PROCALCITONIN IN MULTIPLE MYELOMA

Background: C-reactive protein (CRP) is an acute phase protein (APP) and has prognostic significance in multiple myeloma (MM). Procalcitonin (PCT) is also an APP and has been reported to be elevated in patients with severe systemic infection and sepsis. Aims: We investigated PCT level in patients with MM and its relationship with the stage and activity of the disease. The discriminatory value of PCT level in myeloma patients with and without infection was also assessed. Patients and methods: PCT, CRP, interleukin-6 (IL-6) and IL-1β levels were determined in 69 blood samples from 66 myeloma patients with va- rious disease activity and 25 controls. Infections were verified by micro- biological identification of an infectious specimen together with clinical presentation and radiological findings. Statistical analysis: The Mann- Whitney U test and Spearman’s rank correlation test were performed. P values lower than 0.05 were considered significant. Results: Patients with known infections and inflammatory diseases that might elevate PCT levels were excluded from the data in order to evaluate PCT merely in MM. None of the patients with MM had a PCT level hig- her than 0.5 ng/mL. Mean PCT level in myeloma patients with infection, without infection and controls were 1.42±0.36, 0.38±0.15 and 0.09±0.02, respectively. The difference between mean PCT levels in myeloma pati- ents with and without infection was insignificant (p>0.05). The sensitivity of PCT for the detection of infection was 64%, and the specificity 82%. Conclusion: PCT level seems to be a good parameter to identify systemic bacterial infections and is a useful marker of the severity of infection in patients with MM if coexistent non-infectious conditions that may contri- bute to PCT elevation are excluded by appropriate clinical and laboratory investigations. Key Words: Multiple Myeloma, Procalcitonin, Infection. MULTIPL MYELOMDA PROKALSITONIN Dayanak: Bir akut faz reaktani olan C-reaktif protein (CRP) multipl myelomda (MM) prognostik oneme sahiptir. Prokalsitonin de (PCT) akut faz reaktanidir. PCT duzeyleri siddetli sistemik enfeksiyonlar ve sepsisde yuksek bulunmustur. Amac: Bu calismada MM’lu hastalarda PCT duzeylerinin hastaligin ev- resi ve aktivitesiyle iliskisi arastirilmistir. MM’lu olgularda enfeksiyon- larin ayiriminda PCT’in oneminin degerlendirilmesi de calismanin diger amacidir. Hastalar ve Metodlar: Altmisalti MM’lu hastadan alinan 69 kan ornegi ve 25 saglikli kontrolda PCT, CRP, interlokin-6 (IL-6), ve interlokin-lp (IL-1 P) duzeyleri olculdu. Enfeksiyon tanisi hastanin klinigi, radyolo- jik bulgular ve enfeksiyon etkeninin mikrobiyolojik olarak izolasyonuyla kondu. Istatiksel Analiz: Istatiksel degerlendirme Mann-Whitney-U ve Spear- man korelasyon testleriyle yapildi. 0.05’den kucuk p degerleri Istatiksel okrak anlamli kabul edildi. Sonuclar: MM5da PCT’in hastaligin aktivitesi ve evresiyle iliskisini de- gerlendirmek icin eslik eden inflamatuvar veya enfeksiyoz hastaligi olan- lar degerlendirmeye alinmadi. MM’lu hastalarin tumunde PCT duzeyleri 0.5 ng/ml’den dusuk bulundu. MM ve enfeksiyonu olan; sadece MM’lu olgular ve kontrol grubunda PCT duzeyleri sirasiyla 1.4210.36, 0.38±0.15 and 0.09±0.02 olarak bulundu. Enfeksiyonu olan ve olmayan MM’lu ol- gularin PCT duzeyleri arasindaki fark anlamli bulunmadi. Enfeksiyonla- rin tespitinde PCT’in duyarliligi % 64, ozgunlugu % 82 olarak bulundu. Sonuc: MM’lu olgularda, PCT duzeyini yukseltebilecek enfeksiyon disi nedenler klinik veya laboratuvar arastirmalariyla dislanabilirse, PCT du- zeyleri sistemik bakteriyel enfeksiyonlarin tanisi ve enfeksiyonun siddeti- ni degerlendirmek icin faydali bir tani yontemi olarak gorunmektedir. Anahtar Sozcukler: Multipl Myelom, Prokalsftonin, Enfeksiyon