The Frequency of Folate Deficiency in Multiple Myeloma Patients

Background: At the time of being diagnosed with multiple myeloma, more than half of patients will be anemic; therefore, anemia is considered to be an important disease characteristic for multiple myeloma. Folate deficiency is one possible cause of anemia in multiple myeloma patients. The frequency of folate deficiency in multiple myeloma patients is largely unknown.

Objective: The objective of this study is to describe the frequency of serum folate deficiency in patients with multiple myeloma.

Methods: A retrospective chart review study was conducted in Einstein Medical Center, Philadelphia between the dates of 01/01/2004 and 09/25/2014. Of the 216 patients that were reviewed, 175 patients fulfilled the criteria for a diagnosis for multiple myeloma: 1) monoclonal plasma cell in the bone marrow >/= 10% 2) monoclonal protein present in the serum and/or urine 3) at least one of the following: serum calcium > 10.5 mg/l, Creatinine > 2 mg/100 ml, hemoglobin< 10g/100ml, or lytic bone lesions. The relationship between serum folate level and age at diagnosis, gender, race, disease staging defined by International staging system (ISS), percent of bone marrow infiltration, immunoglobulin (Ig) subtypes, number of death and loss to follow up, complete blood count parameters, and other metabolic parameters (glomerular filtration rate, calcium, albumin and beta-2 microglobulin) were analyzed using Chi-Square test or t-tests as appropriate.

Results: Information on folate status was available for 78 consecutive multiple myeloma patients. Of them, 67 patients (85.9%) had a normal serum folate level, and 11 patients (14.1%) had laboratory-defined folate deficiency (serum folate level < 3.5 ng/mL). The mean hemoglobin level in the patients who had low folate level was 9.39 g/dL compared with 10.08 in the patients who had normal folate level (P=0.580). There were no statistical differences between the normal and the folate deficiency group in terms of laboratory parameters, baseline characteristics, staging, treatment modalities, and overall survival. However, the patients who had low folate levels were younger than the patients who had normal folate levels (61.55 years versus 69.88 years, P = 0.028).

Conclusion: Folate deficiency is considered to be a contributing cause of anemia in multiple myeloma patients. The findings from our study may emphasize the need for serum folate measurement and folate replacement therapy in multiple myeloma patients.