N-terminal pro-brain natriuretic peptide reflects both left ventricular diastolic dysfunction and myeloma-related renal insufficiency and robustly predicts mortality in patients with symptomatic multiple myeloma

We retrospectively explored the prognostic relevance of N-terminal pro-brain natriuretic peptide (NT-proBNP) and the association of NT-proBNP with cardiac and renal functions in 153 patients with newly diagnosed symptomatic multiple myeloma and no concomitant light chain amyloidosis who received novel agents. We also examined the usefulness of the new frailty system recently introduced by Mayo Clinic (combining age, performance status, and NT-proBNP). Patients with higher NT-proBNP levels (≥300 ng/L) had a significantly higher incidence of left ventricular diastolic dysfunction (LVDD) and myeloma-related renal insufficiency and significantly shorter overall survival (OS) than did those with lower NT-proBNP levels (<300 ng/L). NT-proBNP remained predictive of OS on multivariate analysis. Mayo Clinic's new frailty system showed excellent discrimination of OS. Furthermore, the Instrumental Activity of Daily Living (IADL) score (not evaluated in Mayo Clinic's study) predicted OS independently of this system, and a sharper discrimination of OS curves was obtained by the incorporation of IADL into this system. Our findings demonstrated that NT-proBNP levels were associated with both LVDD (as a host risk factor) and myeloma-related renal insufficiency (resulting from the disease aggressiveness) and provided predictive information regarding OS in patients with symptomatic myeloma. Furthermore, we, for the first time, validated Mayo Clinic's new frailty system. Our modification further improved Mayo Clinic's system by newly incorporating the IADL score.