N-terminal pro-brain natriuretic peptide reflects both left ventricular diastolic dysfunction and myeloma-related renal insufficiency and robustly predicts mortality in patients with symptomatic multiple myeloma
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Yoshiaki Abe1,*, Tetsuya Kobayashi2,*, Yoshiaki Usui3, Kentaro Narita1, Hiroki Kobayashi1, Akihiro Kitadate1, Daisuke Miura1, Masami Takeuchi1 and Kosei Matsue1
1Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Chiba, Japan
2Division of Cardiology, Kameda Medical Center, Chiba, Japan
3Division of Cancer Information and Control, Department of Preventive Medicine, Aichi Cancer Centre Research Institute, Aichi, Japan
*These authors contributed equally to this work
Yoshiaki Abe, email: [email protected]
Keywords: diastolic dysfunction; frailty; multiple myeloma; N-terminal pro-brain natriuretic peptide; prognosis
Received: October 30, 2018 Accepted: January 21, 2019 Published: February 01, 2019
We retrospectively explored the prognostic relevance of N-terminal pro-brain natriuretic peptide (NT-proBNP) and the association of NT-proBNP with cardiac and renal functions in 153 patients with newly diagnosed symptomatic multiple myeloma and no concomitant light chain amyloidosis who received novel agents. We also examined the usefulness of the new frailty system recently introduced by Mayo Clinic (combining age, performance status, and NT-proBNP). Patients with higher NT-proBNP levels (≥300 ng/L) had a significantly higher incidence of left ventricular diastolic dysfunction (LVDD) and myeloma-related renal insufficiency and significantly shorter overall survival (OS) than did those with lower NT-proBNP levels (<300 ng/L). NT-proBNP remained predictive of OS on multivariate analysis. Mayo Clinic’s new frailty system showed excellent discrimination of OS. Furthermore, the Instrumental Activity of Daily Living (IADL) score (not evaluated in Mayo Clinic’s study) predicted OS independently of this system, and a sharper discrimination of OS curves was obtained by the incorporation of IADL into this system. Our findings demonstrated that NT-proBNP levels were associated with both LVDD (as a host risk factor) and myeloma-related renal insufficiency (resulting from the disease aggressiveness) and provided predictive information regarding OS in patients with symptomatic myeloma. Furthermore, we, for the first time, validated Mayo Clinic’s new frailty system. Our modification further improved Mayo Clinic’s system by newly incorporating the IADL score.
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