Staging System to Predict the Risk o Relapse in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation
Staging System to Predict the Risk o Relapse in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation
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DOI：
10.3389/fonc.2019.00633
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发表时间：
2019-07-12
影响因子：
4.7
通讯作者：
Sengupta, Debarka
中科院分区：
文献类型：
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作者：
Goswami, Chitrita;Poonia, Sarita;Sengupta, Debarka
在过去的十年中，自体干细胞移植（ASCT）已成为多发性骨髓瘤（MM）治疗的标准治疗方法。然而，干细胞抢救后早期复发（36个月内）的病例仍然是一个重大挑战。在许多实际用途中，确定接受ASCT的患者属于高危组（可能在36个月内复发）还是低风险组是至关重要的。我们的分析表明，现有的MM分期系统（国际分期系统或ISS和Durie Salmon分期或DSS）不足以显著区分风险组。为了解决这个问题，我们从全印度医学科学研究所（AIIMS）肿瘤内科收集了347名患者的39项临床和实验室参数。我们采用了由光谱聚类和快速节俭树（Fast and Frugal Tree， FFT）技术组成的堆叠机器学习模型，提出了一个三因素多变量两阶段分期方案，该方案对干细胞抢救的结果至关重要。我们的模型提出了一个三因素(1)。如果患者在缓解后复发，2。3.感应响应；移植前肾小球滤过率（GFR）分期方案。由此产生的模型将患者分为高风险和低风险组，其无进展（中位生存期- 24个月对91个月）和总生存期（中位生存期-51个月对135个月）模式明显不同。
Over the last decade autologous stem cell transplantation (ASCT) has emerged as the standard of care in the management of Multiple Myeloma (MM). However, the cases of early relapse (within 36 months) after the stem cell rescue remains a significant challenge. For a lot of practical purposes, it is crucial to identify whether a patient undergoing ASCT falls into the high-risk group (likely to relapse within 36 months) or a low risk one. Our analysis showed that existing MM staging systems (International Staging System or ISS and Durie Salmon Staging or DSS) are not sufficient to discriminate between the risk groups significantly. To address this, we gathered a total of 39 clinical and laboratory parameters of 347 patients from the Department of Medical Oncology of All India Institute of Medical Sciences (AIIMS). We employed a stacked machine learning model consisting spectral clustering and Fast and Frugal Tree (FFT) technique to come up with a 3-factor multivariate 2-stage staging scheme, which turns out to be extremely decisive about the outcome of the stem cell rescue. Our model comes up with a three-factor (1. if patients has relapsed following remission, 2. response to induction, 3. pre-transplant Glomerular Filtration Rate or GFR) staging scheme. The resulting model stratifies patients into high-risk and low-risk groups with markedly distinct progression-free (median survival - 24 months vs. 91 months) and overall survival (median survival -51 months vs. 135 months) patterns.