Liang Qi, Zhang Limei, Huang Qianqian, Lv Weiran, Liang Zhijian, Liu Shutong, Nie Runcong, Xia Zhongjun, Liang Yang, Wang Yun
Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.
Department of Hematology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China.
Pharmaceuticals (Basel). 2025 Jun 12;18(6):878. doi: 10.3390/ph18060878.
Oxidative stress contributes to the initiation and progression of multiple myeloma and can be reflected by various biochemical indicators. However, whether systemic oxidative stress level can serve as a simple and effective alternative for prognostic risk stratification in newly diagnosed multiple myeloma (NDMM) patients remains to be explored and validated in large clinical cohorts. A retrospective analysis was conducted on 1107 NDMM patients, 774 patients were randomly assigned to the training cohort and 333 to the validation cohort. They were divided into two groups based on the oxidative stress score (OSS), calculated by the weights of systemic oxidative stress indicators. The relationship between systemic oxidative stress levels of multiple myeloma and prognosis were analyzed both in the training and validation cohorts. Constructed by three oxidative stress-related indicators, OSS was associated with significantly shorter overall and progression-free survival in the high OSS group compared to the low OSS group. The 5-year AUC value of the time-dependent ROC for OSS was comparable to that of RISS, and significantly higher than that of the DS staging system. Moreover, patients with high OSS did not benefit significantly from standard combination therapy with IMiDs and PIs over monotherapy in terms of prognosis when compared to the low OSS group (all < 0.05). OSS was observed to be an independent prognostic factor for overall survival and progression-free survival in patients with NDMM, suggesting systemic oxidative stress could serve as a new approach for accurate prognostic prediction and guiding treatment in multiple myeloma.
氧化应激促进多发性骨髓瘤的发生和发展，并可通过多种生化指标反映出来。然而，全身氧化应激水平能否作为新诊断的多发性骨髓瘤（NDMM）患者预后风险分层的一种简单有效的替代指标，仍有待在大型临床队列中进行探索和验证。对1107例NDMM患者进行了回顾性分析，将774例患者随机分配到训练队列，333例患者分配到验证队列。根据全身氧化应激指标的权重计算氧化应激评分（OSS），将患者分为两组。在训练队列和验证队列中分析了多发性骨髓瘤全身氧化应激水平与预后的关系。由三个与氧化应激相关的指标构建而成，与低OSS组相比，高OSS组的OSS与总生存期和无进展生存期显著缩短相关。OSS的时间依赖性ROC的5年AUC值与RISS相当，且显著高于DS分期系统。此外，与低OSS组相比，高OSS组患者在接受免疫调节药物（IMiDs）和蛋白酶体抑制剂（PIs）标准联合治疗时，在预后方面并不比单药治疗有显著获益（均P<0.05）。观察到OSS是NDMM患者总生存期和无进展生存期的独立预后因素，提示全身氧化应激可作为多发性骨髓瘤准确预后预测和指导治疗的新方法。
