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Identification of patients with smouldering multiple myeloma at ultra‐high risk of progression using serum parameters: the Czech Myeloma Group model
Author(s) -
Hájek Roman,
Sandecka Viera,
Špička Ivan,
Raab Marc,
Goldschmidt Hartmut,
Beck Susanne,
Minařík Jiří,
Pavlíček Petr,
Radocha Jakub,
Heindorfer Adriana,
Jelínek Tomáš,
Stejskal Lukáš,
Brožová Lucie,
Ševčíková Sabina,
Straub Jan,
Pika Tomáš,
Pour Luděk,
Maisnar Vladimír,
Seckinger Anja,
Hose Dirk
Publication year - 2020
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.16572
Subject(s) - medicine , multiple myeloma , hazard ratio , confidence interval , proportional hazards model , gastroenterology , univariate analysis , multivariate analysis
Summary Smouldering multiple myeloma (SMM) presents without MM defining symptoms. We aimed to identify patients with SMM with an 80% risk of progression within 2 years using only serum parameters. In total, 527 patients with SMM were included and divided into a training group (287 patients from the Czech Myeloma Group [CMG]) and an independent validation group (240 patients from Heidelberg). The median follow‐up was 2·4 and 2·5 years, respectively. Progression to MM occurred in 51·9% of the CMG and 38·8% of the Heidelberg patients, respectively. The median risk of progression was 11·0% (CMG) and 9·7% (Heidelberg) per year, during the 5 years after diagnosis. A serum involved/uninvolved free light‐chain ratio of >30, immunoparesis, and serum monoclonal (M) protein of ≥2·3 g/dl emerged as powerful predictors of 2‐year progression rate with a hazard ratio (HR) of 2·49 (95% confidence interval [CI] 1·49–4·17), HR of 2·01 (95% CI 1·36–2·96) and HR of 2·00 (95% CI 1·44–2·79) ( P < 0·001) in univariate Cox regression analysis, respectively. Based on this, the CMG model identified patients with SMM with a 2‐year risk of progression of 78·7% (95% CI 53·1–95·7; HR 6·8; P < 0·001, CMG) and 81·3% (95% CI 47·1–98·8; HR 38·63; P < 0·001, Heidelberg). Serum parameters in the CMG model allow identification of patients with SMM with an 80% risk of progression to symptomatic MM within 2 years.