Guo Wancheng, Strouse Christopher, Mery David, Siegel Eric R, Munshi Manit N, Ashby Timothy Cody, Cheng Yan, Sun Fumou, Wanchai Visanu, Zhang Zijun, Bailey Clyde, Alapat Daisy V, Peng Hongling, Al Hadidi Samer, Thanendrarajan Sharmilan, Schinke Carolina, Zangari Maurizio, van Rhee Frits, Tricot Guido, Shaughnessy John D, Zhan Fenghuang
Myeloma Center, Department of Internal Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot# 508, Little Rock, AR 72205, USA.
Department of Haematology, Second Xiangya Hospital, Central South University, Changsha 410011, China.
Cancers (Basel). 2024 Mar 11;16(6):1116. doi: 10.3390/cancers16061116.
Autologous stem cell transplantation (ASCT) has been a mainstay in myeloma treatment for over three decades, but patient prognosis post-ASCT varies significantly. In a retrospective study of 5259 patients with multiple myeloma (MM) at the University of Arkansas for Medical Sciences undergoing ASCT with a median 57-month follow-up, we divided the dataset into training (70%) and validation (30%) subsets. Employing univariable and multivariable Cox analyses, we systematically assessed 29 clinical variables, identifying crucial adverse prognostic factors, such as extended duration between MM diagnosis and ASCT, elevated serum ferritin, and reduced transferrin levels. These factors could enhance existing prognostic models. Additionally, we pinpointed significant poor prognosis markers like high serum calcium and low platelet counts, though they are applicable to a smaller patient population. Utilizing seven easily accessible high-risk variables, we devised a four-stage system (ATM4S) with primary stage borders determined through K-adaptive partitioning. This staging system underwent validation in both the training dataset and an independent cohort of 514 ASCT-treated MM patients from the University of Iowa. We also explored cytogenetic risk factors within this staging system, emphasizing its potential clinical utility for refining prognostic assessments and guiding personalized treatment approaches.
自体干细胞移植（ASCT）三十多年来一直是骨髓瘤治疗的主要手段，但ASCT后的患者预后差异很大。在阿肯色大学医学科学分校对5259例接受ASCT的多发性骨髓瘤（MM）患者进行的一项回顾性研究中，中位随访时间为57个月，我们将数据集分为训练集（70%）和验证集（30%）。采用单变量和多变量Cox分析，我们系统评估了29个临床变量，确定了关键的不良预后因素，如MM诊断与ASCT之间的时间延长、血清铁蛋白升高和转铁蛋白水平降低。这些因素可以改进现有的预后模型。此外，我们还确定了血清钙升高和血小板计数低等显著的不良预后标志物，尽管它们适用于较小的患者群体。利用七个易于获取的高风险变量，我们设计了一个四阶段系统（ATM4S），其主要阶段边界通过K自适应划分确定。该分期系统在训练数据集和来自爱荷华大学的514例接受ASCT治疗的MM患者的独立队列中均得到了验证。我们还在该分期系统中探讨了细胞遗传学危险因素，强调了其在完善预后评估和指导个性化治疗方法方面的潜在临床应用价值。
