在国际骨髓瘤工作组 (IMWG) 生物标志物（SLiM 标准）推出十年后，这项现实世界的研究检验了它们对骨髓瘤诊断、治疗和结果的影响。使用 ANZ MRDR，对 2013 年至 2023 年新诊断的 3489 例患者进行了分析，其中 3232 例通过 CRAB 诊断（“CRAB 患者”，其中 1758 例也满足 ≥1 SLiM 标准），257 例通过 SLiM（“SLiM 患者”）标准诊断。 CRAB 患者具有较高的 R-ISS 和较低的体能状态，但细胞遗传学风险没有差异。 SLiM 患者的无进展生存期（PFS，37.5 个月与 32.2 个月，风险比 [HR] 1.31 [1.08-1.59]，p= 0.003）、总生存期（80.9 个月与 73.2 个月，HR 1.64 [1.26-2.13]）得到改善与 CRAB 患者相比，p<0.001）和 PFS2（54.6 个月与 40.3 个月，HR 1.51 [1.22-1.86]，p<0.001），部分原因是早期诊断，浆细胞和轻链标准之间没有差异影响关于 PFS。然而，34% 的 CRAB 患者没有表现出 SLiM 特征，这增加了 SLiM 特征与不同生物学行为相关的可能性，有助于更好的预后，例如，SLiM 患者的 PFS2 改善表明首次复发时的疾病抵抗力较低。这些数据支持更早开始 SLiM 治疗。 SLiM 患者优于 CRAB 患者的生存结果凸显了在解释诱导和首次复发时的治疗结果时定义这些亚组的重要性。© 2024 作者。英国血液学杂志由英国血液学会和约翰·威利出版

A decade after International Myeloma Working Group (IMWG) biomarkers (SLiM criteria) were introduced, this real-world study examined their impact on diagnosis, therapy and outcomes in myeloma. Using the ANZ MRDR, 3489 newly diagnosed patients from 2013 to 2023, comprising 3232 diagnosed by CRAB ('CRAB patients', including 1758 who also satisfied ≥1 SLiM criteria) and 257 by SLiM ('SLiM patients') criteria were analysed. CRAB patients had higher R-ISS and lower performance status, with no difference in cytogenetic risk. SLiM patients had improved progression-free survival (PFS, 37.5 vs. 32.2 months, hazard ratio [HR] 1.31 [1.08-1.59], p = 0.003), overall survival (80.9 vs. 73.2 months, HR 1.64 [1.26-2.13], p < 0.001) and PFS2 (54.6 vs. 40.3 months, HR 1.51 [1.22-1.86], p < 0.001) compared with CRAB patients, partially explained by earlier diagnosis, with no differential impact between the plasma cell and light-chain criteria on PFS. However, 34% of CRAB patients did not manifest SLiM characteristics, raising the possibility that SLiM features are associated with different biological behaviours contributing to a better prognosis, for example, improved PFS2 in SLiM patients suggested less disease resistance at first relapse. These data support earlier initiation of therapy by SLiM. The superior survival outcomes of SLiM versus CRAB patients highlight the importance of defining these subgroups when interpreting therapeutic outcomes at induction and first relapse.© 2024 The Author(s). British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.