Lower HDL-C, total cholesterol and apolipoprotein A-I levels encountered in multiple myeloma

Hence, the researchers suggest considering lipid profile parameters when assessing such patients.

Multiple myeloma, also called plasma cell myeloma, is the second most common haematological malignancy, characterized by uncontrolled monoclonal proliferation of plasma cells in the bone marrow. In multiple myeloma, variations are seen in several laboratory and clinical parameters, including those in lipid profiles, particularly in high-density lipoprotein cholesterol (HDL-C).

HDL have many protective properties, including anti-apoptotic, anti-oxidative, and anti-inflammatory effects. HDL and their major constituent, apolipoprotein A-I, inhibit hematopoietic stem and progenitor cell proliferation. Consequently, low levels of apoA-I and/or HDL-C are associated with an increased risk of haematological cancers like MM, while they may also promote resistance to therapy and cancer aggression.

To date, the association between hypoalphalipoproteinemia and MM has not been studied well, despite relevant supportive evidence. Therefore, Anastasios Makris, School of Medicine, European University Cyprus, Nicosia, Cyprus, and colleagues performed a systematic review and meta-analysis to determine the value of HDL-C and other lipid parameters as biomarkers in multiple myeloma disease.

For this purpose, the researchers searched online databases for studies with evidence on HDL-C in MM patients. A qualitative synthesis was performed of published retrospective and prospective studies for the role of HDL-C and other lipid profile parameters in MM. Additionally, a meta-analysis was performed on HDL-C mean differences (MD) between MM cases and controls.

The study led to the following findings:

• Fourteen studies (3 prospective, 11 retrospective) comprising 895 MM patients were eligible for the systematic review.
• Ten studies compared HDL-C levels in MM patients with healthy controls. In these ten studies (n = 17,213), pooled analyses showed that MM patients had significantly lower HDL-C levels compared to healthy controls (MD: −13.07 mg/dl).
• Regarding secondary endpoints, total cholesterol (MD: −22.19 mg/dl) and apolipoprotein A-I (−40.20 mg/dl) demonstrated significant decreases, while differences in low-density lipoprotein cholesterol (LDL-C) (MD: −11.33 mg/dl) and triglycerides (MD: 9.93 mg/dl) were not significant.

The meta-analysis provides clarity that HDL-C and, apoA-I and total cholesterol do not only reflect cardiovascular risk but also represent important features in MM.

"Our findings point towards a need for implementing larger clinical studies that will provide more robust data on the clinical significance of the association between HDL-C and MM, and clinical value of lipid panel addition in assessing MM patients," the researchers wrote.

"Finally, future research perspectives in multiple myeloma include investigating the role of lipids as potential biomarkers of treatment response and disease burden," they concluded.

Reference:

Makris, A., Pagkali, A., Nikolousis, E., Filippatos, T. D., & Agouridis, A. P. (2023). High-density lipoprotein cholesterol and multiple myeloma: A systematic review and meta-analysis. Atherosclerosis Plus, 54, 7-13. https://doi.org/10.1016/j.athplu.2023.09.003