Journal Article Ahead of print
PubMed: 42635069 DOI: 10.1002/ajh.70479
Myeloma Elderly Prognostic Score (MEPS): A Proposed Prognostic Score Integrating Age, Renal Function, Performance Status, and Ultra-High-Risk Cytogenetics.
Am J Hematol
Authors: Eirini Katodritou, Bruna Velosa Ferreira, Efstathios Kastritis, Dimitra Dalampira, Emmanouil Spanoudakis, Joana Vieira, Sosana Delimpasi, Ioannis Ntanasis-Stathopoulos, Aikaterini Daiou, Helena Martins, Elpiniki Rentzeperi, Foteini Theodorakakou, Elisabeth Karadrakonti, Graca Luiza O P Neto Vasconcelos Esteves, Vasiliki Tara, Vasiliki Douka, Dionysios Stoumpos, Xanthippi Dimitriadou, Catarina Isabel Batista Geraldes Santos, Vasiliki Palaska, Maria Tsirogianni, Maria Kotsopoulou, Rui Bergantim, Maria Gavriatopoulou, Adriana Roque, Konstantinos Kostikas, Meletios A Dimopoulos, Cristina João, Evangelos Terpos
Affiliations
- Hematology-Oncology, Theagenio Cancer Hospital, Thessaloniki, Greece.
- Hemato-Oncology Department, Champalimaud Foundation, Lisbon, Portugal, Lisbon, Portugal.
- School of Medicine, Athens, Clinical Therapeutics, National and Kapodistrian University, Athens, Greece.
- Alexandroupolis, Hematology, Democritus University, Alexandroupolis, Greece.
- Unidade Local de Saúde de Santa Maria (ULS Santa Maria), Lisbon, Portugal.
- Faculdade de Medicina de Lisboa, Lisbon, Portugal.
- Hematology and Bone Marrow Transplantation Unit, Evangelismos General Hospital, Athens, Greece.
- Department of Hematology and Bone Marrow Transplantation Unit, "G. Papanikolaou" General Hospital, Thessaloniki, Greece.
- Hematology, Metaxa Cancer Hospital, Athens, Greece.
- Clinical Hematology Service, Unidade Local de Saúde de Coimbra (ULS Coimbra), Coimbra, Portugal.
- Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal.
- Hematology, Agios Savvas Cancer Hospital, Athens, Greece.
- Unidade Local de Saúde São João, Porto, Portugal.
- Institute for Research and Innovation in Health, Porto, Portugal.
- Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.
- HIPA (Health Information Platform Services), Thessaloniki, Greece.
- NOVA Medical School, Nova University, Lisbon, Portugal.
Abstract
Established disease-centered prognostic systems may be less tailored to elderly/non-transplant-eligible (NTE) patients with multiple myeloma (MM), in whom host-related factors such as age, performance status, and renal function strongly influence all-cause outcomes. We developed and evaluated the Myeloma Elderly Prognostic Score (MEPS), a pragmatic four-factor score integrating age ≥ 75 years, renal function < 40 by eGFR or available creatinine clearance (CrCl), ECOG performance status ≥ 2, and ultra-high-risk cytogenetics, using baseline registry data from 881 newly diagnosed NTE MM patients from Greece, with OS analyses performed in the 878 patients with evaluable survival follow-up, and externally evaluated it in an independent Portuguese cohort. In the Greek OS-evaluable cohort, 485 deaths were observed. Median OS by MEPS group was 96, 65, 39, and 15.3 months for scores 0, 1, 2, and ≥ 3, respectively. In a baseline score-level Cox model, each ordinal MEPS category increase was associated with inferior OS (HR 1.74, 95% CI 1.58-1.92; p < 0.001). MEPS showed higher OS discrimination than R2-ISS in the Greek cohort (C-index 0.655 vs. 0.602; bootstrap delta 0.053, 95% CI 0.021-0.085). The Portuguese validation dataset included 300 patients, of whom 290 were evaluable for the primary OS analysis, with 151 deaths. Median OS was 59.6 months (95% CI 52.4-75.7), and MEPS again showed higher discrimination than R2-ISS (C-index 0.729 vs. 0.647; bootstrap delta 0.082, 95% CI 0.041-0.127). MEPS provides a simple all-cause prognostic tool for elderly/NTE MM, complementing biologically oriented staging with routinely available host-related variables.
MeSH
Hematology, Aged, Multiple Myeloma, Cytogenetics, Prognosis