Hematopoietic score predicts outcomes in newly diagnosed multiple myeloma patients

Abstract

Risk stratification of multiple myeloma (MM) at diagnosis is critical. We examined the ability of hematopoietic indices including mean corpuscular volume (MCV), hemoglobin (Hgb), and platelet (Plt) to predict outcomes. This was a retrospective study of patients treated at Mayo Clinic between January 2004 and April 2018. We incorporated three variables (Hgb < 10 g/dL, Plt < 150 × 10 9 /L, and MCV > 96 fL), assigning a score of 1 to each. We identified 1540 newly diagnosed MM patients, of whom 707 (46%) had a score of 0, 513 (33%) had a score of 1, 260 (17%) had a score of 2, and 60 (4%) had a score of 3. The score risk stratified patients into four groups with differing survivals. The median PFS was 32.3 months for score 0, 24.8 months for score 1, 21.7 months for score 2, and 18.3 months for score 3, for P < .001. The median OS was 80.7 months for score 0, 59.9 months for score 1, 51.7 months for score 2, and 31.3 months for score 3, P < .0001. Predictors of OS on the multivariable analysis were age ≥ 65 (HR, 1.93; P < .0001), R-ISS stage (1-2 vs 3) (HR, 0.48; P < .0001), and hematopoietic score (0-2 vs 3) (HR, 0.51; P = .006). A hematopoietic score can predict survival in newly diagnosed myeloma patients.

Hematopoietic Score for the Prognostic Evaluation of Multiple Myeloma Patients Undergoing First-Line Treatment With A Bortezomib-Based Regimen

“…In an early Mayo clinic study (with patients enrolled from 1985 to 1988), it was found that a Hgb level < 100 g/L and a Plt count < 150×10 9 /L were predictive of relatively worse outcomes based on univariate analysis (2). In 2020, clinical data of MM patients treated at the Mayo Clinic in the United States for more than 10 years were retrospectively analysed (11), and propose the in uence of hematopoietic score composed of Hgb level, MCV and plt count on the prognosis of MM patients, which con rmed that patients with high hematopoietic scores tend to have a worse prognosis. However, those data were obtained for patients in the previous era of traditional chemotherapy, less than 45% of the patients in this group were treated with a proteasome inhibitor and/or immunomodulator-based regimen; therefore, the prognostic signi cance of the hematopoietic score needs further con rmation in the era of new drugs.…”

“…The role of Hgb in the prognosis of MM patients is clearly de ned in the Durie-Salmon staging system and 100 g/L is used as one of the cut-off values for an abnormal Hgb level (6). In addition, abnormal red blood cell size, indicated by abnormal red blood cell distribution width (RDW) or average red blood cell volume values, and Plt counts are important MM prognostic indicators (2,6,(9)(10)(11)(12)(13).…”

Haematopoietic Score for the Prognostic Evaluation of Multiple Myeloma Patients Undergoing First-line Treatment With a Bortezomib-based Regimen

“…An increased red blood cell volume is often an indication of folic acid or vitamin B12 de ciency; however, it is regrettable that only a few patients in our group were tested for serum vitamin levels, with no de ciency found. According to the literature, vitamin B12 de ciency has been reported in approximately 13-20% of patients with plasma cell disease (9,16,17). Regardless, this may not be related to macrocytosis in these patients, and some patients with vitamin B12 de ciency do not show an increase in their MCV (9,16).…”

“…According to the literature, vitamin B12 de ciency has been reported in approximately 13-20% of patients with plasma cell disease (9,16,17). Regardless, this may not be related to macrocytosis in these patients, and some patients with vitamin B12 de ciency do not show an increase in their MCV (9,16). It is believed that increased an erythrocyte volume is more common in elderly patients, which may be related to the shortened erythrocyte life span and the emergence of more new erythrocytes (reticulocytes) to replace the lost red blood cells, resulting in a slightly larger volume (18) and an increased peripheral blood red blood cell distribution width (12,19).…”

“…In 2020, clinical data of MM patients treated at the Mayo Clinic in the United States for more than 10 years were retrospectively analysed (9), and the haematopoietic score, which considers the haemoglobin (Hgb) level, mean corpuscular volume (MCV) and platelet (Plt) count, on the patients' prognosis was found to have prognostic value. However, less than 45% of the patients in this group were treated with a proteasome inhibitor and/or immunomodulator-based regimen; therefore, the prognostic signi cance of the haematopoietic score needs further con rmation in the era of new drugs.…”