The combination of serum calcium levels, neutrophil‑to‑lymphocyte ratio and platelet count in the prognosis of multiple myeloma: A retrospective cohort study and review of the literature

Abstract

The prognosis of multiple myeloma (MM) can be determined by the serum calcium levels, the neutrophil-to-lymphocyte ratio (NLR) and the platelet count (PLT). The objective of the present study was to determine the influence of the combined prognostic index (CPI), which included the aforementioned three indices (serum calcium levels, NLR and PLT), on the survival rates of patients with MM. A total of 111 patients newly diagnosed with MM undergoing treatment were analyzed. The prognostic values for the survival times were determined at the time of pre-treatment. The patients with high serum calcium levels (2.665 mmol/l), a high NLR (2.245) and a low PLT (<150x10 9 /l) received a score of 1. Based on the scores obtained, the CPI was formed, in which the patients were grouped into a low-risk group (0-1 points), an intermediate-risk group (2 points) and a high-risk group (3 points). Univariate analysis demonstrated significant differences between the three CPI groups (P<0.001). Multivariate analysis indicated that the CPI was an independent prognostic factor for overall survival [intermediate-risk group: Hazard ratio (HR), 3.244; 95% confidence interval (CI), 1. 4.290; 95% CI, P<0.001]. This level of significance was also observed in the subgroups, which were divided according to the percentage of bone marrow plasma cells (≥30 or <30%) and age (≥65 or <65 years). On the whole, the present study demonstrates that the CPI determined by the high serum calcium levels, high NLR and low PLT may be used as an independent prognostic indicator for patients with MM.