Abstract
In multiple myeloma (MM), a high number of focal lesions (FL) detected using positron emission tomography/computed tomography (PET/CT) was found to be associated with adverse prognosis. To design a new risk stratification system that combines the Revised International Staging System (R-ISS) with FL, we analyzed the data of 380 patients with newly diagnosed MM (NDMM) who underwent 18F-fluorodeoxyglucose (18F-FDG) PET/CT upon diagnosis. The K-adaptive partitioning algorithm was adopted to define subgroups with homogeneous survival. The combined R-ISS with PET/CT classified NDMM patients into four groups: R-ISS/PET stage I (n = 31; R-ISS I with FL ≤ 3), stage II (n = 156; R-ISS I with FL > 3 and R-ISS II with FL ≤ 3), stage III (n = 162; R-ISS II with FL > 3 and R-ISS III with FL ≤ 3), and stage IV (n = 31; R-ISS III with FL > 3). The 2-year overall survival rates for stages I, II, III, and IV were 96.7%, 89.8%, 74.7%, and 50.3%. The 2-year progression-free survival rates were 84.1%, 64.7%, 40.8%, and 17.1%, respectively. The new R-ISS/PET was successfully validated in an external cohort. This new system had a remarkable prognostic power for estimating the survival outcomes of patients with NDMM. This system helps discriminate patients with a good prognosis from those with a poor prognosis more precisely.
Highlights
Multiple myeloma (MM) is a hematologic malignancy in which a single clone of plasma cell infiltrates the bone marrow (BM) and end-organs, thereby provoking morbidity and mortality [1]
We report that the new risk stratification system could effectively stratify patients according to their survival outcomes
The new risk stratification model Revised International Staging System (R-ISS)/PET can categorize newly diagnosed MM (NDMM) patients into four risk groups and can clearly stratify these patients according to survival differences
Summary
Multiple myeloma (MM) is a hematologic malignancy in which a single clone of plasma cell infiltrates the bone marrow (BM) and end-organs, thereby provoking morbidity and mortality [1]. A better understanding of MM biology and pathogenesis, in the aspects of BM tumor microenvironment and genetic alteration, has enabled the development of novel agents such as proteasome inhibitors (PI) and immunomodulatory drugs (IMiD) [2]. These agents have provided patients with increased response and prolonged survival rates [3, 4]. Despite the therapeutic efficacy of the novel agents, the natural course of MM remains highly variable. Some patients experience refractory or rapid progression after adequate management, whereas others may live for more than ten years without disease progression. Establishing parameters for predicting survival heterogeneity is necessary for guiding treatment decision-making
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