MRD and Biomarkers

Category: MRD and Biomarkers

Serum cholesterol levels demonstrate dynamic changes following autologous hematopoietic stem cell transplantation in patients with multiple myeloma

(PA-164) Serum Cholesterol Levels Demonstrate Dynamic Changes Following Autologous Hematopoietic Stem Cell Transplantation in Patients with Multiple Myeloma

Friday, September 19, 2025

Yuan Chen

Resident Physician
Beijing Jishuitan Hospital, Capital Medical University

Introduction: Multiple myeloma (MM) is a hematological malignancy dependent on the bone marrow microenvironment, where adipocytes play a critical role in disease progression. Cholesterol metabolism and lipoprotein levels are emerging prognostic factors in MM, but long-term data on lipid dynamics remain scarce. This study analyzed long-term follow-up data from 115 autograft patients over the past 7.5 years to investigate the long-term changes in lipid metabolism during the course of MM.

Methods:   A retrospective analysis was conducted on 115 MM patients undergoing ASCT between 2016 to 2023. Lipid parameters and vitamin D levels were measured at diagnosis, pre-transplant, 100 days post-transplant, and up to 2 years post-transplant or relapse.

Results:   This study analyzed 115 multiple myeloma patients (66 males, 49 females) with a median age of 55.8 years. Immunoglobulin type distribution showed IgG (45 cases), IgA (27), IgD (5), light chain (33), and non-secretory (5). Most patients had ISS stage I disease. Genetic risk stratification revealed 38 patients (33.93%) without high-risk abnormalities, 54 with one, and 20 with two high-risk abnormalities. Pretransplant treatment response rates included 85.22% achieving CR/VGPR and 14.78% PR, with a median PFS of 51.43 months. Notable metabolic findings showed consistently subnormal lipid profiles (total cholesterol, triglycerides, HDL, LDL) and vitamin D levels at initial diagnosis. At diagnosis, cholesterol levels were low in 20%, elevated in 20%, and normal in 60% of patients. Post-induction therapy, cholesterol normalized in 62%, while 38% remained elevated. The proportion of vitamin D deficiency (< 20 ng/ml) further increased after induction therapy. Induction therapy correlated with improved cholesterol normalization but exacerbated vitamin D deficiency.

Cholesterol, triglycerides, and LDL levels were significantly higher at both the pre-transplantation and 100-day post-transplantation time points compared to baseline values. However, no significant changes were observed in serum vitamin D levels or in HDL, Apo A1, and Apo B levels.

Cholesterol levels were tracked at 100 days, 1 year, and 2 years post-transplant. Patients with early relapse (within 2 years) showed significantly lower cholesterol levels at 2 years compared to 100-day post-transplant levels In contrast, non-relapsed patients maintained stable, higher cholesterol levels over the same period, with a statistically significant difference observed.

Conclusions:

This study is the first to characterize dynamic post-transplant cholesterol variations in MM. Relapsed patients displayed declining cholesterol levels, while sustained higher cholesterol levels during remission were associated with improved outcomes, suggesting that elevated cholesterol levels during remission may indicate a favorable prognosis. Our findings advocate for incorporating lipid metabolism monitoring into the long-term management of MM to guide personalized therapeutic approaches and enhance survival outcomes.