The Relationship Between FIB,D-dimer,AT-Ⅲ And Clinical Characteristics And Prognosis In Primary Multiple Myeloma

Objective:To investigate the relationship between fibrinogen(FIB),D-dimer(D-D),antithrombin Ⅲ(AT-Ⅲ)and the clinicopathological characteristics and survival time of patients with primary diagnosis of MM,to elucidate the value of FIB,D-dimer and AT-Ⅲ in the prognosis of MM,so as to provide reference for prognosis evaluation and clinical treatment.Methods:1.The clinical data of 65 patients with MM diagnosed in the First Affiliated Hospital of Dali University from June 2016 to November 2020 were retrospectively analyzed,including FIB,D-D,AT-Ⅲ,gender,age,hemoglobin(HB),platelet(PLT),serum albumin(ALB),serum calcium(Ca),β 2-microglobulin(β 2-MG),lactate dehydrogenase(LDH),serum creatinine(SCR),DS stage,ISS stage,immune classification,myeloma cell ratio,bone marrow pathology and other clinicopathological information.2.The cut-off values of FIB,D-dimer and AT-Ⅲ were determined by receiver operating characteristic curve(ROC),according to this standard,the patients were divided into high value group and low value group.3.The differences in clinicopathological characteristics,progression free survival(PFS)time and overall survival(OS)time between high and low value groups of FIB,D-dimer and AT-Ⅲ before treatment were analyzed,as well as the risk factors for clinical prognosis in patients with primary diagnosis of MM.Statistical software SPSS 25.0 was used for data analysis,p<0.05 was considered statistically significant.Results:1.Among the 65 MM patients,30(46.2%)were women and 35(53.8%)were men.The age of onset ranged from 32 to 87 years,with a median age of 55.5 years.The most common symptom at presentation was bone pain,and the DS and ISS stages were mostly II and Ⅲ.Immunotyping is most common with Ig G,followed by Ig A.2.The optimal cut-off values for FIB,D-dimer and AT-Ⅲ in circulating blood before initial chemotherapy were determined according to the ROC curve and divided into groups with high FIB(≥2.46g/L,43 cases),D-dimer(≥ 1.75ug/ml,23 cases),AT-Ⅲ(≥83.75%,41cases)and low FIB(<2.46g/L,22 cases),D-dimer(<1.75ug/ml,42 cases),AT-Ⅲ(<83.75%,24cases)groups.3.Compared with the low FIB group,patients in the high FIB group had higher age,SCR andβ2-MG levels,and the differences were statistically significant(all P<0.05).There were no statistically significant differences in terms of gender,DS stage,ISS stage,immune classification,HB,PLT,ALB,myeloma cell ratio and plasma cell maturation status in bone marrow pathology(all P>0.05).4.Compared with the low D-dimer group,patients in the high D-dimer group had higher age,later ISS stage and lower ALB level,and the differences between the two groups were statistically significant(all P<0.05).There were no significant differences in gender,DS stage,immune classification,HB,PLT,β 2-MG,SCR,myeloma cell ratio and plasma cell maturation status in bone marrow pathology between the two groups(all P > 0.05).5.Compared with the high AT-Ⅲ group,patients in the low AT-Ⅲ group had lower levels of PLT and ALB,and the differences in immune classification,PLT and ALB were statistically significant(all P<0.05).The differences between the two groups in age,gender,DS stage,ISS stage,HB,β2-MG,SCR,myeloma cell proportion,and plasma cell maturation status in bone marrow pathology were no statistically significant(all P>0.05).6.PFS time was generally shorter in the high FIB group than in the low FIB group,and the difference between the two groups was statistically significant(P<0.05);PFS time was generally shorter in the high D-dimer group than in the low D-dimer group,and the difference between the two groups was statistically significant(P<0.05).The difference in PFS time between the high AT-Ⅲ group(AT-Ⅲ ≥ 83.75%)and the low AT-Ⅲ group(AT-Ⅲ < 83.75%)was not statistically significant(P > 0.05).7.The median OS time of high D-dimer group was shorter than that of low D-dimer group(P< 0.05).The difference in OS time between the high FIB an,AT-Ⅲ groups and the low FIB,AT-Ⅲ groups was not statistically significant(all P > 0.05).8.In the data from the included studies,univariate analysis showed that D-dimer ≥1.74ug/ml,ISS stage,SCR,and β2-MG were prognostic risk factors for MM patients(all P < 0.05),and gender,age,HB,PLT,ALB,LDH,myeloma cell ratio,FIB ≥2.46g/L,and AT-Ⅲ ≥83.75%were not associated with MM prognosis of patients(all P > 0.05).Multivariate analysis showed that HB and ISS stage were independent risk factors for the prognosis of MM patients(all P < 0.05).Conclusions:1.The increase of FIB,D-dimer and AT-Ⅲ levels in plasma of MM patients was correlated with the elderly,renal dysfunction and ISS staging,which indicates tumor burden and poor prognosis;2.The median PFS time of MM patients with increased FIB and D-dimer was shortened,while the median OS time of patients with D-dimer increased was shorter.Therefore,plasma FIB and D-dimer are important in assessing the prognosis of primary MM,and AT-Ⅲ was not associated with the prognosis of MM patients in this data set.