Therefore, it is desirable to have a staging system that includes the variations in the clinical characteristics of the patients pertaining to distinct ethnic groups. Though ethnicity is an important prognostic factor in predicting the risk for MM ( 12), the variations in the clinical characteristics among the different ethnic groups have not been evaluated adequately.
Similarly, HRCA, which is used to determine the intensity of frontline therapy, does not track with survival outcomes in African Americans ( 10), thereby highlighting the need for a race-specific risk-stratification system. However, this was significant only for White Americans and not for African Americans even at lower cutoffs of deficiency ( 11). In a recent study, vitamin D deficiency at diagnosis was found to be a predictor of poor overall survival in MM ( 11). Recent studies have observed a significant variation in the overall survival of different groups belonging to distinct races/ethnicities since the introduction of novel treatment agents in MM ( 7– 10). It is evident from the studies that African Americans experience two to three times higher incidence rates than Asians, Mexican-Americans, or Europeans ( 6).
Currently, triplet combination therapy is the new standard of care in MM which has shifted many high-risk patients to standard-risk category, thereby justifying the need for a new risk-stratification system with the possibility of inclusion of more prognostic factors.Īlthough human physiological and genetic profile is known to vary across ethnic groups, the current MM risk-staging systems do not account for ethnicity-specific information that can have a huge impact on the risk score prediction. The ISS utilizes serum albumin and beta2-microglobulin, while the R-ISS makes use of ISS, lactate dehydrogenase (LDH), and high-risk cytogenetic aberrations (HRCA). The first staging system for MM was proposed in 1975 ( 1) followed by the development of the International Staging System (ISS) ( 2) in 2005 and a Revised ISS (R-ISS) ( 3) in 2015. These risk groups further assist in identifying high-risk patients who may require intense therapy upfront and/or a higher monitoring frequency during the follow-up periods. Multiple prognostic systems ( 1– 5) have been described in MM that stratify patients into different risk groups. Substantial advances in tumor biology have made it possible to dissect the tumor heterogeneity present in MM, optimize patient treatment, and examine patient outcome. The variability in the outcome of patients is an implication of the clinical and biological heterogeneity underlying multiple myeloma (MM). Multiple myeloma is a hematopoietic malignancy of plasma cells with an overall survival period ranging from 6 months to more than 10 years.