Baseline Total Protein As a Prognostic Biomarker for Progression-Free Survival in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation Publisher



Younesian S ; Parkhideh S ; Shiraji S T ; Younesian O ; Shahsavan S ; Asadi M ; Mohammadi M H ; Bashash D
Source: International Journal of Cancer Management Published:2026

Abstract

Background: Albumin and the albumin-to-globulin ratio (AGR) are established prognostic markers in multiple myeloma (MM); however, the prognostic value of baseline serum total protein in patients with MM undergoing autologous stem cell transplantation (ASCT) remains unclear. Objectives: This study investigated the prognostic significance of baseline total protein for progression-free survival (PFS) in patients with MM undergoing autologous stem cell transplantation (ASCT). Methods: Twenty-one consecutive patients with MM who underwent ASCT between 2023 and 2025 at the Stem Cell Transplant Research Center of Taleghani Hospital were included. Survival outcomes were evaluated using Kaplan-Meier estimates stratified by baseline total protein levels and Cox proportional hazards models. Patients were followed for a median of 19 months (range, 10.5 - 32 months). Results: Higher baseline total protein was significantly associated with inferior PFS (HR, 2.10; 95% CI, 1.08 - 4.08; P = 0.028). Patients with total protein > 9 g/dL had significantly shorter PFS and 12-month PFS than those with total protein ≤ 9 g/dL (log-rank test; P = 0.008 and P = 0.029, respectively). A trend toward inferior OS was observed (log-rank test; P = 0.052). Elevated total protein was strongly correlated with M-protein and globulin levels and was associated with lower hemoglobin levels and a higher erythrocyte sedimentation rate (ESR). Conclusions: Higher baseline total protein is associated with inferior PFS in patients with MM undergoing ASCT. Given its simplicity and universal availability, it may serve as a cost-effective and accessible prognostic marker at the time of diagnosis. Larger prospective studies are needed to validate its independent prognostic value. Copyright © 2026, Younesian et al.