‘Readily available biomarker’ can predict outcomes in multiple myeloma
Key takeaways:
- Lymphopenia at diagnosis or during follow-up can predict OS among patients with multiple myeloma.
- Researchers recommend measuring absolute lymphocyte count every 6 months for the first 2 years of therapy.
Peripheral blood absolute lymphocyte count at diagnosis is an effective biomarker that can be used to risk-stratify patients with multiple myeloma, according to retrospective study results.
Continued monitoring of absolute lymphocyte count (ALC) during treatment and follow-up can predict OS, results showed.
“The peripheral blood ALC is a readily available biomarker that can offer prognostication over time,” Grace M. Ferri, MD, internal medicine resident physician at Boston Medical Center, and colleagues wrote. “Based on our results, ALC measured every 6 months during the initial 2 years of multiple myeloma treatment could identify patients with poor prognosis.
“If these peripheral blood markers were incorporated into predictive models during treatment, clinicians would have access to dynamic indicators of host immune system — irrespective of scoring or adverse cytogenetics at diagnosis — guiding use of risk-adapted treatment strategies,” they added.
The bone marrow microenvironment typically plays an important role in the growth and survival of multiple myeloma cells, which can be augmented while anti-tumor immune responses are inhibited, according to study background.
Immune status has been identified as a potential mediator of disease behavior.
Ferri and colleagues used data from the Veterans Affairs Corporate Data Warehouse — which includes electronic health record and cancer registry data from Veterans Affairs facilities across the country — to assess the potential of peripheral blood ALC as an accessible biomarker representing immune microenvironment at diagnosis and following treatment for patients with multiple myeloma.
Investigators identified 11,427 patients (median age, 69.8 years; interquartile range = 63-76.8) diagnosed between 2000 and 2019. They analyzed ALC data obtained closest to diagnosis and for up to 2.5 years afterward.
Researchers stratified patients into three ALC categories: severely low (< 1 x 103 mm3), low (1–1.5 x 103 mm3) and normal (> 1.5 x 103 mm3).
About half (53%) of patients had lymphopenia — defined as severely low or low ALC — at multiple myeloma diagnosis.
Median OS reached 2.7 years for those identified as severely low, 3.3 years for those identified as low and 4.2 years for those with normal ALC.
Persistent or new development of lymphopenia during treatment and follow-up appeared associated with inferior OS among patients.
Researchers acknowledged study limitations, including a heavy male presence in the study population due to it being comprised of individuals in the U.S. Veterans Affairs system. Additionally, all cases of lymphopenia could not be attributed to multiple myeloma.
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