Identification of High Serum Apolipoprotein A1 As a Favorable Prognostic Indicator in Patients with Multiple Myeloma

Purpose

To explore the prognostic significance of serum lipid profiles in patients with multiple myeloma (MM).

Patients and methods

The study retrospectively enrolled 307 MM patients in Zhongshan Hospital, Shanghai, China, from 2007 to 2016. We evaluated the prognostic significance of the prediagnostic serum lipid profile [cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL), Apolipoprotein A1 (Apo A1) and Apolipoprotein B (Apo B)]. Prognostic factors identified through univariate and multivariate analysis were used to construct a new model based on Lasso Cox regression.

Results

In our cohort, lipid levels showed significant difference between ISS stages (P<0.001 in cholesterol, P<0.001 in LDL, P=0.002 in HDL, P<0.001 in Apo A1, P<0.001 in Apo B). However, only Apo A1 showed statistically significance in overall survival (OS), progression free survival (PFS) and cause specific survival (CSS) (P=0.038, P=0.028, P=0.011) in univariate Cox regression. Patients with higher Apo A1 displayed longer OS (median OS, 67 months vs. 30 months; P<0.001). Also, Apo A1 was revealed to be independent prognostic parameters through multivariate analysis. Combining the Apo A1 level, a Zhongshan Score model was constructed with Lasso regression for prognosis prediction. This model exhibited higher accuracy than International Staging System (ISS) and Durie and Salmon (DS) system.

Conclusion

Among all the serum lipid profiles, serum Apo A1 is a powerful prognostic indicator for patients with MM.