Prognostic Significance of Isolated Beta 2-Microglobulin Elevation in Thai Multiple Myeloma: Impact of Renal Function Assessment

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Background: -microglobulin (β2M) with normal serum creatinine (SCr) as high-risk multiple myeloma (MM). However, creatinine-based renal definitions may be inaccurate in Asian populations with lower muscle mass. We aimed to evaluate the prognostic impact of isolated elevated β2M on overall survival (OS) using SCr- and Cockcroft-Gault-derived creatinine clearance (CrCl)-based definitions. Methods: This retrospective study included newly diagnosed MM patients (2006-2023). Patients were classified as group A (β2M < 5.5 mg/L), group B (β2M ≥ 5.5 mg/L, SCr < 1.2 mg/dL), or group C (β2M ≥ 5.5 mg/L, SCr ≥ 1.2 mg/dL). In secondary analyses, renal function was redefined using CrCl (≥ 60 mL/min). Results: Among 250 patients (mean age 61.0 ± 12.1 years; 62.0% male), 34.4% underwent autologous stem cell transplantation. Groups A, B, and C included 109 (43.6%), 29 (11.6%), and 112 (44.8%) patients, respectively. At a median follow-up of 4.55 years, 4-year OS for groups A, B, and C was 79.8%, 71.6%, and 60.0% (P = 0.015). Group B did not demonstrate significantly inferior OS compared with group A (adjusted hazard ratio (aHR), 1.51; 95% confidence interval (CI), 0.70-3.24), whereas group C had significantly worse OS (aHR, 1.79; 95% CI, 1.11-2.86). When renal function was defined by CrCl, reclassified group B (n = 19) showed significantly inferior OS (aHR, 2.61; 95% CI, 1.17-5.86). Conclusions: Isolated β2M elevation showed a trend toward inferior OS using the SCr-based definition. CrCl-based reclassification appeared to improve prognostic stratification by identifying occult renal impairment not detected by SCr alone. These findings require validation in larger studies.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.