariate analyses. In conclusion, NTproBNP appears to be an independent predictor factor for OS in symptomatic TIMM patients. The use of NTproBNP as a frailty marker remains to be elucidated. However, NTproBNP could potentially be used to guide treatment decisions aimed to minimize cardiovascular and renal toxicity for myeloma therapies that potentially do have cardio-renal implications.
包括利钠肽（NPs）如氨基末端脑钠肽前体（NTproBNP）在内的血清心血管标志物水平升高，已与癌症患者的疾病严重程度和生存率相关，最近在多发性骨髓瘤（MM）中也是如此。在本研究中，我们回顾性分析了2017年至2020年在我们机构接受治疗且进行了NTproBNP检测的87例连续有症状的适合移植（TEMM）患者和126例不适合移植（TIMM）患者。TEMM组和TIMM组诊断时的中位年龄分别为59.3岁和75.4岁（p = 0.0001）。NTproBNP≥300 ng/L用于评估有症状MM患者的生存结局。患有AL淀粉样变性和有症状MM的患者被排除在研究之外。与NTproBNP<300 ng/L（未达到）的患者相比，NTproBNP≥300 ng/L的患者中位总生存期较短（45.9个月）（p = 0.0001）。此外，CCI>2、ISS2-3、FISH检测显示高危细胞遗传学且年龄≥70岁的患者总生存期较短。多因素分析显示，高危细胞遗传学和ISS2-3是整个MM患者队列总生存期的独立预测因素。当仅限于TIMM患者时，年龄≥80岁和NTproBNP≥800 ng/L在单因素和多因素分析中是总生存期的预测因素。总之，NTproBNP似乎是有症状TIMM患者总生存期的独立预测因素。NTproBNP作为虚弱标志物的用途仍有待阐明。然而，NTproBNP可能潜在地用于指导治疗决策，以尽量减少对可能有心肾影响的骨髓瘤治疗的心血管和肾脏毒性。
