Increased LDH Remains a Crucial Prognostic Factor in Patients With Multiple Myeloma

Background and Aims

Multiple myeloma is the second most common hematologic cancer and remains incurable. Several prognostic factors have been identified, but many are costly and inaccessible to most hematology centers. To explore the clinical, laboratory, and cytogenetic factors that influence survival in patients with newly diagnosed multiple myeloma.

Methods

The research included 286 patients treated with different regimens: 64.5 % received thalidomide-based combinations, while 35.5 % were treated with proteasome inhibitor combinations.

Results

Stringent complete remission was achieved in 15.5 %, complete remission in 30.5 %, very good partial response in 41 %, and partial response in 5 %. Progression-free survival (PFS) and overall survival (OS) were lower in patients with high lactate dehydrogenase (LDH), renal disease, t(4;14), RB1 mutation, and in those who did not achieve complete remission or were not treated with transplantation and proteasome inhibitors. Elevated LDH was identified as the most significant independent prognostic factor. A scoring system based on LDH, renal disease, t(4;14), and RB1 mutation was developed and showed differences in PFS and OS based on the score (0,1,2,3, or 4,5 points).

Conclusions

An elevated LDH level was the most significant prognostic factor. A simple scoring system is suggested, especially for patients without access to expensive cytogenetic testing.