• 18F-FDG PET/CT
• Multiple myeloma
• plasma cell infiltration rate
• systemic immune-inflammatory index

Multiple myeloma (MM) is an incurable plasma cell malignancy. Red cell distribution width (RDW) is a prognostic marker in various diseases, solid tumors, and hematologic neoplasms, but its prognostic significance in MM is controversial. In this study, we aimed to assess the relationship between RDW and the clinical prognosis of MM patients through a meta-analysis.

Relevant literature were retrieved from PubMed, Embase, and Web of Science databases according to PRISMA guideline. All relevant parameters were extracted and combined for statistical analysis. The effect size was presented as hazard ratio (HR)/odds ratio (OR) and 95% confidence interval (CI). HR/OR > 1 in MM patients with high RDW suggested a worse prognosis. Heterogeneity test evaluation was performed using Cochran's Q test and I2 statistics. A P_{heterogeneity} < 0.10 or I² > 50% suggested significant heterogeneity. P < 0.05 was considered statistically significant. Statistical analysis was performed using Stata 12.0 software.

8 articles involving 9 studies with 1165 patients were included in our meta-analysis. Our results suggested that elevated RDW is significantly associated with poor prognosis in MM (OS: HR = 1.91, 95%CI: 1.48–2.46; PFS: HR = 2.87, 95% CI: 2.02–4.07). A significant correlation was not found between RDW and International Staging System (ISS) staging (ISS III VS ISS I-II: OR:1.53; 95%CI:0.97–2.42).

Our results suggested that RDW is a robust predictor of newly diagnosed MM outcomes.

• Meta-analysis
• Multiple myeloma (MM)
• Prognosis
• Red cell distribution width (RDW)

The neutrophil-lymphocyte ratio (NLR) is often used to predict a poor prognosis in patients with tumors. This study investigated the preoperative peripheral blood NLR in predicting postoperative survival (POS) in patients with multiple myeloma bone disease (MMBD).

To evaluate whether NLR can be used to predict the prognosis of MMBD patients after surgery.

The clinical data of 82 MMBD patients who underwent surgical treatments in Beijing Chao-yang Hospital were collected. The NLR was obtained from the absolute number of neutrophils and lymphocytes, calculated by the number of neutrophils and divided by the number of lymphocytes. The peripheral blood lymphocyte percentage was used as the major marker to analyze the change in characteristics of the immune statuses of multiple myeloma patients.

The NLR cut-off values of NLR ≥ 3 patients and NLR ≥ 4 patients were significantly correlated with POS. The 3- and 5-year cumulative survival rates of the high NLR group (NLR ≥ 3 patients) were 19.1% and 0.0%, respectively, which were lower than those of the low NLR group (NLR < 3 patients) (67.2% and 48.3%) (P = 0.000). In the high NLR group, POS (14.86 ± 14.28) was significantly shorter than that in the low NLR group (32.68 ± 21.76). Univariate analysis showed that the lymphocyte percentage 1 wk after the operation (19.33 ± 9.08) was significantly lower than that before the operation (25.72 ± 11.02). Survival analysis showed that postoperative chemotherapy, preoperative performance status and preoperative peripheral blood NLR ≥ 3 were independent risk factors for POS.

The preoperative peripheral blood NLR can predict POS in MMBD patients. MMBD patients with a high preoperative NLR (NLR ≥ 3) showed poor prognosis.

• Multiple myeloma bone disease
• Neutrophil-lymphocyte ratio
• Lymphocyte percentage
• Postoperative survival

• lymphocyte-to-monocyte ratio (LMR)
• meta-analysis
• monocyte-to-lymphocyte ratio (MLR)
• multiple myeloma (MM)
• neutrophil-to-lymphocyte ratio (NLR)
• platelet-to-lymphocyte ratio (PLR)
• prognosis

Recently, the British Myeloma Research Alliance put forward a Myeloma Risk Profile (MRP) for the first time to stratify the prognosis risk of non-transplanted patients with multiple myeloma. However, only limited studies have evaluated the applicability of this model in the Chinese population. This study aimed to estimate the prognostic value of MRP in newly diagnosed multiple myeloma patients without autologous stem cell transplantation in China.

Patients with multiple myeloma in Wuxi People’s Hospital from January 1, 2007, to June 30, 2018 were evaluated based on the MRP score, and the relationship between the clinical outcome of patients with MM and the score was analyzed retrospectively.

First, significant differences were observed in the overall survival (OS) (P<0.05) and progression-free survival (PFS) (P<0.05) between the low-, middle-, and high-risk groups. Second, in the bortezomib treatment subgroup and complex chromosome karyotype subgroup, OS and PFS were significantly shorter in the high-risk group than in the low-risk group (P<0.05). Third, the depth of remission still showed prognostic significance in the high-risk MRP group.

MRP is also applicable in Chinese patients with newly diagnosed MM who did not undergo transplantation, as it is simple and cost effective; hence, it is worth popularizing.

• bortezomib
• complex chromosome karyotype
• multiple myeloma
• myeloma risk profile
• prognosis

评估外周血细胞检测结果在以硼替佐米为一线治疗的多发性骨髓瘤（MM）患者中的预后作用。

回顾性分析2014年1月至2016年12月浙江大学医学院附属第一医院和浙江省舟山医院收治的155例初诊MM患者的临床数据，患者均一线接受以硼替佐米为基础方案的治疗。分析外周血细胞检测结果，包括ANC、单核细胞计数（AMC）、HGB、红细胞平均体积（MCV）、PLT以及其他临床特征对MM患者的预后评估作用。

AMC（>0.6×10⁹/L）、MCV（>99.1fl）以及PLT（<150×10⁹/L）明显影响MM患者无进展生存（PFS）和总生存（OS），以上3个因子分别赋值1分，形成血细胞积分。结果显示，64例（41.3％）积分0，57例（36.8％）积分1，32例（20.6％）积分2，2例（1.3％）积分3，4组患者中位PFS时间分别为42.8、26.5、15.8、6.4个月（P<0.001），中位OS时间分别为未达到和48.2、31.1、31.4个月（P＝0.001）。多因素分析提示，血细胞积分（2～3对0～1）和骨髓浆细胞比例（>30％对≤30％）为PFS的独立预后因素（HR分别为1.95和1.76），而患者年龄（>65岁对≤65岁）、R-ISS分期（Ⅲ期对Ⅰ～Ⅱ期）和血细胞积分（2～3对0～1）是OS的独立预后因素（HR分别为2.08、2.13和2.12）。

血细胞积分简单易得，可用于新药时代初治MM患者的预后评估，但仍需扩大病例并进行前瞻性研究进一步明确。

• Bortezomib
• Mean corpuscular volume
• Monocyte
• Multiple myeloma
• Platelet