Diagnostic and prognostic value of bone metabolism biomarkers in newly diagnosed plasma cell myeloma

Plasma cell myeloma (PCM) is the second most common type of haematological cancer. Lytic lesions and bone pain are among the most common symptoms of PCM. The study aimed to evaluated the diagnostic and prognostic value of markers of bone metabolism, i.e. activin A, Dkk-1, GDF-15, β-CTX and sclerostin in patients with PCM. The study involved 76 patients with PCM and 25 healthy volunteers. The concentration of above markers was determined by ELISA method. Patients showed significantly higher pretreatment concentration of activin A, Dkk-1, GDF-15 and β-CTX compared to the control. The number of bone lesions (based on X-ray) showed a significant correlation with the concentration of activin A (rho = 0.276), Dkk-1 (rho = 0.598), GDF-15 (rho = 0.489), and β-CTX (rho = 0.381). The ROC curves analyses revealed that the determination of Dkk-1 was characterized by the highest diagnostic utility in the detection of osteolytic lesions (AUC = 0.81). Moreover the high levels of Dkk-1 were significantly associated with poor PFS (HR = 1.75) and OS (HR = 3.04). The assessment of Dkk-1 concentration may become a new biomarker useful in the detection and monitoring of bone lesions and may indicate an unfavourable prognosis in PCM.