New Inflammation Scoring System Aims to Add to ISS Staging

Inflammation is an essential factor in tumor cell growth, and more studies are investigating inflammation and tumor prognosis. However, despite having a proven scale by which to manage tumor burden and grade, the Revised International Staging System (R-ISS), multiple myeloma (MM) does not have a similar scale for inflammation as it relates to tumor prognosis. Two scales could lead to a more precise diagnosis and individualized therapy.

The authors of a recent study in Cancer Management and Research tested the usefulness of an inflammatory prognostic scoring index (IPSI) and believe that it could supplement the International Staging System (ISS) by furthering risk stratification in patients with MM, because the disease is so heterogeneous. They used 3 variables in their investigation as they pertain to overall survival (OS): red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and platelet count (PLT). High RDW and NLR and low PLT are all indicators of a poor prognosis in patients with MM.

In this study, for each variable, the patients were divided into low and high groups:

• RDW: low, 14 μm or smaller; high, greater than 14 μm
• NLR: low, 2 or below; high, greater than 2
• PLT: low, 150 or fewer x 10³ μL; high, above 150 x 10³ μL

Broken out, an RDW increase signifies anemia; changing NLR could signify shifting neutrophil and lymphocyte levels, indicating immune system response; and PLT fluctuations mean interrupted production. All are indications of inflammation.

The study cohort comprised 175 patients with newly diagnosed MM. The average age was 61, 54.29% were men, and 45.71% were women. Patients were excluded if any of the following were diagnosed: reactive plasmacytosis, monoclonal gammopathy of unknown significance, Waldenstrom macroglobulinemia, amyloidosis, and plasma cell leukemia.

Treatment on days 1, 8, 15, and 22 consisted of a subcutaneous (SC) injection of 1.3-mg/m² bortezomib and 40-mg oral dexamethasone or an SC injection of 1.3-mg/m² bortezomib, 300-mg/m² oral cyclophosphamide, and 40-mg oral dexamethasone. At the final study follow-up in April 2019, 90 patients had died, and the median overall survival was 29.33 months (range, 23.51-35.49). RDW, NLR, and PLT were shown to be both significant and independent prognostic factors for OS.

The authors believe “the inclusion of the IPSI to assess a patient’s inflammatory status contributes to a more comprehensive and accurate prognostic stratification of MM patients, and the IPSI is expected to be a useful complement to ISS staging.”

They do, however, acknowledge several limitations to their research: small study size, lack of inclusion of cytogenetic risk, and no patients received autologous stem cell transplant, so that how the IPSI relates to progression-free survival and transplantation results could not be determined. The IPSI will require further study with larger patient groups to ultimately determine its usefulness.

Reference

Liu S, Shi J, Guo H, et al. Prognostic significance of the inflammatory index-based scoring system in patients preliminarily diagnosed with multiple myeloma in the bortezomib-based chemotherapy era. Cancer Manag Res. 2019;11:9409-9420.