Risk Stratification Before and During Treatment in Newly Diagnosed Multiple Myeloma: From Clinical Trials to the Real-World Setting

Abstract

Multiple Myeloma (MM) is a hematologic malignancy characterized by a wide clinical and biological heterogeneity leading to different patient outcomes. Various prognostic tools to stratify newly diagnosed (ND)MM patients into different risk groups have been proposed. At baseline, the standard-of-care prognostic score is the Revised International Staging System (R-ISS), which stratifies patients according to widely available serum markers (i.e., albumin, β 2-microglobulin, lactate dehydrogenase) and high-risk cytogenetic abnormalities detected by fluorescence in situ hybridization. Though this score clearly identifies a low-risk and a high-risk population, the majority of patients are categorized as at “intermediate risk”. Although new prognostic factors identified through molecular assays (e.g., gene expression profiling, next-generation sequencing) are now available and may improve risk stratification, the majority of them need specialized centers and bioinformatic expertise that may preclude their broad application in the real-world setting. In the last years, new tools to monitor response and measurable residual disease (MRD) with very high sensitivity after the start of treatment have been developed. MRD analyses both inside and outside the bone marrow have a strong prognostic impact, and the achievement of MRD negativity may counterbalance the high-risk behavior identified at baseline. All these techniques have been developed in clinical trials. However, their efficient application in real-world clinical practice and their potential role to guide treatment-decision making are still open issues. This mini review will cover currently known prognostic factors identified before and during first-line treatment, with a particular focus on their potential applications in real-world clinical practice.

Low Barthel index score is a poor prognostic factor for newly diagnosed multiple myeloma patients

“…Compared with GA score, Facon model had more signi cant prognostic evaluation advantages, and its method of dividing MM patients into two groups was more convenient for clinical practice than that of dividing MM patients into three groups. This model was also used to assess the general condition of MM patients to develop appropriate treatment [20][21][22][23].…”

Calculated Whole Blood Viscosity and Albumin/Fibrinogen Ratio in Patients with a New Diagnosis of Multiple Myeloma: Relationships with Some Prognostic Predictors

“…Actually, the reduction in albumin levels is due to the fact that interleukin-6 (IL-6), but above all the altered cytokine network present in MM, reduces the hepatic synthesis of albumin, approximately equal to 200 mg per kilogram of body weight per day [ 34 , 35 , 36 ]. Even if in most recent nomograms related to the prognostic stratification of these patients’ cytokines are not taken into account [ 37 , 38 ], other authors have included the cytokines in prognostic nomograms, in particular, for newly diagnosed MM patients [ 39 ].…”

Multiple Myeloma in 2023 Ways: From Trials to Real Life

“…Both systems stratify patients into 3 stages with different survival. Lastly, R2-ISS replaces t(14;16) with the amplification of 1q21 and stratifies patients as low risk/low-intermediate risk/intermediate-high risk/high risk, with different OS and PFS [30]. Other factors that predict un unfavorable prognosis are the presence of CTPCs and extramedullary disease [30].…”