Novel risk stratification algorithm for estimating the risk of death in patients with relapsed multiple myeloma: external validation in a retrospective chart review

Objectives and designA novel risk stratification algorithm estimating risk of death in patients with relapsed multiple myeloma starting second-line treatment was recently developed using multivariable Cox regression of data from a Czech registry. It uses 16 parameters routinely collected in medical...

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Bibliographic Details
Published in:	BMJ open 2020-07, Vol.10 (7), p.e034209-e034209
Main Authors:	Hájek, Roman, Gonzalez-McQuire, Sebastian, Szabo, Zsolt, Delforge, Michel, DeCosta, Lucy, Raab, Marc S, Bouwmeester, Walter, Campioni, Marco, Briggs, Andrew
Format:	Article
Language:	eng
Subjects:	Algorithms Clinical decision making Clinical medicine Decision making Europe France Germany Humans Medical prognosis Multiple Myeloma Oncology Patients Physicians Retrospective Studies Risk Assessment
Online Access:	Get full text
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Summary:	Objectives and designA novel risk stratification algorithm estimating risk of death in patients with relapsed multiple myeloma starting second-line treatment was recently developed using multivariable Cox regression of data from a Czech registry. It uses 16 parameters routinely collected in medical practice to stratify patients into four distinct risk groups in terms of survival expectation. To provide insight into generalisability of the risk stratification algorithm, the study aimed to validate the risk stratification algorithm using real-world data from specifically designed retrospective chart audits from three European countries.Participants and settingPhysicians collected data from 998 patients (France, 386; Germany, 344; UK, 268) and applied the risk stratification algorithm.MethodsThe performance of the Cox regression model for predicting risk of death was assessed by Nagelkerke’s R2, goodness of fit and the C-index. The risk stratification algorithm’s ability to discriminate overall survival across four risk groups was evaluated using Kaplan-Meier curves and HRs.ResultsConsistent with the Czech registry, the stratification performance of the risk stratification algorithm demonstrated clear differentiation in risk of death between the four groups. As risk groups increased, risk of death doubled. The C-index was 0.715 (95% CI 0.690 to 0.734).ConclusionsValidation of the novel risk stratification algorithm in an independent ‘real-world’ dataset demonstrated that it stratifies patients in four subgroups according to survival expectation.
ISSN:	2044-6055 2044-6055