| Objective: To conduct a clinical study on the role of corrected blood calcium in assessing the severity of disease and prognostic assessment value in patients with primary multiple myeloma(MM).Methods: The clinical data of 142 patients with primary MM who attended and received treatment at Jiangsu Subei People’s Hospital during a total of five years from January 1,2015 to December 31,2019 were retrospectively analyzed,including patients’ hospitalization number,name,gender,age,onset symptoms,creatinine,hemoglobin,serum albumin,lactate dehydrogenase,total plasma calcium level,immunoglobulin assay and serum immunofixation electrophoresis,bone marrow-related tests and imaging findings(including DR,CT,MRI,PET-CT,and PET-like tests),treatment regimen,and all patients completed at least 2 cycles of treatment;an additional 39 patients underwent FISH testing.Progression free survival(PFS)and overall survival(OS)were determined for patients included in the study by telephone follow-up or by collecting inpatient medical records.The differences between paired groups in this study were tested for normality using Shapiro-Wilk,and those that met the normal distribution were compared within groups using the paired t-test,those that did not meet the normal distribution were compared between groups using the Wilcoxon rank sum test,and the independent samples t-test was applied to compare between groups,and the χ2 test was applied to the study of differences in occupancy.Time-to-event curves were plotted using Kaplan-Meier analysis,and log-rank was applied to compare survival curves.Kappa concordance test was applied for the concordance of the two staging systems.Various that may affect the prognosis of MM were studied by incorporating a multifactorial Cox proportional risk regression model.p< 0.05 differences were statistically significant.Results:1.Basic data: A total of 142 patients with MM who met the criteria and were first diagnosed in our hospital were collected for inclusion in the study,with a mean age of63±9 years(34-86)and 85 male patients(59%).The most common MM subtype was Ig G-κ.Data on survival time and time to presentation of disease recurrence or progression were compiled for 135 patients with a median observation time of 25months(2-66).A total of 39 patients died during the follow-up period.2.Significance of blood calcium before and after correction: comparing 142 patients before and after blood calcium correction,the mean value of blood calcium before correction was 2.48 ± 0.42 mmol/L,and the mean value of blood calcium after correction was 2.55 ± 0.42 mmol/L.The results showed that there was a statistical difference before and after blood calcium correction,and the incidence of hypercalcemia after correction was 35%,which was significantly higher than that before correction,and the difference was statistically significant(p values were less than 0.05).3.Relationship with different ISS stages: Patients were divided into different subgroups according to different ISS stages,and the test showed that there was no statistical difference in blood calcium before and after correction in patients with ISS stage I(p>0.05),and there was a statistical difference in blood calcium before and after correction in patients with ISS stages II and III(p<0.05),and the mean value of blood calcium was higher after correction in higher stages.4.Relationship with disease: Patients were grouped differently according to whether they had anemia,whether they had renal impairment,and whether they had osteolytic impairment at the time of initial diagnosis.Patients with anemia,with renal impairment,and with osteolytic impairment had higher blood calcium concentrations before and after correction than those without the above concomitant symptoms(p <0.05),and the corrected blood calcium better reflected the true severity of the disease.5.Survival analysis: comparing the PFS and OS of hypercalcemic and non-hypercalcemic groups before and after blood calcium correction,the results suggested that the OS and PFS of patients with hypercalcemia at the initial diagnosis were shorter,and the corrected blood calcium was a better indicator of the survival time of patients.6.Factors affecting the prognosis of MM: Multi-factor Cox risk proportional regression model suggested that calcium >2.75 mmol/L and elevated LDH after correction were independent risk factors affecting the prognosis of MM patients.The risk of death with corrected elevated blood calcium was 1.933 times higher than that in the corrected non-high calcium group.7.Role in prognostic assessment: In 39 patients with measured FISH results,corrected calcium was replaced by FISH to form corrected Ca-LDH-ISS staging and compared with R-ISS staging,and the kappa concordance test suggested concordance between the two systems(p < 0.05).Conclusions:1.The true nature of corrected blood calcium is stronger: the incidence of hypercalcemia is significantly higher in patients with primary MM after albumin correction,and the corrected blood calcium can more truly reflect the true blood calcium level of patients.2.The corrected blood calcium is more suggestive of the disease: when the first diagnosis of MM patients with elevated blood calcium,the ISS stage is higher,and the blood calcium concentration is higher in patients with concomitant anemia,abnormal renal function,and osteolytic damage,and the corrected blood calcium is more suggestive of the patient’s disease.3.Poor prognosis in patients with elevated corrected blood calcium: Patients with elevated pre-corrected or post-corrected blood calcium at initial diagnosis had a shorter survival time,and positive calcium in colleges and universities was an independent factor affecting the prognosis of MM.The new corrected Ca-LDH-ISS staging system to be developed in this study still has a role in prognostic assessment and is consistent and complementary to the R-ISS staging system. |
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