Prognostic Nutrıtıonal Index is Independently Associated with Overall Survıval in Newly Diagnosed Multıple Myeloma: A Retrospectıve Single-Center Cohort Study
The Prognostic Nutritional Index (PNI), calculated from serum albumin and
lymphocyte count, reflects nutritional and immunological status. Its independent prognostic
value in multiple myeloma (MM) beyond established staging systems remains unclear.
Materials and Methods/Case Presentation/Objective:
We retrospectively analyzed 269 consecutive MM patients treated at a single center
between 2010 and 2024. PNI was calculated as 10 × albumin (g/dL) + 0.005 × absolute
lymphocyte count (cells/mm³). The optimal cutoff for PNI was identified using maximally
selected rank statistics and validated by 1,000-iteration bootstrap resampling. Multivariable
Cox regression was stratified by autologous stem cell transplantation (ASCT) to address
proportional hazards violations, and inverse probability of treatment weighting (IPTW) was
applied as a sensitivity analysis.
Results/Description/Main Outcome Measure(s):
Over a median follow-up of 32.7 months, 172 deaths (63.9%) occurred. The optimal
PNI cutoff was 42.6, classifying 111 patients (41.3%) as low PNI and 158 (58.7%) as high
PNI. Median overall survival (OS) was 24.3 months for low PNI versus 64.5 months for high
PNI (p < 0.001). In multivariable analysis, low PNI independently predicted higher mortality
(HR 1.73; 95% CI: 1.21-2.48; p = 0.003), a finding consistent after IPTW adjustment and
bootstrap validation. Adding PNI to R-ISS increased the C-index from 0.610 to 0.663. PNI
was associated with progression-free survival in univariable analysis but not after
multivariable adjustment.
Conclusion(s).:
PNI is a simple, independent prognostic marker for OS in newly diagnosed
MM. Patients with low PNI have substantially poorer survival. PNI may serve as a readily
available, cost-effective, and easily implementable tool for routine clinical risk
stratification. These findings warrant external validation in independent cohorts.
Trademarked Items:
References: 1. Rajkumar SV. Multiple myeloma: 2022 update on diagnosis, risk stratification, and management. Am J Hematol. 2022 Aug;97(8):1086-1107. doi: 10.1002/ajh.26590.
2.Sun X, Song M, Wang P, Zhang Z, Dai R, Shi J. Improvement of revised international staging system risk stratification in patients with newly diagnosed multiple myeloma using a high bone marrow plasma cell percentage: a real-world study in China. Front Oncol. 2025 Oct 3;15:1627653. doi: 10.3389/fonc.2025.1627653.
3. Onodera T, Goseki N, Kosaki G. [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai Zasshi. 1984 Sep;85(9):1001-5. Japanese.
4. Peng P, Chen L, Shen Q, Xu Z, Ding X. Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score for predicting outcomes of breast cancer: A systematic review and meta-analysis. Pak J Med Sci. 2023 Sep-Oct;39(5):1535-1541. doi: 10.12669/pjms.39.5.7781.
5.He J, Wang L, Xu W. [The Prognostic Value of Prognostic Nutritional Index in Patients with Lymphoma--Review]. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2022 Apr;30(2):641-644. Chinese. doi: 10.19746/j.cnki.issn.1009-2137.2022.02.054
