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Validation and prognostic utility of the mSMART 4.0 risk stratification system in Chinese patients with multiple
Jian Yin1, Rui Liu2, Yanping Zhang1
1Department of Laboratory, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
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.
