Serum levels of total-RANKL in multiple myeloma.
BACKGROUND
Receptor activator of nuclear factor-kappaB ligand (RANKL) plays a key role in osteoclast activation in myeloma bone disease. The increased expression of RANKL in the bone marrow microenvironment was demonstrated in several studies, but there are only rare data on circulating RANKL levels in patients with multiple myeloma (MM).


METHODS
In the current study, we investigated the clinical significance of serum RANKL levels, using an enzyme-linked immunosorbent assay test that detects both free and osteoprotegerin (OPG)-bound RANKL (total-RANKL, tRANKL) in patients with newly diagnosed MM (n = 93) and monoclonal gammopathy of undetermined significance (MGUS; n = 20) compared with healthy controls (n = 20).


RESULTS
Circulating serum tRANKL was significantly elevated in patients with MM compared with controls (P < .001) or MGUS (P < .001). Furthermore, tRANKL levels were higher in smoldering MM versus MGUS (P = .031) and in symptomatic versus smoldering MM (P < .001). Serum tRANKL increased parallel to International Staging System stages I to III (P = .004) and correlated with the presence of lytic bone lesions (P < .001). Total-RANKL was a prognostic factor for overall survival in symptomatic MM (P = .043). A significantly longer progression-free survival was observed in patients with a > 50% decrease in tRANKL levels after 3 months of combined chemotherapy and bisphosphonate treatment.


CONCLUSIONS
Our study demonstrates for the first time that serum tRANKL reflects advanced disease, lytic bone destruction, and poor prognosis in MM.
Jakob
Christian
C
Department of Hematology and Oncology, Charité, Universitätsmedizin Berlin, Berlin 10117, Germany.
Goerke
Andrea
A
Terpos
Evangelos
E
Sterz
Jan
J
Heider
Ulrike
U
Kühnhardt
Dagmar
D
Ziefle
Susanne
S
Kleeberg
Lorenz
L
Mieth
Maren
M
Metzler
Ivana von
Iv
Müller
Christian
C
Sezer
Orhan
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood* / Q000401:mortality; D053244:Osteoprotegerin / Q000097:blood; D011379:Prognosis; D053245:RANK Ligand / Q000097:blood*
D053244:Osteoprotegerin; D053245:RANK Ligand; C505688:TNFSF11 protein, human