Impact of pre-transplant serum levels of activin A, activin B, IGF-1 and IL-6 on transplant outcomes and survival in patients with multiple myeloma: a prospective study.

UNLABELLED: OBJECTIVE: This prospective study aimed to assess the impact of activin A/B, interleukin 6 (IL-6) and insulin-like growth factor-1 (IGF-1) on end-organ damage, clinical outcomes of high-dose chemotherapy-supported autologous stem cell transplantation (ASCT) and survival rates. MATERIALS AND METHODS: The serum cytokine levels of 78 multiple myeloma (MM) patients scheduled for ASCT at our clinic and 18 healthy volunteers were studied with the Enzyme-Linked ImmunoSorbent Assay (ELISA) method. The association between pre-transplant cytokine levels and clinical data of the patients, the effects of cytokine levels on transplantation results, and the correlation between cytokine concentrations and survival were analyzed. RESULTS: Pre-transplant activin A levels were significantly increased in patients with osteolytic lesions (n=48) compared to those without osteolytic lesions (n=30) (p=0.01). Activin A levels were significantly increased in patients with renal impairment (n=27) compared to those without renal impairment (n=51) (p=0.032). A significant difference was observed between International Staging System (ISS)-3 and ISS-1 stage MM patients according to IL-6 levels (p=0.001). The median follow-up duration was 36.3 months. Progression-free survival (PFS) was 24.8±2.4 months for patients with activin A levels >34.85 pg/ml and 29.7±1.82 months for those with ≤34.85 pg/ml (p=0.044). In univariate analysis, activin A>34.85 pg/ml was identified as an independent prognostic factor for PFS (p=0.012). In the multivariate analysis, activin A levels >34.85 pg/ml (p=0.020) and activin B levels >9.28 pg/ml (p=0.037) were identified as independent prognostic factors for PFS. CONCLUSIONS: Our study demonstrated that elevated activin A levels are correlated with lytic lesions and renal damage. Besides, elevated serum activin A levels before ASCT constitute an independent risk factor for PFS.

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