Evaluation of chemotherapeutic effect and prognosis of serum and urine IGFBP7 and TIMP-2 in multiple myeloma with renal injury

Hou Ruihong; Zhu Jiangtao; Xi Zhenfang; Duan Xiaojuan; Liu Fei

doi:10.3969/j.issn.1671-6450.2025.08.013

Abstract：Objective To assess the utility of serum/urinary insulin-like growth factor binding protein 7(IGFBP7)and tissue inhibitor of metalloproteinases-2(TIMP-2)in predicting chemotherapy response and prognosis in myeloma with re-nal injury.Methods A total of 328 patients with multiple myeloma and renal injury admitted to Linfen People's Hospital from June 2018 to June 2023 were enrolled.All patients received chemotherapy with the BTD(bortezomib+thalidomide+dexamethasone)regimen.Serum and urinary levels of IGFBP7 and TIMP-2 were measured before chemotherapy.After chem-otherapy,patients were divided into a remission group and a non-remission group based on efficacy.Follow-up was conducted for 12 months,and patients were divided into a death group and a survival group based on prognosis.Multivariate Cox regres-sion analysis was used to identify factors influencing the prognosis of patients with multiple myeloma and renal injury.Receiv-er operating characteristic(ROC)curve analysis was performed to evaluate the value of serum and urinary IGFBP7 and TIMP-2 in assessing chemotherapy efficacy and predicting prognosis.Results All patients completed 4 cycles of chemotherapy.There were 135 non-remission cases and 193 remission cases.Serum and urinary levels of IGFBP7 and TIMP-2 in the non-re-mission group were significantly higher than those in the remission group(t/P=29.113/＜0.001,21.386/＜0.001,27.663/＜0.001,23.716/＜0.001).During follow-up,5 patients were lost to follow-up,and 35 died.Serum and urinary levels of IGFBP7 and TIMP-2 in the death group were significantly higher than those in the survival group(t/P=14.298/＜0.001、17.110/＜0.001,17.088/＜0.001,22.987/＜0.001).The area under the curve(AUC)of serum IGFBP7,TIMP-2 and urine IGFBP7,TIMP-2 in predicting the efficacy of chemotherapy in patients with multiple myeloma complicated with renal injury was 0.771,0.760,0.811,0.770,respectively.The AUC of combined prediction was 0.885,0.811,which was higher than that of IGFBP7 and TIMP-2 alone(P＜0.05).The AUC of serum IGFBP7,TIMP-2 and urine IGFBP7,TIMP-2 in predicting the prognosis of pa-tients with multiple myeloma complicated with renal injury were 0.679,0.715,0.786,0.794,respectively.The AUC of combined prediction was 0.887,0.895,which was higher than that of IGFBP7 and TIMP-2 alone(P＜0.05).The value of urinary IGFBP7 and TIMP-2 in predicting the efficacy of chemotherapy and poor prognosis in patients with multiple myeloma complicated with renal injury was greater than that of serum IGFBP7 and TIMP-2.Non-remission of chemotherapy,high FLC-κ/λ,high se-rum and urine IGFBP7 and TIMP-2 were risk factors for poor prognosis in patients with multiple myeloma complicated with renal injury[HR(95％CI)=2.803(1.503-5.229),1.384(1.103-1.737),1.668(1.036-2.687),1.511(1005-2.272),2.164(1.207-3.891),1.868(1.086-3.215)].Conclusion Urinary IGFBP7/TIMP-2 are superior to serum markers for monitoring therapeutic efficacy and survival in myeloma-associated kidney injury.