Indicating the heterogeneity of the volume of erythrocytes, RDW is a simple and immediately inflammatory marker and it reflects the increase of some cytokines, such as IL-6 and tumor necrosis factor-alpha (TNF-alpha), but also of hepcidin in the blood. Many papers in the literature underline the prognostic role of RDW in MM. In fact, in the subgroup with higher RDW values, we observed a decrease in hematocrit, in albumin levels, and the albumin/fibrinogen ratio, associated with an increase in the total plasma proteins. The results obtained with the subdivision of the whole cohort of patients according to the median of the RDW were similar. Even if in most recent nomograms related to the prognostic stratification of these patients’ cytokines are not taken into account, other authors have included the cytokines in prognostic nomograms, in particular, for newly diagnosed MM patients. Actually, the reduction in albumin levels is due to the fact that interleukin-6 (IL-6), but above all the altered cytokine network present in MM, reduces the hepatic synthesis of albumin, approximately equal to 200 mg per kilogram of body weight per day. In MM patients, the reduction in albumin levels does not seem to depend on age and/or gender, nor does it appear to be affected by liver and kidney function, by the presence of bone osteolytic lesions, Bence−Jones proteinuria, hypercalcemia, and body weight. In the subdivision performed based on the albumin levels, the patients with values below the median showed a reduction in hematocrit, an increase in total plasma proteins, and a rise, although not significant, in c-WBV a decrease in the albumin/fibrinogen ratio was also markedly present. In this revision, 1q gain/amplification are included in the risk calculation. Recently, a second revision of the R-ISS, named R2-ISS, has been proposed. However, this revised staging system has a limitation represented by the fact that 62% of patients were classified into the intermediate-risk category, when instead the patients could belong to different risk levels of progression/death. This new prognostic system includes, in addition to albumin and beta2-MG, too high-risk chromosomal abnormalities detected by interphase fluorescence in situ hybridization (FISH) (deletion (17p), translocation t(4 14) (p16 q32), or t(14 16) (q32 q23)) and serum lactate dehydrogenase (LDH) levels. Considering the remarkable role of cytogenetic alterations, in 2015, the Revised International Staging System (R-ISS) was introduced. It is robustly validated and applicable across geographical areas. The International Staging System (ISS), which has surpassed the Durie–Salmon classification, is widely available, and it is based on two simple and routine laboratory tests: serum albumin and beta2-microglobulin (beta2-MG). Conclusions: Through the changes in blood viscosity in relation to different prognostic factors, this analysis might underline the role of the hemorheological pattern in multiple myeloma.Īmong these prognostic factors, the staging systems play a key role. Moreover, we observed that, as the ISS stage progressed, the albumin/fibrinogen ratio was reduced, and the same hemorheological trend was traced in subgroups with lower albumin levels, higher beta2-microglobulin and red cell distribution width RDW values, and in the presence of a greater bone marrow plasma cell infiltrate. Results: From our analysis, it emerged that the evaluated hemorheological pattern differed in the three isotypes of multiple myeloma, and the whole blood viscosity was higher in IgA and IgG isotypes with respect to the light chain multiple myeloma ( p < 0.001). Methods: In a cohort of 190 patients, we examined the calculated blood viscosity using the de Simone formula, and the albumin/fibrinogen ratio as a surrogate of erythrocyte aggregation, and then we related these parameters to prognostic factors, using the Kruskal–Wallis and the Mann–Whitney tests, respectively. Background: In this single center study, we retrospectively evaluated the calculated hemorheological profile in patients with a new diagnosis of multiple myeloma, with the aim to evaluate possible relationships with some prognostic predictors, such as ISS, albumin levels, beta2-microglobulin, red cell distribution width, and bone marrow plasma cell infiltration.
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