Preliminary establishment of a spinal stability scoring system for multiple myeloma

BACKGROUND Multiple myeloma is an incurable malignant plasma cell disorder that represents the most common primary malignant bone tumor.It commonly involves bone metastasis in multiple vertebral bodies,and the Spinal Instability Neoplastic Score scoring system may not be fully applicable to multiple myeloma(MM)patients.AIM To evaluate the spinal stability of patients with MM spinal involvement to guide their clinical treatment.METHODS By using the Delphi method,we collected and extracted information through a series of questionnaires and improved it via feedback.We also preliminarily established a spinal stability scoring system for multiple myeloma.RESULTS Fifteen clinicians completed a second round of questionnaires and compared their answers with those of the first round of questionnaires to identify significant comments or changes that required group discussions.As a result,no further feedback was used to improve the scoring system.After integrating the information from the expert consultation questionnaire,we established the initial scoring system for MM spine stability and used the scoring system to assess a series of representative clinical cases.The MM spinal stability scoring system was created by calculating the scores of the six separate components:location,pain,number of segments,physiological curvature,comorbidities,and neurological function.The minimum value was"0",and the maximum value was"24".A score of"0-10"indicated"spine stability",a score of"11-17"indicated"potential instability",and a score of"18-24"indicated"spine instability".Patients with a score of"11-24"need an intervention such as surgery.CONCLUSION The initial establishment of the MM spine stability scoring system provides a vital theoretical basis for the evaluation of spine stability in individuals with MM.

Significance of preoperative peripheral blood neutrophil-lymphocyte ratio in predicting postoperative survival in patients with multiple myeloma bone disease

BACKGROUND The neutrophil-lymphocyte ratio(NLR)is often used to predict a poor prognosis in patients with tumors.This study investigated the preoperative peripheral blood NLR in predicting postoperative survival(POS)in patients with multiple myeloma bone disease(MMBD).AIM To evaluate whether NLR can be used to predict the prognosis of MMBD patients after surgery.METHODS The clinical data of 82 MMBD patients who underwent surgical treatments in Beijing Chao-yang Hospital were collected.The NLR was obtained from the absolute number of neutrophils and lymphocytes,calculated by the number of neutrophils and divided by the number of lymphocytes.The peripheral blood lymphocyte percentage was used as the major marker to analyze the change in characteristics of the immune statuses of multiple myeloma patients.RESULTS The NLR cut-off values of NLR≥3 patients and NLR≥4 patients were significantly correlated with POS.The 3-and 5-year cumulative survival rates of the high NLR group(NLR≥3 patients)were 19.1%and 0.0%,respectively,which were lower than those of the low NLR group(NLR<3 patients)(67.2%and 48.3%)(P=0.000).In the high NLR group,POS(14.86±14.28)was significantly shorter than that in the low NLR group(32.68±21.76).Univariate analysis showed that the lymphocyte percentage 1 wk after the operation(19.33±9.08)was significantly lower than that before the operation(25.72±11.02).Survival analysis showed that postoperative chemotherapy,preoperative performance status and preoperative peripheral blood NLR≥3 were independent risk factors for POS.CONCLUSION The preoperative peripheral blood NLR can predict POS in MMBD patients.MMBD patients with a high preoperative NLR(NLR≥3)showed poor prognosis.