Онкогематология (Oct 2020)
Prognostic value of the modified multiple myeloma comorbidity index in real clinical practice
Abstract
Background. An increase in the number of patients with multiple myeloma (MM) necessitates the creation of reliable tools for assessing their somatic status (comorbidity) in order to personalize the optimal treatment regimen that helps to minimize its toxicity, improves survival and patients quality of life.The objective of this study was to modify the MM comorbidity index (MCI) by adding an additional variable reflecting the biological properties of the tumor, and to determine the informativeness of the new scale – a modified MM comorbidity index (M-MCI), to predict the outcome and select personalized therapy in patients with MM in real clinical practice.Materials and methods. From January 2012 to December 2017 the study included 369 patients with newly diagnosed MM (134 men and 235 women) who were hospitalized in the hematology department of the City Clinical Hospital No. 2, Novosibirsk. The median age of the patients was 67 (32–82) years. The prognostic value of concomitant diseases and individual prognostic factors in relation to the overall survival of patients with MM was evaluated.Results. Cox multivariate analysis showed that the most significant predictors of reduced overall survival of patients with MM are impaired renal function (glomerular filtration rate <30 ml / min / 1.73 m2 (according to the CKD-EPI formula), general condition according to the Karnowski scale ≤70 %, chronic obstructive pulmonary disease with moderate (50 % ≤ forced expiratory volume in 1 second <80 %) and severe (30 % ≤ forced expiratory volume in 1 second <50 %) severity of bronchial obstruction and the ratio κ / λ free light chains <0.04 or >65. These factors were combined into a weighted 5‑point scale M-MCI. A comparative analysis of survival depending on the value of the M-MCI allowed us to distribute patients with MM into groups of high (M-MCI 3–4 points) and standard (M-MCI 0–2 points) risk with significantly different indicators of overall survival (median overall survival amounted to 15.5 months in the high and 60 months in the standard risk group; χ2 = 58, p <0.016) and confirm the prognostic value of M-MCI in relation to the outcome of MM.Conclusion. In terms of its prognostic significance in predicting an adverse outcome, the proposed M-MCI scale is superior to its prototype – the MCI. The median overall survival in the high-risk group according to the M-MCI was 15.5 months compared to 20 months according to the MCI; the median overall survival in the group the standard risk was 60 and 50 months, respectively (χ2 = 58 (M-MCI) versus χ2 = 42 (MCI); p <0.001). The advantages of M-MCI are also its more accurate assessment of the physical condition of patients with MM and its simple clinical applicability.
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