Abstract: Objective  To investigate the prognostic value of baseline red cell distribution width (RDW) level  in patients with multiple myeloma (MM) at the first visit.  Methods  A total of 279 MM patients were included and divided into high RDW group (>15.5%,  n=146) and normal RDW group (≤15.5%,  n=133). RDW levels were detected on the latest day within 1 week before the frontline treatment,  within 1 week after patients had good treatment response confirmed,  and within 1 week after disease progression confirmed. Clinical data such as treatment response and survival data were collected,  and the prognostic value of RDW was evaluated with Cox proportional hazards models.Results  There were significant changes of RDW levels between the time points of diagnosis and good treatment response (P=0.0491),  and the time points of obtaining good treatment response and disease progression  (P=0.0314),  when estimated the series of samples of the same individual patient. It was indicated that RDW might act as a biomarker for disease progression surveillance. The median overall survival (OS) times of high RDW and normal RDW groups were 22 months and 46 months,  respectively (P<0.01). And the median progression free survival (PFS) times of high RDW and normal RDW groups were 12 months and 30 months,  respectively (P<0.01). Multivariate analysis showed that RDW level was an independent risk factor for OS (P=0.0010,  HR=2.248,  95%CI: 1.3683.694) and PFS (P=0.0000,  HR=2.797,  95%CI: 1.8424.248). Conclusion  The elevated RDW level at the first visit predicted adverse clinical outcomes in MM patients.

Key words: multiple myeloma, red cell distribution width, overall survival, progressionfree survival, prognosis