Elevated pre-transplant C-reactive protein identifies a high-risk subgroup in multiple myeloma patients undergoing delayed autologous stem cell transplantation

Abstract

The significance of elevated C-reactive protein (CRP) prior to autologous stem cell transplantation (ASCT) in multiple myeloma (MM) has not been studied. We analyzed 1111 MM patients who underwent ASCT at Mayo Clinic from 2007 to 2015. A total of 840 patients (76%) received early ASCT (⩽12 months from diagnosis) and 271 patients (24%) received delayed ASCT (>12 months from diagnosis). Elevated CRP (> upper normal limit (8 mg/L)) was seen in 14% and 22% of patients undergoing early and delayed ASCT, respectively (P=0.003). There was no correlation of CRP with pre-transplant response, bone marrow plasma cell percentage or labeling index. Patients with an elevated CRP had a higher likelihood of having circulating plasma cells prior to ASCT (33 vs 19%; P<0.001). In the early ASCT cohort, the median overall survival (OS) in patients with normal and elevated CRP was not reached and 91 months respectively (P=0.011). In the delayed ASCT cohort, the median OS in respective groups were 73 and 30 months respectively (P<0.001), with elevated CRP being an independent prognostic marker on multivariate analysis (hazard ratio 2.0; 95% confidence interval, 1.0-3.8; P=0.045). Elevated pre-transplant CRP identifies a high-risk population especially in patients undergoing delayed ASCT and should be incorporated in the pre-transplant evaluation.

Proteomic analysis of the bone marrow microenvironment in extramedullary multiple myeloma patients

“…Further, serum levels of CRP together with IL-6 were found to be significantly upregulated in MM patients compared to healthy controls, and expression of these cytokines decreased after vincristine-adriamycin-dexamethasone-based chemotherapy [55]. In addition, elevated levels of pre-transplant CRP enabled to identify high-risk subgroup of MM patients undergoing delayed autologous stem cell transplantation [56]. In our study, BM plasma levels of CRP were significantly reduced in MM patients compared to EMD patients; this change corresponded to the difference in serum CRP levels.…”

Examining allostatic load, neighborhood socioeconomic status, symptom burden and mortality in multiple myeloma patients

“…The bifactor model may be a plausible pathway for how the biomarkers used in our AL measurement affect overall survival. Independently, C-reactive protein (CRP), albumin, creatinine, creatine clearance, BMI, and alkaline phosphatase have all been implicated in survival among patients with MM [ 34 – 38 ]. Elevated CRP, renal failure (elevated creatinine and/or creatinine clearance) and elevated alkaline phosphatase have been associated with worse mortality among patients with MM [ 34 , 35 , 37 ].…”

Pretransplant C-reactive protein as a prognostic marker in allogeneic stem cell transplantation

“…Additionally, in patients who received ASCT for hematological malignancies disease relapse and progression is another key factor affecting overall survival. It is reported that malignant hematological cells is capable of constitutively releasing IL-6, and in turn IL-6 can promote the proliferation and survival of malignant hematological cells, [14–17] subsequently impacting OS in patients with hematological malignancies disease. C-reactive protein (CRP), as an acute-phase protein in response to IL-6, [18] is considered as a surrogate marker of serum IL-6.…”

“…It is reported that malignant hematological cells is capable of constitutively releasing IL-6, and in turn IL-6 can promote the proliferation and survival of malignant hematological cells, subsequently which impacts the long-term survival in patients who received ASCT for hematological malignancies disease. [14–17]…”