A concise revised Myeloma Comorbidity Index as a valid prognostic instrument in a large cohort of 801 multiple myeloma patients
A concise revised Myeloma Comorbidity Index as a valid prognostic instrument in a large cohort of 801 multiple myeloma patients
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DOI：
10.3324/haematol.2016.162693
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发表时间：
2017-05-01
期刊：
影响因子：
10.1
通讯作者：
Waesch, Ralph
中科院分区：
文献类型：
--
作者：
Engelhardt, Monika;Domm, Anne-Saskia;Waesch, Ralph
随着越来越多的老年多发性骨髓瘤患者，需要可靠的工具来评估他们的脆弱性。本文分析的目的是开发和验证易于使用的骨髓瘤风险评分（修订的骨髓瘤合并症指数），该评分允许在大型患者队列中对总生存期和无进展生存期差异进行风险预测。我们对801例连续骨髓瘤患者进行了全面的合并症、虚弱和残疾评估，包括诊断时获得的合并症风险。在训练和验证集内检查队列。多变量分析确定肾、肺和Karnofsky功能状态损害、虚弱和年龄是总生存率的显著风险。将这些组合在加权的修订的骨髓瘤合并症指数中，允许识别拟合（修订的骨髓瘤合并症指数6 [n=108，13.5%]）：通过验证分析确认的这些亚组显示中位总生存率分别为10.1、4.4和1.2年。将修订后的骨髓瘤合并症指数与其他常用的合并症指数（Charlson合并症指数、造血细胞移植特异性合并症指数、Kaplan-Feinstein指数）进行比较：如果根据25%和75%的四分位数将每种指数分为风险组，则使用修订后的骨髓瘤合并症指数可获得最高风险比、最佳预测和Brier评分。修订后的骨髓瘤合并症指数的优点包括其准确评估患者的身体状况和简单的临床适用性。我们建议在多中心分析和未来的临床试验中使用“参考”国际骨髓瘤工作组虚弱评分对修订后的骨髓瘤合并症指数进行测试。该研究已在德国临床试验注册中心注册（DRKS-00003868）。
With growing numbers of elderly multiple myeloma patients, reliable tools to assess their vulnerability are required. The objective of the analysis herein was to develop and validate an easy to use myeloma risk score (revised Myeloma Comorbidity Index) that allows for risk prediction of overall survival and progression-free survival differences in a large patient cohort. We conducted a comprehensive comorbidity, frailty and disability evaluation in 801 consecutive myeloma patients, including comorbidity risks obtained at diagnosis. The cohort was examined within a training and validation set. Multivariate analysis determined renal, lung and Karnofsky Performance Status impairment, frailty and age as significant risks for overall survival. These were combined in a weighted revised Myeloma Comorbidity Index, allowing for the identification of fit (revised Myeloma Comorbidity Index 6 [n=108, 13.5%]): these subgroups, confirmed via validation analysis, showed median overall survival rates of 10.1, 4.4 and 1.2 years, respectively. The revised Myeloma Comorbidity Index was compared to other commonly used comorbidity indices (Charlson Comorbidity Index, Hematopoietic Cell Transplantation-Specific Comorbidity Index, Kaplan-Feinstein Index): if each were divided in risk groups based on 25% and 75% quartiles, highest hazard ratios, best prediction and Brier scores were achieved with the revised Myeloma Comorbidity Index. The advantages of the revised Myeloma Comorbidity Index include its accurate assessment of patients' physical conditions and simple clinical applicability. We propose the revised Myeloma Comorbidity Index to be tested with the "reference" International Myeloma Working Group frailty score in multi-center analyses and future clinical trials. The study was registered at the German Clinical Trials Register (DRKS-00003868).