BMC cancer · 2026
Validation and prognostic utility of the mSMART 4.0 risk stratification system in Chinese patients with multiple myeloma.
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Yin Jian, Liu Rui, Zhang Yanping, Liu Zeshi, Gong Yangyang, He Aili
Аннотация
OBJECTIVE: The 2024 Mayo Clinic mSMART 4.0 risk stratification system features significant revisions, yet its utility in Chinese multiple myeloma (MM) patients remains unvalidated. This study evaluates its prognostic performance in a Chinese cohort.
METHODS: We retrospectively collected clinical data from newly diagnosed MM (NDMM) patients and followed them up. Clinical characteristics, therapeutic responses, and survival were compared between high-risk and standard-risk groups defined by mSMART 4.0. Harrell's concordance index (C-index) analysis was used to compare the predictive efficacy of mSMART 4.0 versus version 3.0.
RESULTS: Among 202 patients, 69 (34.2%) were high-risk according to mSMART 4.0. The mSMART 4.0 high-risk group demonstrated significantly lower deep response rates, alongside shorter median PFS (P < 0.001) and OS (P < 0.001). The proportion of the high-risk group was lower under mSMART 4.0 (34.2%) compared to mSMART 3.0 (51.9%). C-index revealed that mSMART 4.0 possessed superior prognostic predictive validity (C-index = 0.738, 95% CI: 0.677-0.792) relative to mSMART 3.0 (C-index = 0.572, 95% CI: 0.490-0.649). The increase in the C-index was statistically significant (ΔC-index = 0.167, 95% CI: 0.065-0.269, P = 0.003). Multivariate analysis identified mSMART 4.0 high-risk status as an independent adverse prognostic factor for both PFS (HR = 2.027; 95% CI: 1.364-3.012) and OS (HR = 5.352; 95% CI: 2.794-10.250). Additionally, elevated lactate dehydrogenase (LDH) was an independent predictor of poor PFS (HR = 1.002; 95% CI: 1.001-1.004).
CONCLUSION: In this Chinese cohort, mSMART 4.0 effectively stratifies multiple myeloma patients and serves as an independent predictor of inferior prognosis, demonstrating superior prognostic value over version 3.0.
METHODS: We retrospectively collected clinical data from newly diagnosed MM (NDMM) patients and followed them up. Clinical characteristics, therapeutic responses, and survival were compared between high-risk and standard-risk groups defined by mSMART 4.0. Harrell's concordance index (C-index) analysis was used to compare the predictive efficacy of mSMART 4.0 versus version 3.0.
RESULTS: Among 202 patients, 69 (34.2%) were high-risk according to mSMART 4.0. The mSMART 4.0 high-risk group demonstrated significantly lower deep response rates, alongside shorter median PFS (P < 0.001) and OS (P < 0.001). The proportion of the high-risk group was lower under mSMART 4.0 (34.2%) compared to mSMART 3.0 (51.9%). C-index revealed that mSMART 4.0 possessed superior prognostic predictive validity (C-index = 0.738, 95% CI: 0.677-0.792) relative to mSMART 3.0 (C-index = 0.572, 95% CI: 0.490-0.649). The increase in the C-index was statistically significant (ΔC-index = 0.167, 95% CI: 0.065-0.269, P = 0.003). Multivariate analysis identified mSMART 4.0 high-risk status as an independent adverse prognostic factor for both PFS (HR = 2.027; 95% CI: 1.364-3.012) and OS (HR = 5.352; 95% CI: 2.794-10.250). Additionally, elevated lactate dehydrogenase (LDH) was an independent predictor of poor PFS (HR = 1.002; 95% CI: 1.001-1.004).
CONCLUSION: In this Chinese cohort, mSMART 4.0 effectively stratifies multiple myeloma patients and serves as an independent predictor of inferior prognosis, demonstrating superior prognostic value over version 3.0.