Tian M R, Yang P Y, Yue T T, Li M Y, Zhang Y J, Zhang M X, Zhang L M, Yan Y R, Hu Z L, Du Y Z, Li Y Y, Jin F Y
Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China.
Zhonghua Xue Ye Xue Za Zhi. 2021 Aug 14;42(8):666-672. doi: 10.3760/cma.j.issn.0253-2727.2021.08.009.
To investigate risk factors for early mortality (EM) in patients with newly diagnosed multiple myeloma (NDMM) and to build an EM-predictive model. In a cohort of 275 patients with NDMM, risk factors for EM at 6, 12, and 24 months after diagnosis (EM6, EM12, and EM24, respectively) were determined to establish a model to predict EM. The rates of EM6, EM12, and EM24 were 5.5% , 12.7% , and 30.2% , respectively. The most common cause for EM was disease progression/relapse, accounting for 60.0% , 77.1% , and 84.3% of EM6, EM12, and EM24, respectively. EM6 was associated with corrected serum calcium >2.75 mmol/L and platelet count <100×10(9)/L, whereas risk factors for EM12 included age >75 years, ISS Ⅲ, R-ISS Ⅲ, corrected serum calcium >2.75 mmol/L, serum creatinine >177 µmol/L, platelet count <100×10(9)/L, and bone marrow plasma cell ratio ≥ 60% . In addition to the risk factors for EM12, EM24 was also associated with male sex and 1q21 gain. By multivariate analysis, age >75 years, platelet count <100×10(9)/L, and 1q21 gain were independent risk factors for EM24 but there were no independent risk factors significantly associated with EM6 and EM12. Using a scoring system including these three risk factors, a Cox model for EM24 was generated to distinguish patients with low (score<3) and high (score ≥ 3) risk. The sensitivity and specificity of the model were 20.7% and 99.2% , respectively. Further, an internal validation performed in a cohort of 183 patients with NDMM revealed that the probability of EM24 in high-risk patients was 26 times higher than that in low-risk patients. Moreover, this model was also able to predict overall survival. The median overall survival of patients with scores of 0, 1, 2, 3, 4, and 5 were 59, 41, 22, 17.5, and 16 months, respectively. In the study cohort, the EM6, EM12, and EM24 rates were 5.5% , 12.7% , and 30.2% , respectively, and disease progression or relapse were main causes of EM. An EM24-predictive model built on three independent risk factors for EM24 (age>75 years, platelet count<100×10(9)/L, and 1q21 gain) might predict EM risk and overall survival.
探讨新诊断的多发性骨髓瘤（NDMM）患者早期死亡（EM）的危险因素，并建立EM预测模型。在一组275例NDMM患者中，确定诊断后6个月、12个月和24个月时EM的危险因素（分别为EM6、EM12和EM24），以建立预测EM的模型。EM6、EM12和EM24的发生率分别为5.5%、12.7%和30.2%。EM最常见的原因是疾病进展/复发，分别占EM6、EM12和EM24的60.0%、77.1%和84.3%。EM6与校正血清钙>2.75 mmol/L和血小板计数<100×10⁹/L相关，而EM12的危险因素包括年龄>75岁、国际分期系统（ISS）Ⅲ期、修订的国际分期系统（R-ISS）Ⅲ期、校正血清钙>2.75 mmol/L、血清肌酐>177 µmol/L、血小板计数<100×10⁹/L以及骨髓浆细胞比例≥60%。除了EM12的危险因素外，EM24还与男性性别和1q21扩增相关。多因素分析显示，年龄>75岁、血小板计数<100×10⁹/L和1q21扩增是EM24的独立危险因素，但与EM6和EM12无显著相关的独立危险因素。使用包含这三个危险因素的评分系统，生成了EM24的Cox模型，以区分低风险（评分<3）和高风险（评分≥3）患者。该模型的敏感性和特异性分别为20.7%和99.2%。此外，在另一组183例NDMM患者中进行的内部验证显示，高风险患者发生EM24的概率比低风险患者高26倍。此外，该模型还能够预测总生存期。评分分别为0、1、2、3、4和5的患者的中位总生存期分别为59个月、41个月、22个月、17.5个月和16个月。在研究队列中，EM6、EM12和EM24的发生率分别为5.5%、12.7%和30.2%，疾病进展或复发是EM的主要原因。基于EM24的三个独立危险因素（年龄>75岁、血小板计数<100×10⁹/L和1q21扩增）建立的EM24预测模型可能预测EM风险和总生存期。
