Validation and prognostic utility of the mSMART 4.0 risk stratification system in Chinese patients with multiple myeloma
- 1Department of Laboratory, The Second Affiliated Hospital of Xi’an Jiaotong University
- 2Department of Hematology, The Second Affiliated Hospital of Xi’an Jiaotong University
Abstract
Objective The 2024 Mayo Clinic mSMART 4.0 risk stratification system features significant revisions, yet its utility in Chinese multiple myeloma (MM) patients remains unvalidated. This study evaluates its prognostic performance in a Chinese cohort. Methods We retrospectively collected clinical data from newly diagnosed MM (NDMM) patients and followed them up. Clinical characteristics, therapeutic responses, and survival were compared between high-risk and standard-risk groups defined by mSMART 4.0. Harrell’s concordance index (C-index) analysis was used to compare the predictive efficacy of mSMART 4.0 versus version 3.0. Results Among 202 patients, 69 (34.2%) were high-risk according to mSMART 4.0. The mSMART 4.0 high-risk group demonstrated significantly lower deep response rates, alongside shorter median PFS (P < 0.001) and OS (P < 0.001). The proportion of the high-risk group was lower under mSMART 4.0 (34.2%) compared to mSMART 3.0 (51.9%). C-index revealed that mSMART 4.0 possessed superior prognostic predictive validity (C-index = 0.738, 95% CI: 0.677–0.792) relative to mSMART 3.0 (C-index = 0.572, 95% CI: 0.490–0.649). The increase in the C-index was statistically significant (ΔC-index = 0.167, 95% CI: 0.065–0.269, P = 0.003). Multivariate analysis identified mSMART 4.0 high-risk status as an independent adverse prognostic factor for both PFS (HR = 2.027; 95% CI: 1.364–3.012) and OS (HR = 5.352; 95% CI: 2.794–10.250). Additionally, elevated lactate dehydrogenase (LDH) was an independent predictor of poor PFS (HR = 1.002; 95% CI: 1.001–1.004). Conclusion In this Chinese cohort, mSMART 4.0 effectively stratifies multiple myeloma patients and serves as an independent predictor of inferior prognosis, demonstrating superior prognostic value over version 3.0.
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BibTeX
@article{yin2026validation,
title = {{Validation and prognostic utility of the mSMART 4.0 risk stratification system in Chinese patients with multiple myeloma}},
author = {Jian Yin and Rui Liu and Yanping Zhang and Zeshi Liu and Yangyang Gong and Aili He},
journal = {BMC Cancer},
year = {2026},
month = jul,
doi = {10.1186/s12885-026-16521-1},
url = {https://doi.org/10.1186/s12885-026-16521-1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Validation and prognostic utility of the mSMART 4.0 risk stratification system in Chinese patients with multiple myeloma
AU - Jian Yin
AU - Rui Liu
AU - Yanping Zhang
AU - Zeshi Liu
AU - Yangyang Gong
AU - Aili He
PY - 2026
DA - 2026/07/01
JO - BMC Cancer
DO - 10.1186/s12885-026-16521-1
UR - https://doi.org/10.1186/s12885-026-16521-1
AB - Objective The 2024 Mayo Clinic mSMART 4.0 risk stratification system features significant revisions, yet its utility in Chinese multiple myeloma (MM) patients remains unvalidated. This study evaluates its prognostic performance in a Chinese cohort. Methods We retrospectively collected clinical data from newly diagnosed MM (NDMM) patients and followed them up. Clinical characteristics, therapeutic responses, and survival were compared between high-risk and standard-risk groups defined by mSMART 4.0. Harrell’s concordance index (C-index) analysis was used to compare the predictive efficacy of mSMART 4.0 versus version 3.0. Results Among 202 patients, 69 (34.2%) were high-risk according to mSMART 4.0. The mSMART 4.0 high-risk group demonstrated significantly lower deep response rates, alongside shorter median PFS (P < 0.001) and OS (P < 0.001). The proportion of the high-risk group was lower under mSMART 4.0 (34.2%) compared to mSMART 3.0 (51.9%). C-index revealed that mSMART 4.0 possessed superior prognostic predictive validity (C-index = 0.738, 95% CI: 0.677–0.792) relative to mSMART 3.0 (C-index = 0.572, 95% CI: 0.490–0.649). The increase in the C-index was statistically significant (ΔC-index = 0.167, 95% CI: 0.065–0.269, P = 0.003). Multivariate analysis identified mSMART 4.0 high-risk status as an independent adverse prognostic factor for both PFS (HR = 2.027; 95% CI: 1.364–3.012) and OS (HR = 5.352; 95% CI: 2.794–10.250). Additionally, elevated lactate dehydrogenase (LDH) was an independent predictor of poor PFS (HR = 1.002; 95% CI: 1.001–1.004). Conclusion In this Chinese cohort, mSMART 4.0 effectively stratifies multiple myeloma patients and serves as an independent predictor of inferior prognosis, demonstrating superior prognostic value over version 3.0.
SN - 1471-2407
ER -