Department of Nephrology and Transplantology, Jagiellonian University Medical College, 30-688 Kraków, Poland.
Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland.
Medicina (Kaunas). 2022 Mar 11;58(3):417. doi: 10.3390/medicina58030417.
Anemia is common in multiple myeloma (MM) and is caused by a complex pathomechanism, including impaired iron homeostasis. Our aim is to evaluate the biomarkers of iron turnover: serum soluble transferrin receptor (sTfR) and hepcidin-25 in patients at various stages of MM in relation with markers of anemia, iron status, inflammation, renal impairment and burden of the disease and as predictors of mortality. Seventy-three MM patients (six with smoldering and 67 with symptomatic disease) were recruited and observed for up to 27 months. Control group included 21 healthy individuals. Serum sTfR and hepcidin were measured with immunoenzymatic assays. MM patients with and without anemia had higher sTFR compared to controls, while only anemic patients had higher hepcidin-25. Both hepcidin-25 and sTfR were higher in anemic than non-anemic patients. Higher hepcidin-25 (but not sTfR) was associated with increasing MM advancement (from smoldering to International Staging System stage III disease) and with poor response to MM treatment, which was accompanied by lower blood hemoglobin and increased anisocytosis. Neither serum hepcidin-25 nor sTfR were correlated with markers of renal impairment. Hepcidin-25 predicted blood hemoglobin in MM patients independently of other predictors, including markers of renal impairment, inflammation and MM burden. Moreover, both blood hemoglobin and serum hepcidin-25 were independently associated with patients' 2-year survival. Our results suggest that hepcidin-25 is involved in anemia in MM and its concentrations are not affected by kidney impairment. Moreover, serum hepcidin-25 may be an early predictor of survival in this disease, independent of hemoglobin concentration. It should be further evaluated whether including hepcidin improves the early diagnosis of anemia in MM.
贫血是多发性骨髓瘤（MM）的常见并发症，其发病机制复杂，包括铁稳态失衡。我们旨在评估铁代谢生物标志物：血清可溶性转铁蛋白受体（sTfR）和hepcidin-25 在 MM 不同阶段患者中的变化，并与贫血、铁状态、炎症、肾功能损害和疾病负担的标志物相关，以及作为死亡率的预测因子。共招募了 73 名 MM 患者（6 名冒烟型和 67 名症状性疾病），并进行了长达 27 个月的随访。对照组包括 21 名健康个体。采用免疫酶联测定法测定血清 sTfR 和 hepcidin。与对照组相比，有或无贫血的 MM 患者的 sTfR 更高，而仅贫血患者的 hepcidin-25 更高。与非贫血患者相比，贫血患者的 hepcidin-25 和 sTfR 均更高。较高的 hepcidin-25（但不是 sTfR）与 MM 进展（从冒烟型到国际分期系统 III 期疾病）和对 MM 治疗的不良反应相关，这伴随着较低的血红蛋白和较高的不均一性。血清 hepcidin-25 与肾功能损害标志物均无相关性。hepcidin-25 可独立于其他预测因子（包括肾功能、炎症和 MM 负担标志物）预测 MM 患者的血红蛋白。此外，血红蛋白和血清 hepcidin-25 均与患者的 2 年生存率独立相关。我们的研究结果表明，hepcidin-25 参与 MM 中的贫血，其浓度不受肾功能损害的影响。此外，血清 hepcidin-25 可能是该疾病独立于血红蛋白浓度的早期生存预测因子。应进一步评估是否包括 hepcidin 可改善 MM 贫血的早期诊断。
