@article {7843,
	title = {Cystatin-C is an independent prognostic factor for survival in multiple myeloma and is reduced by bortezomib administration},
	journal = {Haematologica},
	volume = {94},
	year = {2009},
	note = {Cited By :39Export Date: 21 February 2017},
	month = {2009},
	pages = {372 - 379},
	abstract = {Background Renal impairment is a common complication of multiple myeloma. Cystatin-C is considered an accurate marker of glomerular filtration rate in several renal disorders. Microarray analysis has revealed that cystatin-C is one of the most highly up-regulated genes in multiple myeloma. The aim of this study was to evaluate the serum levels of cystatin-C in myeloma patients, explore possible correlations with clinical data, including survival, and assess the effect of bortezomib on cystatin-C in relapsed multiple myeloma. Results We measured serum cystatin-C in 157 newly diagnosed, previously untreated myeloma patients, in 28 patients with relapsed disease pre- and post-bortezomib therapy and in 52 healthy controls, using a latex particle-enhanced nephelometric immunoassay. Results In newly diagnosed patients, cystatin-C was elevated and showed strong correlations with advanced ISS stage, extensive bone disease, high ffc-microglobulin, high serum creatinine, and low creatinine clearance. Multivariate analysis revealed that only cystatin-C and lactate dehydrogenase had an independent prognostic impact on patients{\textquoteright} survival. The combination of cystatin-C and lactate dehydrogenase revealed three prognostic groups of patients: a high-risk group (both elevated cystatin-C and lactate dehydrogenase) with a median survival of 24 months, an intermediate-risk group (elevated cystatin-C or elevated lactate dehydrogenase) with a median survival of 48 months and a low-risk group (both low cystatin-C and lactate dehydrogenase) in which median survival has not yet been reached (p<0.001). Cystatin-C could also identify a subset of ISS-II patients with worse outcome. Relapsed patients had higher cystatin-C levels even compared to newly diagnosed patients. Treatment with bortezomib produced a significant reduction of cystatin- C, mainly in responders. Conclusions Serum cystatin-C is not only a sensitive marker of renal impairment but also reflects tumor burden and is of prognostic value in myeloma. Its reduction after treatment with bortezomib reflects bortezomib{\textquoteright}s anti-myeloma activity and possibly bortezomib{\textquoteright}s direct effect on renal function. {\textcopyright} 2009 Ferrata Storti Foundation.},
	keywords = {bortezomib, Cystatin-c, multiple myeloma, renal impairment, Survival},
	url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-63149145552\&doi=10.3324\%2fhaematol.2008.000638\&partnerID=40\&md5=0f7d53ec610a5906b3036745ea099595},
	author = {Terpos, E. and Katodritou, E. and Tsiftsakis, E. and Kastritis, E. and Christoulas, D. and Pouli, A. and Michalis, E. and Verrou, E. and Anargyrou, K. and Tsionos, K. and Dimopoulos, M.A. and Zervas, K.}
}
