At present, MM is still an incurable disease, but with the successive application of proteasome inhibitors, immunomodulators, monoclonal antibody drugs and autologous hematopoietic stem cell transplantation, the prognosis of MM patients has been significantly improved. In China, due to various reasons, few patients are willing to carry out autologous hematopoietic stem cell transplantation, and most patients only choose drug treatment. there is a need to choose an appropriate prognosis score to select appropriate induction, maintenance and consolidation programs. In recent years, with the continuous development of molecular detection technology, the corresponding second-generation sequencing and gene expression techniques have been gradually applied to predict the prognosis of MM. EMC-92, Inid-14, Mayo SMART staging and other gene-based prognostic indicators have been put forward [5-6]. In addition, some scholars have put forward the point of view of double hit and triple hit according to the high-risk genetic factors. [7-8] But for most developing countries, it is not mature to improve such expensive and complex laboratory conditions, hindering further cytogenetic analysis of prognostic stratification. Therefore, the relatively simple staging system without molecular genetic parameters has also become a research hotspot, such as MRP based on tumor load and host factors and IPSI based on inflammatory factors proposed in 2019 all avoid molecular genetic parameters and show good prognostic value in newly diagnosed MM patients treated with protease inhibitors. This provides a new direction for us to evaluate the prognosis of this kind of patients.
The MRP combines the four factors of WHO ECOG, age, ISS stage and CRP, including both tumor factors and host factors, while the IPSI creatively evaluates the prognosis of MM patients from the perspective of inflammation, combined with RDW, NLR and PLT, and selects patients with different prognostic grades. At present, there are few real-world studies related to MRP and IPSI. In addition to the data from the British Myeloma Research Alliance, Redder et al counted 1377 multiple myeloma patients over the age of 65 who were not eligible for transplantation in Denmark, and concluded that the MRP high-risk group had a higher early mortality rate than the low-risk group, and the MRP high-risk group had shorter duration of treatment and poorer treatment response. Unfortunately, there is no other research data on IPSI at present. In this study, because the patients included in IPSI were patients based on bortezomib treatment, initially only patients who had been treated with bortezomib were studied, and both of them can show that there are statistical differences in OS and PFS stratification of non-transplant patients based on bortezomib treatment.The sample was then further extended to all patients (including patients who were treated only with thalidomide at an early stage), and similar conclusions could be obtained.
In this study, through the MRP and IPSI analysis of the same group of data, both of them can show that there are statistical differences in OS and PFS stratification of non-transplant patients based on bortezomib treatment, but by comparison, there are still some similarities and differences between them.
Among the subgroups of MRP, IPSI did not show prognostic significance in patients with low and moderate risk of MRP, but in the high-risk subgroup of MRP, the OS and PFS of patients with high-risk IPSI were shorter; Similarly, MRP in the high-risk subgroup of IPSI can further stratify the prognosis of patients. Considering that MRP and IPSI evaluate patients from different angles, it can be considered that patients with both MRP high-risk factors and IPSI high-risk factors have worse prognosis and shorter survival time than general high-risk patients, and belong to ultra-high-risk patients. For such ultra-high-risk patients, if autologous hematopoietic stem cell transplantation can be performed after evaluation, it is recommended that transplantation be carried out as soon as possible to improve the prognosis; if the patient is really unable to perform transplantation or has no intention to transplant, it may be necessary to add immunotargeted therapy with monoclonal antibodies such as daratumumab, and new immunomodulators may even enter clinical trials to further benefit. Of course, this needs to be assessed by further evidence-based research on this type of patients in the future.
In the actual process of clinical diagnosis and treatment, the factors affecting the prognosis of MM are complex. In recent years, a variety of new prognostic scoring systems about MM are constantly emerging, most of which require a variety of genetic testing. The MRP and IPSI scoring system avoids the relevant genetic indicators, and can also confirm its evaluation effect in the relevant clinical verification, indicating the value of application in the current medical conditions, especially through comparative analysis, it shows that the two systems have combined and complementary effects in some patients, which is helpful to further stratify the discrimination of this kind of patients and provide early warning for the next step of treatment. Of course, with the continuous development of scientific and technological conditions, the corresponding molecular biotechnology can be widely carried out in clinical practice. It is believed that it can provide patients with more accurate and applicable prognosis and treatment strategies in the future.