文章：

国际骨髓瘤工作组（IMWG）冒烟型多发性骨髓瘤（SMM）风险分层模型

International Myeloma Working Group risk stratification model for smoldering multiple myeloma (SMM)

原文发布日期：2020-10-16

DOI: 10.1038/s41408-020-00366-3

类型: Article

开放获取: 是

英文摘要：

Smoldering multiple myeloma (SMM) is an asymptomatic precursor state of multiple myeloma (MM). Recently, MM was redefined to include biomarkers predicting a high risk of progression from SMM, thus necessitating a redefinition of SMM and its risk stratification. We assembled a large cohort of SMM patients meeting the revised IMWG criteria to develop a new risk stratification system. We included 1996 patients, and using stepwise selection and multivariable analysis, we identified three independent factors predicting progression risk at 2 years: serum M-protein >2 g/dL (HR: 2.1), involved to uninvolved free light-chain ratio >20 (HR: 2.7), and marrow plasma cell infiltration >20% (HR: 2.4). This translates into 3 categories with increasing 2-year progression risk: 6% for low risk (38%; no risk factors, HR: 1); 18% for intermediate risk (33%; 1 factor; HR: 3.0), and 44% for high risk (29%; 2–3 factors). Addition of cytogenetic abnormalities (t(4;14), t(14;16), +1q, and/or del13q) allowed separation into 4 groups (low risk with 0, low intermediate risk with 1, intermediate risk with 2, and high risk with ≥3 risk factors) with 6, 23, 46, and 63% risk of progression in 2 years, respectively. The 2/20/20 risk stratification model can be easily implemented to identify high-risk SMM for clinical research and routine practice and will be widely applicable.
 

摘要翻译： 

冒烟型多发性骨髓瘤（SMM）是多发性骨髓瘤（MM）的无症状前驱状态。近期MM的定义更新纳入了可预测SMM高进展风险的生物标志物，因此需要重新界定SMM及其风险分层。我们根据修订后的IMWG标准组建大型SMM患者队列，建立新型风险分层体系。研究纳入1996例患者，通过逐步筛选和多变量分析，确定三个预测2年进展风险的独立因素：血清M蛋白>2g/dL（风险比：2.1）、受累/未受累游离轻链比值>20（风险比：2.7）及骨髓浆细胞浸润度>20%（风险比：2.4）。据此将患者分为三个风险层级，对应2年进展风险逐级递增：低危组（38%病例，无风险因素，风险比：1）为6%；中危组（33%病例，1个因素，风险比：3.0）为18%；高危组（29%病例，2-3个因素）达44%。加入细胞遗传学异常（t(4;14)、t(14;16)、+1q和/或del13q）后可进一步分为四组（低危0个因素、中低危1个因素、中危2个因素、高危≥3个因素），2年进展风险分别为6%、23%、46%和63%。这种2/20/20风险分层模型可便捷应用于临床科研与实践中的高危SMM识别，具有广泛适用性。

原文链接：

International Myeloma Working Group risk stratification model for smoldering multiple myeloma (SMM)