Objective: Multiple myeloma is a malignant disease of clonal plasma cells and anemia takes part in most of the patients. Although it is similar to the anemia of chronic disease with many parameters, the exact mechanism has not been clarified. Hepcidin, Growth differentiation factor-15 (GDF-15), soluble transferrin receptor (sTfR) have been investigated in many forms of anemia, especially in chronic diseases and cancers. However, there are few studies investigating their role in anemia in myeloma. In this project, we aimed to determine the relationship between hepcidin, sTfR and GDF-15 levels in multiple myeloma patients and their clinical features such as anemia parameters and disease stage.
Methodology: This study was approved by Duzce University Faculty of Medicine Non-Invasive Ethics Committee with the decision dated 20.01.2015 and numbered 2015/110 and supported by Düzce University Department of Scientific Research Projects with Project number 2015.04.03.336. Multiple myeloma patients who were diagnosed at our hematology clinic were evaluated for the study. Among these newly diagnosed patients, those who received erythrocyte or whole blood transfusion, iron, B12 or folic acid treatment within the last month were excluded and total 28 patients were enrolled. A control group of 28 people was formed from the volunteers without any disease and fasting blood samples were taken from all participants. After reaching the targeted number of patients and control groups, serum hepcidin, sTfR and GDF-15 levels were obtained from these preserved samples by ELISA method.
Results: Although myeloma patients had significantly lower Hb and Hct levels compared to the control group (median Hb 9.95 vs. 13.40g/dL and median Hct 30.35% vs. 40.00%, p<0.001), none of the GDF-15, hepcidin and sTfR levels showed a significant difference between the myeloma and control groups. Among multiple myeloma patients, we found that the anemic subgroup had significantly lower hepcidin levels than the non-anemic subgroup (p=0.043) but GDF-15 or sTfR levels were not different (p>0.05). When the correlations were examined, GDF-15, hepcidin and sTfR levels showed correlation with each other, while GDF15 was positively correlated with creatinine and sTfR levels were positively correlated with many parameters such as LDH, CRP, ferritin, albumin, creatinine, Hb and ISS stage. None of the levels of GDF-15, hepcidin and sTfR had a significant effect on survival.
Conclusion: Our findings suggested that mediators of chronic inflammation may play an important role in myeloma anemia but there is not always a clear interaction as in chronic disease anemia, there may be mechanisms that include partial response deficiencies and accommodate variable responses according to the characteristics of the patient groups.
