Blood Cancer Journal (Dec 2021)

Development of a new risk stratification system for patients with newly diagnosed multiple myeloma using R-ISS and 18F-FDG PET/CT

  • Hee Jeong Cho,
  • Sung-Hoon Jung,
  • Jae-Cheol Jo,
  • Yoo Jin Lee,
  • Sang Eun Yoon,
  • Sung-Soo Park,
  • Do Young Kim,
  • Ho-Jin Shin,
  • Yeung-Chul Mun,
  • Jun Ho Yi,
  • Hyo Jung Kim,
  • Da Jung Kim,
  • Ho Sup Lee,
  • Sung Hwa Bae,
  • Chae Moon Hong,
  • Shin Young Jeong,
  • Jung-Joon Min,
  • Sang Kyun Sohn,
  • Chang-Ki Min,
  • Kihyun Kim,
  • Je-Jung Lee,
  • Joon Ho Moon,
  • The Korean Multiple Myeloma Working Party

DOI
https://doi.org/10.1038/s41408-021-00577-2
Journal volume & issue
Vol. 11, no. 12
pp. 1 – 8

Abstract

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Abstract In multiple myeloma (MM), a high number of focal lesions (FL) detected using positron emission tomography/computed tomography (PET/CT) was found to be associated with adverse prognosis. To design a new risk stratification system that combines the Revised International Staging System (R-ISS) with FL, we analyzed the data of 380 patients with newly diagnosed MM (NDMM) who underwent 18F-fluorodeoxyglucose (18F-FDG) PET/CT upon diagnosis. The K-adaptive partitioning algorithm was adopted to define subgroups with homogeneous survival. The combined R-ISS with PET/CT classified NDMM patients into four groups: R-ISS/PET stage I (n = 31; R-ISS I with FL ≤ 3), stage II (n = 156; R-ISS I with FL > 3 and R-ISS II with FL ≤ 3), stage III (n = 162; R-ISS II with FL > 3 and R-ISS III with FL ≤ 3), and stage IV (n = 31; R-ISS III with FL > 3). The 2-year overall survival rates for stages I, II, III, and IV were 96.7%, 89.8%, 74.7%, and 50.3%. The 2-year progression-free survival rates were 84.1%, 64.7%, 40.8%, and 17.1%, respectively. The new R-ISS/PET was successfully validated in an external cohort. This new system had a remarkable prognostic power for estimating the survival outcomes of patients with NDMM. This system helps discriminate patients with a good prognosis from those with a poor prognosis more precisely.