Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group.
Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group.
复制标题
DOI：
10.1200/jco.2015.61.2267
复制
发表时间：
2015-09-10
期刊：
影响因子：
--
通讯作者：
Moreau P
中科院分区：
文献类型：
--
作者：
Palumbo A;Avet-Loiseau H;Oliva S;Lokhorst HM;Goldschmidt H;Rosinol L;Richardson P;Caltagirone S;Lahuerta JJ;Facon T;Bringhen S;Gay F;Attal M;Passera R;Spencer A;Offidani M;Kumar S;Musto P;Lonial S;Petrucci MT;Orlowski RZ;Zamagni E;Morgan G;Dimopoulos MA;Durie BG;Anderson KC;Sonneveld P;San Miguel J;Cavo M;Rajkumar SV;Moreau P
多发性骨髓瘤（MM）的临床结局是异质性的。需要一种简单可靠的工具来对MM患者进行分层。我们将国际分期系统（ISS）与CD 138浆细胞纯化后的间期荧光原位杂交（iFISH）检测的染色体异常（CA）和血清乳酸脱氢酶（LDH）结合起来，以评估其在新诊断的MM（NDMM）中的预后价值。将11项国际试验中4445例NDMM患者的临床和实验室数据汇总在一起。使用K-自适应分割算法来定义具有同质生存的最合适的亚组。3060/4445例患者的ISS、CA和LDH数据同时可用。我们定义了三个组：修订版ISS（R-ISS）I（N=871），包括ISS I（血清β2-微球蛋白<3.5mg/L，血清白蛋白≥3.5g/dL），无高危CA [del（17 p）和/或t（4;14）和/或t（14;16）]，LDH水平正常（低于正常范围上限）; R-ISS III（N=295），包括ISS III（血清β2-微球蛋白>5.5mg/L）和高危CA或高LDH水平; R-ISS II（N=1894），包括所有其他可能的组合。中位随访46个月时，R-ISS I组的5年OS为82%，R-ISS II组为62%，R-ISS III组为40%; 5年PFS分别为55%、36%和24%。R-ISS是一个简单而强大的预后分期系统，我们建议在未来的临床研究中使用它来对NDMM患者进行有效的生存相对风险分层。
The clinical outcome of multiple myeloma (MM) is heterogeneous. A simple and reliable tool is needed to stratify MM patients. We combined the International Staging System (ISS) with chromosomal abnormalities (CA) detected by interphase Fluorescence In Situ Hybridization (iFISH) after CD138 plasma cells purification and serum lactate dehydrogenase (LDH) to evaluate their prognostic value in newly diagnosed MM (NDMM). Clinical and laboratory data from 4445 NDMM patients enrolled in eleven international trials were pooled together. The K-adaptive partitioning algorithm was used to define the most appropriate subgroups with homogeneous survival. ISS, CA, and LDH data were simultaneously available in 3060/4445 patients. We defined three groups: revised ISS (R-ISS) I (N=871), including ISS I (serum β2-microglobulin level <3.5mg/L and serum albumin level ≥3.5g/dL), no high-risk CA [del(17p) and/or t(4;14) and/or t(14;16)] and normal LDH level (below the upper limit of normal range); R-ISS III (N=295), including ISS III (serum β2-microglobulin level >5.5mg/L) and high-risk CA or high LDH level; R-ISS II (N=1894), including all the other possible combinations. At a median follow-up of 46 months, the 5-year OS was 82% in the R-ISS I, 62% in the R-ISS II, and 40% in the R-ISS III groups; the 5-year PFS was 55%, 36% and 24%, respectively. The R-ISS is a simple and powerful prognostic staging system and we recommend its use in future clinical studies to stratify NDMM patients effectively with respect to the relative risk to their survival.