Effect of Bortezomib Treatment in Multiple Myeloma on Blood Coagulation Function, Renal Function, Immune Function, and the NF-κB Pathway-Associated Indicators.

Abstract

Aims/Background Multiple myeloma (MM) presents several underlying mechanisms of immune dysfunction. Advanced research on these mechanisms has introduced new drugs for MM into clinical practice. However, several challenges occur, particularly in cases of relapsed and refractory MM. In recent years, bortezomib has been recognized, for its anti-myeloma effect in both newly identified and refractory MM patients, but its mechanism of action on MM remains unexplored. Consequently, this study aims to explore the influence of bortezomib on coagulation function, renal function, immune function, and related indexes of nuclear transcription factor-κB (NF-κB) pathway in MM patients. Methods This retrospective study analyzed 120 MM patients admitted to the First People's Hospital of Nantong, China, between August 2018 and August 2023. Based on different treatment methods, patients were divided into a control group (thalidomide, cyclophosphamide, and dexamethasone (TCD), 58 cases) and an observation group (TCD regimen and bortezomib, 62 cases). The therapeutic efficacy of the drug was observed, and the levels of blood indexes, coagulation function indexes, NF-κB related indexes, renal function indexes and immunosuppressive factors were compared between the groups both before and after treatment. Results There were no significant differences in disease control rate (DCR) between the two groups (p > 0.05). After treatment, the objective response rate (ORR) and the hemoglobin levels were significantly higher in the observation group than in the control group, with lower M protein levels (p < 0.05). Furthermore, the prothrombin time (PT), the activated partial thromboplastin time (APTT), fibrinogen (FIB) values, NF-κB expression levels, β2-microglobulin (β2-MG) levels, blood urea nitrogen (BUN), serum creatinine (Scr), transforming growth factor-β (TGF-β), interleukin-6 (IL-6) and interleukin-17 (IL-17) levels were substantially decreased in the observation group compared to the control group (p < 0.001). Additionally, the progression-free survival rate was significantly higher in the observation group than in the control group (p < 0.001). However, no significant difference was observed in the overall survival (OS) rate between the two groups (p > 0.05). Moreover, the median progression-free survival (PFS) time was 11.95 months in the observation group and 9 months in the control group, while the median OS time was 11.7 months in the control group. Conclusion In summary, bortezomib treatment improves coagulation and renal function in MM patients. Furthermore, it helps reduce immune suppression, prolong survival time, and inhibit the NF-κB pathway activation.