A research team at Seoul St. Mary’s Hospital has developed a new comorbidity-based index to predict survival in patients with multiple myeloma, offering a practical tool to help clinicians tailor treatment intensity for older and medically complex patients.
Professors Park Sung-soo, Choi Sue-in, and Kazuhito Suzuki developed a new tool to predict survival in multiple myeloma patients by reflecting comorbidities. (Credit: Seoul St. Mary’s Hospital)
The team said it developed the Multiple Myeloma-specific Comorbidity Index (MM-CI) using large-scale Korean health insurance data and validated the model with independent real-world clinical cohorts from Korea and Japan. The findings were published in Blood Cancer Journal/
The study was conducted by Professors Park Sung-soo of the Division of Hematology at Seoul St. Mary’s Hospital and Choi Sue-in of the Department of Pharmacology at the Catholic University of Korea College of Medicine, with Kazuhito Suzuki of Tokyo Jikei University School of Medicine in Japan joining the validation using Japanese clinical data.
Multiple myeloma is a blood cancer caused by the malignant proliferation of plasma cells in the bone marrow. About 70 percent of patients develop the disease at age 65 or older, and many have underlying conditions such as heart failure, cerebrovascular disease, liver disease, diabetes or kidney disease. These comorbidities can affect survival and treatment tolerability, making precise assessment important when determining treatment intensity.
Until now, clinicians have commonly used tools such as the Charlson Comorbidity Index, or CCI, and the International Myeloma Working Group frailty score to assess patient risk. However, the Seoul St. Mary’s team said these tools have limitations in multiple myeloma. CCI does not fully reflect disease-specific characteristics, while the IMWG frailty score relies partly on activities of daily living, which may classify patients as frailer than they actually are if they have acute symptoms at diagnosis.
To develop MM-CI, the researchers analyzed Health Insurance Review and Assessment Service data from 17,273 Korean patients with multiple myeloma diagnosed between 2007 and 2022. The model was then externally validated using an independent Korean cohort of 1,473 patients and a Japanese cohort of 314 patients.
Professors Park Sung-soo (left) of Seoul St. Mary’s Hospital and Kazuhito Suzuki of Tokyo Jikei University School of Medicine. (Credit: Seoul St. Mary’s Hospital)
In the Korean dataset, the median age was 63, and men accounted for 53.7 percent of patients. The most common comorbidities were kidney disease at 22.4 percent, diabetes at 17.1 percent and cerebrovascular disease at 7.9 percent. In the Japanese validation cohort, the median age was 71, and men accounted for 51 percent. The most common comorbidities were peripheral vascular disease at 40.4 percent, diabetes at 18.8 percent, malignancy at 14.6 percent and heart failure at 10.2 percent, showing differences in comorbidity patterns between the two countries.
Through statistical analysis, the team finalized six variables for the MM-CI model -- sex, age, heart failure, cerebrovascular disease, liver disease and coexisting malignancy. Based on weighted scores, patients were classified into four risk groups: low risk, intermediate risk I, intermediate risk II and high risk.
The difference in survival between risk groups was substantial. The median overall survival was about 72.5 months, or roughly six years, in the low-risk group, compared with 20.3 months, or about one year and seven months, in the high-risk group. The same pattern was consistently observed in the Korean and Japanese validation cohorts.
The researchers also found that MM-CI showed statistically significant predictive accuracy compared with existing assessment models. Patients in the high-risk group had a 2.75-fold higher risk of death than those in the low-risk group, and the index remained an independent prognostic factor even after adjustment for other variables.
The team said the findings highlight the need to incorporate comorbidities into treatment planning for multiple myeloma, particularly as the disease is common among older adults. In Korea, more than 2,000 people are newly diagnosed with multiple myeloma each year, and the incidence continues to rise with population aging. The disease can cause serious complications, including bone fractures, anemia and kidney failure. Although survival has improved with the introduction of new therapies, multiple myeloma remains difficult to treat because relapse and drug resistance are common.
The hospital said MM-CI could be used easily in clinical practice because it can be calculated using medical record information without complex additional testing. A higher score may indicate the need for more active supportive care, prevention of complications and careful discussion with specialists before deciding treatment intensity.
The researchers have also released MM-CI as a free R Shiny-based web application so that clinicians and patients can use the tool more easily.
Park said the hospital has already improved its internal system so the model can be used immediately at Seoul St. Mary’s Hospital’s Catholic Hematology Hospital.
“Based on the published results, we have improved the system so the model can be used immediately at the Catholic Hematology Hospital,” Park said. “It will become a practical tool for adjusting treatment intensity under a more scientific basis.”
Lee Han-soo
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