Autologous stem cell transplantation (ASCT) has been a mainstay in myeloma treatment for over three decades, but patient prognosis post-ASCT varies significantly. In a retrospective study of 5259 patients with multiple myeloma (MM) at the University of Arkansas for Medical Sciences undergoing ASCT with a median 57-month follow-up, we divided the dataset into training (70%) and validation (30%) subsets. Employing univariable and multivariable Cox analyses, we systematically assessed 29 clinical variables, identifying crucial adverse prognostic factors, such as extended duration between MM diagnosis and ASCT, elevated serum ferritin, and reduced transferrin levels. These factors could enhance existing prognostic models. Additionally, we pinpointed significant poor prognosis markers like high serum calcium and low platelet counts, though they are applicable to a smaller patient population. Utilizing seven easily accessible high-risk variables, we devised a four-stage system (ATM4S) with primary stage borders determined through K-adaptive partitioning. This staging system underwent validation in both the training dataset and an independent cohort of 514 ASCT-treated MM patients from the University of Iowa. We also explored cytogenetic risk factors within this staging system, emphasizing its potential clinical utility for refining prognostic assessments and guiding personalized treatment approaches.
自体干细胞移植（ASCT）作为多发性骨髓瘤治疗的主要手段已逾三十年，但患者移植后的预后差异显著。在阿肯色大学医学中心对5259例接受ASCT的多发性骨髓瘤患者进行的回顾性研究中（中位随访时间57个月），我们将数据集划分为训练集（70%）和验证集（30%）。通过单变量与多变量Cox回归分析，系统评估了29项临床变量，识别出关键不良预后因素，包括从骨髓瘤确诊至ASCT的间隔时间延长、血清铁蛋白升高以及转铁蛋白水平降低。这些因素可优化现有预后模型。此外，我们发现了如高血钙和低血小板计数等显著不良预后标志物，尽管其适用患者群体规模较小。基于七个易获取的高危变量，我们构建了四阶段分期系统（ATM4S），其主分期界值通过K自适应分割法确定。该分期系统在训练集及爱荷华大学514例接受ASCT治疗的独立患者队列中均得到验证。我们同时在该分期框架内探讨了细胞遗传学风险因素，凸显其优化预后评估、指导个体化治疗策略的临床潜力。
A Risk Stratification System in Myeloma Patients with Autologous Stem Cell Transplantation
肿瘤(癌症)患者之家