title: N-terminal fragment of the type-B natriuretic peptide (NT-proBNP) contributes to a simple new frailty score in patients with newly diagnosed multiple myeloma.
abstract: Multiple myeloma (MM) patient frailty has been delineated primarily by age and ECOG performance score (PS) and recently by the IMWG frailty score based on functional status [Activity of Daily Living (ADL) and Instrumental-ADL scores], comorbidities [Charlson-comorbidity-index (CCI)] and age. It was hypothesized that N-terminal natriuretic peptide type B (NT-proBNP) might be both a more convenient measure of frailty and a predictor of overall survival (OS). Three-hundred and fifty-one consecutive symptomatic MM patients who were seen at Mayo Clinic within 30 days of diagnosis and who had blood stored were eligible. Data from the first visit was abstracted and used to calculate an ADL, CCI, and measure the NT-proBNP level. The best cutoff of NT-proBNP predicting OS was 300 ng/L. Variables predictive for OS were ECOG-PS, age, CCI, ADL, ISS, revised-ISS, and NT-proBNP. On multivariate analysis age ≥70, PS ≥2, and NT-proBNP ≥300 were independent predictors of survival. Patients were assigned a score of 1 for each of these variables, creating stages I-IV with scores of 0-3 points, respectively. The median OS from diagnosis was not reached, 58, 28, and 18 months (P < 0.0001), respectively. This frailty risk schema was independent of initial therapy and the revised-ISS. NT-proBNP is a useful predictor of survival independent of age and PS. It is a widely available biomarker that could be added to the panel of laboratory tests of newly diagnosed MM patients and serve as a simple and objective tool of determining frailty in clinical practice. Am. J. Hematol. 91:1129-1134, 2016. © 2016 Wiley Periodicals, Inc.
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.|Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy.|PhD program in Experimental Medicine, University of Pavia, Pavia, Italy.
authors: Paolo
authors: P
authors: Milani
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: S
authors: S
authors: Vincent Rajkumar
authors: Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy.
authors: Giampaolo
authors: G
authors: Merlini
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Shaji
authors: S
authors: Kumar
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Morie A
authors: MA
authors: Gertz
authors: Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy.
authors: Giovanni
authors: G
authors: Palladini
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Martha Q
authors: MQ
authors: Lacy
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Francis K
authors: FK
authors: Buadi
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Suzanne R
authors: SR
authors: Hayman
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Nelson
authors: N
authors: Leung
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: David
authors: D
authors: Dingli
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: John A
authors: JA
authors: Lust
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Yi
authors: Y
authors: Lin
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Prashant
authors: P
authors: Kapoor
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Ronald S
authors: http://orcid.org/0000-0002-8284-3495
authors: RS
authors: Go
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Yi L
authors: YL
authors: Hwa
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Wilson I
authors: WI
authors: Gonsalves
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Steven R
authors: SR
authors: Zeldenrust
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Robert A
authors: RA
authors: Kyle
authors: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota. dispenzieri.angela@mayo.edu.
authors: Angela
authors: A
authors: Dispenzieri
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012720:Severity of Illness Index; D013647:Task Performance and Analysis
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain