Effect of Induction Chemotherapy on Bone Turnover Markers in Newly Diagnosed Multiple Myeloma

Abstract

Bone disease is a significant clinical manifestation of multiple myeloma, resulting from heightened osteoclastic activity and diminished osteoblastic function. Biochemical markers of bone turnover may assist in evaluating skeletal involvement and monitoring therapy efficacy.

To assess alterations in urinary NTX-1, serum CTX-1, and serum P1NP concentrations in newly diagnosed patients with multiple myeloma receiving induction chemotherapy.

A total of 33 newly diagnosed cases were enrolled, with 24 completing both baseline and post-chemotherapy sampling. Fasting urine and serum samples were obtained before the commencement of treatment and again at week 16. Levels of NTX-1, CTX-1, and P1NP were quantified through ELISA (enzyme-linked immunosorbent assay). Biochemical and clinical parameters critical to the study were extracted from patient records. Statistical comparisons utilized paired t-tests or Wilcoxon signed-rank tests, while correlations were evaluated using Spearman's coefficient.

Urinary NTX-1 levels were within the reference range (7.9–53.5 nmol/L) prior to chemotherapy and exhibited a minor, nonsignificant elevation posttreatment. Serum CTX-1 levels remained continuously within the normal range (0.901–4.81 nmol/L) at both time periods, with no significant variation. Serum P1NP levels were elevated compared to the normal reference range (32.7–47.7 µg/L) prior to chemotherapy and continued to be raised after treatment. P1NP exhibited a significant positive connection with disease duration (p < 0.001). Clinically, 22 out of 24 patients attained remission subsequent to induction treatment.

Induction chemotherapy did not produce significant shifts in NTX-1, CTX-1, or P1NP, indicating minimal early skeletal response despite clinical remission in most patients. Larger, well-powered studies are needed to elucidate the prognostic utility of these bone turnover markers in multiple myeloma.