Determination of prognosis and retrospective using R-ISS (revised international staging system for myeloma), R-MCI (revised myeloma comorbidity index), HCT-CI (hematopoietic cell transplantation - specific comorbidity index) in patients diagnosed with multi̇ple myeloma

Title: DETERMINATION OF PROGNOSIS AND RETROSPECTIVE USING R-ISS (Revised International Staging System for Myeloma), R-MCI (Revised Myeloma Comorbidity Index), HCT-CI (Hematopoietic Cell Transplantation - Specific Comorbidity Index) IN PATIENTS DIAGNOSED WITH MULTİPLE MYELOMA Aim and Objective: Survival of patients with multiple myeloma (MM) is significantly affected due to their comorbidities. In this study, we aimed to evaluate the role of comorbidity scores [ISS (International Staging System for Myeloma), R-ISS (Revised-International Staging System for Myeloma), R-MCI (Revised-Myeloma Comorbidity Index), HCT-CI (Hematopoietic Cell Transplantation-Specific Comorbidity Index)] of patients with MM in determining prognosis retrospectively. Methods: This study was conducted between 01.01.2004 and 10.06.2020 in the form of retrospective archive scanning using the file records of patients diagnosed with MM in Aydın Adnan Menderes University Faculty of Medicine Hospital Department of Hematology, as a single center, multidisciplinary and analytical case control. Demographic findings (age, gender, place of residence, occupation, gender, smoking and alcohol, etc.), diagnostic information (date of diagnosis, age at the time of diagnosis, comorbidities, follow-up time and cytogenetics, etc.) and information about MM treatment were recorded. Survival and follow-up results of all MM patients were evaluated using ISS, R-ISS, R-MCI, HCT-CI and CCI scores. Results: A total of 310 patients, 166 (53.5 %) male and 144 (46.5 %) female, with an average age of 65.1 ± 10.54 (30/88) years were included in our study. The median follow-up period of the patients was found to be 65.04 ± 4.49 months. It was found that 1% of the patients had t (11; 14) and t (4; 14) translocation and 0.6 % had 1q amplification. It was determined that 66.8% of the patients had standard genetic abnormalities and 15.5 % had poor prognostic genetic abnormalities. The most common comorbidities in patients are; hypertension (54.8 %), diabetes mellitus (DM) (23.9 %), respiratory system related diseases (19 %) and gastrointestinal system diseases (5.5 %). In the comorbidity index assessment performed at the time of diagnosis, the mean R-ISS value was 2.09 ± 0.59, the mean R-MCI value was 4.47 ± 1.83, the mean CCI value was 3.91 ± 2.21, and the mean HCT-CI value was 2.83 ± 2.44. It was found that 5.2 % of the patients had del13q mutation and 4.5 % had del17p mutation. It was determined that the survival status was better in the low risk group compared to the CCI, R-MCI and HCT-CI scores (p <0.001, p <0.05 and p <0.05, respectively). There was no significant difference in survival between ISS stages (p> 0.05). There was no significant difference in survival between R-ISS stages (p> 0.05). Conclusion: A significant relationship was found between R-MCI, HTC-CI and CCI moderate and / or high risk status and overall worsening of survival in patients with a diagnosis of MM. This finding could not be demonstrated by R-ISS scores. We think that R-ISS and R-MCI scores can be used as a good criterion in patients with MM, with the development of genetic tests and the more frequent use of KPS and pulmonary disease status in routine clinical practice. Keywords: CCI, HCT-CI, ISS, comorbidity, Multipl Myeloma, R-ISS, R-MCI