The Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) risk stratification model, developed to predict ≥10% abnormal plasma cells in the bone marrow in monoclonal gammopathy of undetermined significance (MGUS) patients, was developed in a predominantly White and genetically homogeneous Icelandic population, lacking external validation. Our study aimed to externally validate this model in a racially and ethnically diverse Bronx population. The medical records of patients at Montefiore Medical Center (2002–2023) were searched to identify patients with MGUS who had undergone a bone marrow biopsy. For each patient, the iStopMM variables were entered into the iStopMM prediction model, and predicted, and actual plasma cell percentages were recorded. The area under the receiver operating characteristic (AUROC) curve assessed the iStopMM model’s performance in predicting ≥10% plasma cells, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Of the initial 663 patients, 190 were included in the final cohort, of whom 52.6% were African-Americans, and 23.2% identified themselves as Hispanic/Latino, remarkably different from the homogenous population of the iStopMM study. The iStopMM predictive model was able to predict greater than or equal to 10% plasma cells on bone marrow biopsy with an AUROC of 0.78 (CI 0.71, 0.85). When set at a 10% threshold for predicting SMM or worse, the iStopMM model had a 93.3% sensitivity, 33.7% specificity, 55.3% PPV, and 85.0% NPV. This AUROC value of 0.778 suggests a reasonable discriminatory performance of the model in our racially and ethnically diverse Bronx population.
冰岛多发性骨髓瘤筛查、治疗与预防（iStopMM）风险分层模型原为预测意义未明的单克隆丙种球蛋白病（MGUS）患者骨髓中异常浆细胞比例≥10%而开发，该模型基于以白人为主且遗传同质性高的冰岛人群建立，缺乏外部验证。本研究旨在纽约布朗克斯区种族与民族多元化人群中对这一模型进行外部验证。通过检索蒙特菲奥里医疗中心（2002-2023年）的病历资料，我们筛选出接受过骨髓活检的MGUS患者。针对每位患者，将iStopMM变量输入预测模型，记录其预测浆细胞百分比与实际检测值。采用受试者工作特征曲线下面积（AUROC）评估该模型预测≥10%浆细胞的效能，并计算其敏感性、特异性、阳性预测值（PPV）及阴性预测值（NPV）。在初始663例患者中，最终纳入190例形成研究队列，其中52.6%为非裔美国人，23.2%自认为西班牙裔/拉丁裔，与iStopMM研究中的同质人群存在显著差异。iStopMM预测模型对骨髓活检中≥10%浆细胞的预测AUROC为0.78（95% CI 0.71-0.85）。当设定预测冒烟型多发性骨髓瘤或更严重疾病的阈值为10%时，该模型敏感性为93.3%，特异性为33.7%，PPV为55.3%，NPV为85.0%。0.778的AUROC值表明，在我们种族与民族多元化的布朗克斯人群中，该模型具有合理的区分效能。
肿瘤(癌症)患者之家