الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
• Multiple myeloma (MM) is a plasma cell disorder that mainly affects older individuals. It is characterized by clonal proliferation of malignant plasma cells in bone marrow (BM) resulting in excessive production of monoclonal immunoglobulins in the serum and/or in the urine.
• One of the biggest challenges in treating MM is drug resistance. Thus, alternative treatment modalities using distinct mechanisms to overcome drug resistance is an area of active research. Furthermore, biomarkers that can predict treatment response will be of great help in choosing optimal drugs to treat MM.
• The soluble interleukin-2 receptor (sIL-2R), also named CD25, is the soluble form of the interleukin-2 receptor (IL2R) expressed on activated lymphocytes. It is produced by cleaving the alpha chain (CD25) of the interleukin-2 receptor through proteolytic processing and is increased in the blood in several inflammation conditions. About the neoplastic process, the IL-2/IL-2R system plays important roles in the activation and proliferation of lymphocytes and exerts anti-tumor immunity.
• Previously reported that elevated serum sIL-2R is related to poor responses to treatments and predicts poor clinical outcomes for patients with extranodal natural killer/T cell lymphoma, nasal type (ENKTL).
• Limited studies showed the prognostic value of sIL-2R in patients with MM, so it is of particular interest to find out whether abnormally elevated serum sIL-2R can also be detected in this disease.
• Aim of our work is to measure sIL2R levels pretransplant in multiple myeloma patients receiving autologous bone marrow transplant and correlate its level with clinical outcome 6 months post transplantation.
• This study included 31 patients with multiple myeloma at the period of July 2022 to June 2023 from bone marrow transplantation unit, Ain shams university hospital. Samples were taken before the time of autologous transplantation of these patients. Patients were followed up for 180 days after transplantation.
• Soluble IL-2R levels were significantly higher in the MM group compared to the control group, by using ROC curve analysis, a level of sIL-2R ≥ 463 is diagnostic of MM with a sensitivity of 93.5% and specificity of 100%. At this cut-off value, only two patients had low sIL-2R levels.
• Patients with high sIL-2R show a significant negative correlation with serum albumin and platelets count (Otherwise, sIL-2R was not associated with age, sex, pretransplant laboratory findings, type of conditioning regimen, and response to treatment.
• In, this study we illustrated that Post-transplant complications including sepsis/pneumonia (2 cases) and mucositis (8 cases) was associated with lower pretransplant platelet count and albumin, higher serum creatinine and sIL-2R compared to non-infection and non-complicated cases, Patients with High sIL-2R showed higher postplant CRP levels and higher frequency of infections,.
• The cumulative overall survival (OS) at six months was 93.5%. No relapses were recorded for up to 6 months. Therefore, all deaths were considered non- relapse mortality (2 cases due to pneumonia and sepsis), and the overall survival was equal to the disease-free survival.
• Overall survival was not affected by the serum level of sIL-2R, serum albumin below 3.5 g/dL was associated with worse overall survival with a trend toward statistical significance, also Low platelet count (< 150 x103) was significantly associated with worse overall survival.
• Serum sIL-2R, which can be easily measured in the clinical practice, could predict outcomes after autologous transplantation, further investigation with more cases and serial measurements of sIL-2R levels before and after transplantation will be required to more clearly define the significance of sIL-2R in MM.
• More research about drugs targeting interleukin2 receptors pathway could be promising in the future management of multiple myeloma.
• Serum albumin is a well-established powerful prognostic marker in multiple myeloma, Hypoalbuminemia may predict poor outcomes after autologous transplantation, therefore a potential area of intervention (e.g. aggressive nutritional supplementation pre-HSCT) that could be targeted to improve outcome.