Seoul St. Mary's Hospital Presents New Indicator for Predicting Survival in Refractory Multiple Myeloma

Survival Varies by Up to 3.6 Times Depending on Comorbidities
Validated with Clinical Data from Korea and Japan

The research team at Seoul St. Mary's Hospital has developed a new indicator, the "MM-CI (Multiple Myeloma-Specific Comorbidity Index)," which predicts survival rates by reflecting the comorbidities of multiple myeloma patients. The study results were published in the international journal Blood Cancer Journal.

Professor Sungsoo Park, Department of Hematology, Seoul St. Mary's Hospital (left), and Professor Kazuhito Suzuki, Jikeikai University School of Medicine, Tokyo, Japan. Seoul St. Mary's Hospital

Multiple myeloma is a type of blood cancer characterized by malignant proliferation of plasma cells in the bone marrow, with over 2,000 new cases diagnosed annually in Korea. Approximately 70% of all patients are aged 65 and older, and often have various comorbidities such as heart failure, cerebrovascular disease, and liver disease, making the determination of treatment intensity complex.

Previously, the Charlson Comorbidity Index (CCI) and the International Myeloma Working Group (IMWG) frailty score were the main assessment tools. However, the CCI does not sufficiently reflect the disease characteristics of multiple myeloma, while the IMWG frailty score has a limitation in that it may classify patients as frailer than they actually are due to acute symptoms at the time of diagnosis.

The research team utilized big data from the Health Insurance Review and Assessment Service to develop the MM-CI based on an analysis of 17,273 multiple myeloma patients in Korea from 2007 to 2022. External validation was then conducted using independent cohorts from Korea (1,473 patients) and Japan (314 patients). Professor Kazuhito Suzuki of Jikei University School of Medicine, Tokyo, Japan, participated as a co-corresponding author.

The MM-CI consists of six variables: sex, age, heart failure, cerebrovascular disease, liver disease, and comorbid malignancies. Based on weighted scores, patients are classified into four groups: low-risk, intermediate-risk I, intermediate-risk II, and high-risk. Analysis showed that the median survival period for the low-risk group was approximately 72.5 months, whereas the high-risk group had a median survival of 20.3 months, a difference of up to 3.6 times. The risk of death in the high-risk group was 2.75 times higher than in the low-risk group, and MM-CI remained an independent prognostic factor even after adjusting for variables. This trend was consistently observed in both the Korean and Japanese validation cohorts.

MM-CI can be calculated using only medical record information, without the need for complex tests, making it immediately applicable in primary care settings. The research team has implemented it as a web application, making it freely available to both medical professionals and patients.

Min Changki, Professor of Hematology at Seoul St. Mary's Hospital, who led the research, stated, "For elderly patients for whom treatment direction cannot be determined solely by cancer staging, the MM-CI will provide objective grounds for deciding treatment intensity and evaluating suitability for transplantation." Professor Sungsoo Park of Seoul St. Mary's Hospital added, "Based on the study results, we have improved the system so that the indicator can be immediately applied to the Hematology Hospital at Seoul St. Mary's Hospital. It will serve as a practical tool to adjust treatment intensity based on more scientific evidence."

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