Yingzi Zhang,1 Xiajuan Yao,1 Yaoquan Zhang,1 Zhuyun Chen,1 Zhongke Qin,1 Ying Cai,2 Wenkai Xia,1 Hong Hu1 

1Department of Nephrology, Jiangyin People’s Hospital Affiliated to Nantong University, Jiangyin, Jiangsu, 214400, People’s Republic of China; 2Department of Hematology, Jiangyin People’s Hospital Affiliated to Nantong University, Jiangyin, Jiangsu, 214400, People’s Republic of China

Correspondence: Wenkai Xia; Hong Hu, Department of Nephrology, Jiangyin People’s Hospital Affiliated to Nantong University, 3 Yingrui Road, Jiangyin, Jiangsu, 214400, People’s Republic of China, Email xiawenkai.xia@gmail.com; huhong1523@163.com

Background: The albumin-to-globulin ratio (AGR) and neutrophil-to-lymphocyte ratio (NLR) have been recently regarded as promising prognostic factors in various malignancies. The present study investigated the prognostic value of combining the AGR and NLR (ANS) for risk assessments in multiple myeloma (MM) with renal impairment (RI).
Methods: From 2011 to 2018, 79 patients with MM and RI were enrolled in this study. Receiver operating curves (ROCs) were constructed to determine optimal AGR and NLR thresholds for predicting overall survival (OS) and progression-free survival (PFS) during follow up. The prognostic values of AGR, NLR, and ANS were evaluated with Cox regression and Kaplan-Meier methods. We also created a predictive nomogram for prognostic evaluations of OS and PFS, and the predictive accuracy was assessed with a concordance index (c-index).
Results: The ROC curves analyses showed that the optimal cut-off levels were 2.27 for NLR and 1.57 for AGR. A high NLR and a high ANS were significantly associated with worse OS and PFS. However, a high NLR combined with a low AGR was associated with worse OS. Multivariate analyses demonstrated that both the NLR and ANS were independent predictors for both OS and PFS and that a low AGR was an independent predictor of a reduced OS. The nomogram accurately predicted OS (c-index: 0.785) and PFS (c-index: 0.786) in patients with MM and RI.
Conclusion: ANS may serve as a potential prognostic biomarker in patients with MM and RI. The proposed nomograms may facilitate prognostic predictions for patients with MM and RI.

Keywords: multiple myeloma, renal impairment, neutrophil–lymphocyte ratio, albumin-to-globulin ratio, prognosis