Serum complement C4 may be a marker for poorer outcomes in patients with multiple myeloma (MM). These findings, from a retrospective analysis, were published in Clinical Medicine Insights: Oncology.

MM is a hematologic malignancy associated with a median survival of 5 years. Treatment selection for MM often considers disease progression; however, early risk factors for poorer outcomes are not fully understood. To test whether serum biomarkers associate with outcomes, records from 72 patients with newly diagnosed MM at the First People’s Hospital of Yunnan Province in China between July 1, 2017, and January 1, 2019, were retrospectively assessed for laboratory indicators.

Median age at diagnosis was 59 years (range, 37 to 83), 42 of participants were men, median time from diagnosis to death was 715 days (range, 15 to 1400), and 2-year overall survival rate was 48.6%. Based on the International Staging System, 39 patients had stage III disease, 20 had stage II, and 13 had stage I.

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At 2 years, 35 patients had survived. The survivor cohort was significantly younger (P =.039), had higher hemoglobin (P =.007) and platelets (P =.046), and had lower blood urea nitrogen (P =.046).

Using a complement C4 cutoff of 0.095 g/L, higher complement C4 was associated with higher survival probability (P =.004) and increased survival time within 2 years (median, 743 vs 180 days; P =.004).

Overall survival was associated with bone marrow plasma cell ≥30.75% (hazard ratio [HR], 0.171; 95% CI, 0.06-0.482; P =.001), age 67 years and older (HR, 0.191; 95% CI, 0.078-0.47; P <.001), complement C4 ≤0.095 g/L (HR, 3.642; 95% CI, 1.486-8.924; P =.005), and platelets ≤115.5×109/L (HR, 5.821; 95% CI, 2.522-13.436; P <.001).

This study was limited by its small sample size and retrospective design. Additional larger prospective studies are needed to confirm these findings.

These data indicated that serum complement C4 may be an independent predictor for overall survival in patients with newly diagnosed MM.


Zhang L, Ling X, Li F, et al. Complement 4 aids in the prediction of newly diagnosed multiple myeloma outcome in patients. Clin Med Insights Oncol. Published online February 28, 2022. doi:10.1177/11795549221079171