Patient-Generated Subjective Global Assessment as a prognosis tool in patients with multiple myeloma

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Vol. 36; pp. 67 - 71
• Main Authors: Kim, Hae Su, M.D, Lee, Ji Yun, M.D, Lim, Sung Hee, M.D, Kim, Seok Jin, M.D, Jang, Jun Ho, M.D, Kim, Won Seog, M.D, Jung, Chul Won, M.D, Kim, Kihyun, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017; Elsevier Limited
• Subjects: Aberration; Adult; Age; Aged; Aged, 80 and over; Amyloid; Amyloidosis; Anorexia; Asian Continental Ancestry Group; Autografts; Body mass; Body Mass Index; Body weight; Body weight loss; Bone marrow; Bortezomib; Cachexia; Cancer; Cancer therapies; Cell proliferation; Chains; Chemotherapy; Chromosome 17; Chromosome deletion; Cytogenetics; Diagnosis; Family medical history; Female; Follow-Up Studies; Food intake; Gastroenterology and Hepatology; Genomes; Hemoglobins - metabolism; Humans; Incidence; Inflammation; Life expectancy; Male; Malnutrition; Malnutrition - complications; Malnutrition - diagnosis; Management; Markers; Measuring instruments; Medical prognosis; Middle Aged; Multiple myeloma; Multiple Myeloma - complications; Multiple Myeloma - diagnosis; Multivariate Analysis; Nutrition; Nutrition Assessment; Nutritional assessment; Nutritional Status; Patient assessment; Patient-Generated Subjective Global Assessment; Patients; Populations; Prognosis; Proportional Hazards Models; Proteins; Regression analysis; Retrospective Studies; Smoldering; Statistical analysis; Statistics; Surveys and Questionnaires; Survival; Transplantation; Underweight; Variance analysis; Young Adult; International System for Human Cytogenetic Nomenclature; Prognosis; PS; Multiple myeloma; Eastern Cooperative Oncology Group; Body mass index; Autologous stem-cell transplantation; PG-SGA; ECOG; International Staging System; BMI; WHO; MM; World Health Organization; OS; Patient-generated subjective global assessment; ISS; HRs; Flurorescent in situ hybridization; Hazard ratios; Nutritional assessment; ISCN; FISH; Overall survival; ASCT; Performance status; Patient-Generated Subjective Global Assessment
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2016.06.009

Abstract Objective Disease-related weight loss is relatively common in patients with newly diagnosed multiple myeloma, but there are limited data about the impact of nutritional status on survival. Methods Using the Patient-Generated Subjective Global Assessment (PG-SGA) score, we retrospectively explored the effect of malnutrition on the survival of Asian patients with multiple myeloma. Results Two hundred sixteen myeloma patients were subdivided into three groups based on their PG-SGA scores. Twenty-three percent of patients (50/216) had PG-SGA scores ≥9, indicating severe malnutrition requiring specialist nutrition intervention. Body mass index and serum hemoglobin were independently associated with PG-SGA scores ( p <0.05). The median survival time was not reached in nourished patients with PG-SGA scores of 0-3, 58.7 months in moderately malnourished patients with PG-SGA scores of 4-8, and 35.0 months in severely malnourished patients with PG-SGA scores ≥9 ( p =0.001). Multivariate analysis revealed that PG-SGA scores ≥9 compared with PG-SGA scores of 0-3 (HR 2.347, 95% confidence interval [CI]: 1.271-4.334; p =0.006), International Staging System (ISS) stage III compared with ISS stage I (HR 2.360, 95% CI: 1.271-4.379, p =0.007) and autologous stem cell transplantation (HR 0.388, 95% CI: 0.248-0.606, p <0.001) were associated with overall survival. Conclusions A higher PG-SGA score prior to chemotherapy was associated with reduced survival among patients with multiple myeloma. Nutritional evaluation should be an integral part of the clinical assessment of MM patients, and the PG-SGA score would be an appropriate tool to evaluate nutritional status.