Effect of Sarcopenia and Nutritional Risk Factors in Patients with Multiple Myeloma

Background:

Multiple myeloma (MM) is a hematological malignancy with poor prognosis. Fitness-based prognosis predict may help facilitate therapeutic strategies. This study was objective to explore the prognostic significance of sarcopenia, prognostic nutritional index (PNI), and controlling nutritional status (CONUT) in patients with MM.

Methods:

We conducted a retrospective analysis of the data derived from 214 patients with newly diagnosed multiple myeloma (NDMM) at Jiangsu Province Hospital from January, 2016 to December, 2022. Skeletal muscle mass was measured by whole-body low-dose CT/PETCT images at diagnosis and further normalized for stature to calculate the skeletal muscle index (SMI). Patients with a low SMI were defined as sarcopenic. Prognostic nutritional index (PNI) was calculated by the following equation: PNI=serum albumin (g/L)+5×peripheral blood lymphocyte count(×10⁹/L). Elements including serum albumin, total cholesterol, and peripheral blood lymphocyte count were collected for estimating the Controlling Nutritional Status (CONUT) score. The thresholds of sarcopenia, PNI, and CONUT were determined by ROC curve analysis, and participants were divided into three groups according to these three metrics. The Kaplan-Meier survival analysis was utilized to investigate the relationship between these indicators as well as collectively prognosis. Independent prognostic predictors of overall survival (OS) were identified using the Cox regression model.

Results:

A total of 72(33.6%) patients were confirmed as sarcopenic, with a higher prevalence in female(P＜0.001), over 65 years of age (P=0.022), and those with a BMI below 24 kg/m²(P＜0.001). Survival curves showed that sarcopenia, low PNI, and high CONUT were all correlated with adverse survival outcomes. The combined model was apparently associated with PFS (P=0.0284) and OS (P=0.0004), and patients with concurrent sarcopenia, low PNI, and high CONUT had the worst survival rates. Multivariate analysis indicated that sarcopenia emerged as a significant and independent predictor of inferior OS (HR=1.820, P=0.048) in NDMM patients.

Conclusion:

In conclusion, sarcopenia served as an autonomous prognostic indicator OS in individuals with NDMM. The integration of PNI and CONUT with sarcopenia was effective in predicting prognosis in MM patients.

No relevant conflicts of interest to declare.