Abstract
To establish a nomogram for predicting the overall survival (OS) of patients with newly diagnosed multiple myeloma (MM), 304 patients with newly diagnosed MM were recruited between June 1, 2010, and June 30, 2015, from the Beijing Chaoyang Hospital, Capital Medical University, and randomly divided into training (n=214) and validation (n=90) cohorts. The Kaplan-Meier method and the Cox proportional hazards regression model were used to evaluate the prognostic effects of multiple clinical and laboratory parameters on survival. Significant prognostic factors were combined to build a nomogram. The discriminative ability and predictive accuracy of the nomogram were evaluated using the index of concordance (C-index) and calibration curves and compared with the five staging systems currently used for MM. Multivariate analysis of the training cohort revealed that the age at diagnosis, clonal bone marrow plasma cells, serum lactate dehydrogenase, serum β2-microglobulin, and del (17p) were independent risk factors for OS and were used to establish the nomogram. The C-index value of the nomogram for predicting OS was 0.749, which was significantly higher than the C-indices of the five most common staging systems currently used for MM. In the validation cohort, the C-index for nomogram-based predictions was 0.711 for OS, and the nomogram discrimination was better than the above mentioned five staging systems (P<0.001). All calibration curves revealed good consistency between predicted and actual survivals. The proposed nomogram is more accurate in predicting the prognoses of patients with newly diagnosed MM.
Highlights
Multiple myeloma (MM) is a clonal plasma cell disease, with the hallmark features of accumulation and proliferation of malignant plasma cells in the bone marrow (BM)
The following information was obtained for each patient: age at diagnosis, sex, clonal BM plasma cells, hemoglobin, serum albumin, serum lactate dehydrogenase (LDH), serum creatinine, serum calcium, serum β2-microglobulin, interphase fluorescence in situ hybridization (iFISH) analysis of 1q21 gain, del (17p), t (4;14), t (11;14), t (14;16), and survival information
A total of 304 patients with newly diagnosed MM were identified for this study
Summary
Multiple myeloma (MM) is a clonal plasma cell disease, with the hallmark features of accumulation and proliferation of malignant plasma cells in the bone marrow (BM). The spectrum of symptoms arises from both the tumor load in the BM and the excessive production of immunoglobulins. Typical symptoms of MM include hypercalcemia, renal insufficiency, anemia, and bone lesions [1] and are known by the moniker “CRAB” [2]. The occurrence of MM is multistep and multistage, and the gradual accumulation of genetic abnormalities leads to aggressive tumor growth; the clinical prognosis of MM is highly heterogeneous [3]. The patients with high-risk MM are treated by proteasome inhibitors, immunomodulator drug-based chemotherapy, combined with autologous stem cell transplantation (ASCT) per the high-risk MM model, but patients with relapsed or refractory MM may still experience rapid progress. For patients with low-risk MM, the use of a new unified drug combination treatment allows these patients to obtain certain survival advantages, but has resulted in significant treatmentrelated adverse reactions.
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