Abstract
Over the last decade autologous stem cell transplantation (ASCT) has emerged as the standard of care in the management of Multiple Myeloma (MM). However, the cases of early relapse (within 36 months) after the stem cell rescue remains a significant challenge. For a lot of practical purposes, it is crucial to identify whether a patient undergoing ASCT falls into the high-risk group (likely to relapse within 36 months) or a low risk one. Our analysis showed that existing MM staging systems (International Staging System or ISS and Durie Salmon Staging or DSS) are not sufficient to discriminate between the risk groups significantly. To address this, we gathered a total of 39 clinical and laboratory parameters of 347 patients from the Department of Medical Oncology of All India Institute of Medical Sciences (AIIMS). We employed a stacked machine learning model consisting spectral clustering and Fast and Frugal Tree (FFT) technique to come up with a 3-factor multivariate 2-stage staging scheme, which turns out to be extremely decisive about the outcome of the stem cell rescue. Our model comes up with a three-factor (1. if patients has relapsed following remission, 2. response to induction, 3. pre-transplant Glomerular Filtration Rate or GFR) staging scheme. The resulting model stratifies patients into high-risk and low-risk groups with markedly distinct progression-free (median survival—24 months vs. 91 months) and overall survival (median survival—51 months vs. 135 months) patterns.
Highlights
Multiple Myeloma (MM) is a cancer of plasma cells
We obtained a cut-off of 3.5 g/dL for serum albumin level, which we cross-referenced with a previous study that linked serum albumin level ≤3.5 g/dL with higher mortality [38]
A lot of this success is attributable to Autologous Stem Cell Transplantation (ASCT), which, over the past decade, has emerged as the standard of care for patients aged below 65 years [14, 17]
Summary
Multiple Myeloma (MM) is a cancer of plasma cells. Clonal expansion of malignant plasma cells in bone marrow and the presence of monoclonal protein (M-protein) in blood and urine are the disease hallmarks [1, 2]. MM is the second most common of all hematological cancer after non-Hodgkin lymphoma [3]. It is responsible for 15–20% of the deaths attributable to the hematological malignancies and about two percent of all cancer-related deaths [4]. In 2018, estimated new cases of multiple myeloma will be 30,770, and an estimated 12,770 people will die of this disease [7]. A study suggests that the incidence of multiple myeloma in black people is double as compared to white people [8]
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