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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