Risk stratification models based on cytogenetics and disease burden help identify high-risk patients with newly diagnosed multiple myeloma (NDMM). However, some high-risk patients remain undetected. This study evaluated the prognostic utility of the proportion of clonal plasma cells in the S-phase of the cell cycle for NDMM. Patients with active multiple myeloma diagnosed between 01/01/2013 and 01/31/2023 who underwent S-phase assessment were included. The S-phase proportion was calculated by analyzing DNA content between G0/G1 and G2/M peaks. Among 823 patients, 16% (135) had S-phase ≥2% at diagnosis. Patients with S-phase ≥2% exhibited significantly worse median progression-free survival (PFS) of 1.4 years (95% CI: 1.2–1.9) compared to 2.9 years (95% CI: 2.6–3.3) for those with S-phase <2% (HR 1.6, p < 0.0001). Median overall survival (OS) was also significantly lower at 3.9 years (95% CI: 2.9–5.7) versus 9.2 years (95% CI: 7.9–not reached; HR 2.2, p < 0.0001). Multivariate analysis confirmed S-phase ≥2% as an independent predictor of inferior PFS (HR 1.56, p = 0.001) and OS (HR 2, p < 0.0001) after adjusting for R2-ISS risk, age, renal function, and treatment strategies. Among patients with S-phase ≥2%, 53% (68/129) experienced progression-free survival (PFS) under 18 months with upfront therapy. Elevated S-phase was associated with a 2.5-fold higher risk of progression within 18 months [OR 2.55 (95% CI: 1.7–3.7), p < 0.001]. Patients with elevated S-phase but no IMS-high risk had a median OS of 5.7 years (95% CI: 4.7–9.2), similar to the IMS-high risk cohort without elevated S-phase (5.4 years, 95% CI: 4–NR). Those with both elevated S-phase and IMS-high risk had significantly worse OS (3.1 years, 95% CI: 1.6–NR, p = 0.043). These findings suggest that S-phase ≥2% is a powerful, independent prognostic marker for NDMM.
基于细胞遗传学和疾病负荷的风险分层模型有助于识别新诊断多发性骨髓瘤（NDMM）的高危患者。然而，部分高危患者仍未被发现。本研究评估了细胞周期S期克隆性浆细胞比例对NDMM的预后价值。研究纳入了2013年1月1日至2023年1月31日期间确诊活动性多发性骨髓瘤并接受S期评估的患者。通过分析G0/G1期与G2/M期峰之间的DNA含量计算S期比例。在823例患者中，16%（135例）在诊断时S期比例≥2%。S期≥2%的患者中位无进展生存期（PFS）显著较差，为1.4年（95% CI：1.2–1.9），而S期<2%的患者为2.9年（95% CI：2.6–3.3）（HR 1.6，p<0.0001）。中位总生存期（OS）亦显著更低，分别为3.9年（95% CI：2.9–5.7）和9.2年（95% CI：7.9–未达到；HR 2.2，p<0.0001）。多变量分析在调整R2-ISS风险、年龄、肾功能和治疗策略后，确认S期≥2%是不良PFS（HR 1.56，p=0.001）和OS（HR 2，p<0.0001）的独立预测因子。在S期≥2%的患者中，53%（68/129）接受一线治疗后PFS不足18个月。S期升高与18个月内进展风险增加2.5倍相关[OR 2.55（95% CI：1.7–3.7），p<0.001]。S期升高但不伴有IMS高风险的患者中位OS为5.7年（95% CI：4.7–9.2），与未伴S期升高的IMS高风险队列相似（5.4年，95% CI：4–未达到）。同时具有S期升高和IMS高风险的患者OS显著更差（3.1年，95% CI：1.6–未达到，p=0.043）。这些发现表明，S期≥2%是NDMM一个强效且独立的预后标志物。
肿瘤(癌症)患者之家