{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T05:03:40Z","timestamp":1785301420215,"version":"3.55.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Second Revision of the International Staging System (R2-ISS) is an prognostic model established in newly diagnosed multiple myeloma (NDMM) patients as a marker of disease-related biological risk. Still, the course of disease is influenced by patient-related factors as well. The International Myeloma Working Group (IMWG) frailty score provides a standardized assessment of patient fitness and may complement biological risk stratification. The aim of study was to analyze prognostic significance of R2-ISS scoring system and IMWG frailty status in NDMM patients (pts) within RWE settings of the routine clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Analyzed group included 371 NDMM patients (pts, 184 males\/187 females, median age 62.9 years, range 36-88) diagnosed between 2018 and 2025. Patients were stratified at the time of diagnosis according to the ISS, R-ISS, R2-ISS, and the original IMWG frailty score. Treatment response and follow-up were assessed according to the IMWG response criteria and EHA-EMN recommendations. Differences in progression-free survival (PFS) and overall survival (OS) were assessed using the Kaplan-Meier method and log-rank test. Independent OS predictors were identified using the Cox proportional hazards regression model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Treatment response (\u2265PR) was achieved in 275 of 340 evaluable patients (80.9%). Increasing R2-ISS stage was associated with a lower probability of achieving treatment response (p=0.027), while frailty independently correlated with inferior response rates (p&amp;lt;0.001). Both PFS (p &amp;lt; 0.001) and OS (p &amp;lt; 0.001) was significantly shorter in patients with higher R2-ISS stages. In accordance to the IMWG frailty score, fit patients had significantly durable PFS (p&amp;lt;0.001) and the OS (p &amp;lt;0.001). Importantly, the composite classification integrating R2-ISS and IMWG frailty score provided additional discrimination of OS (p&amp;lt;0.001). Multivariate model for OS pointed out most significant impact of frailty status (p&amp;lt;0.001), followed by treatment response categories (p&amp;lt;0.001), and R2-ISS (p=0.009).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>R2-ISS and IMWG frailty score provide complementary prognostic information in NDMM. Their combined assessment improves risk stratification beyond disease-related factors alone and may facilitate more individualized treatment planning in the routine clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1869023","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:46:31Z","timestamp":1785300391000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Multiple myeloma in the real-world practice: clinical and prognostic indeces \u2013 single center experience"],"prefix":"10.3389","volume":"16","author":[{"given":"Natalija","family":"Kecman","sequence":"first","affiliation":[{"name":"Clinic of Hematology, University Clinical Center of Serbia","place":["Belgrade, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Sretenovic","sequence":"additional","affiliation":[{"name":"Clinic of Hematology, University Clinical Center of Serbia","place":["Belgrade, Serbia"]},{"name":"Medical Faculty, University of Belgrade","place":["Belgrade, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marko","family":"Mitrovic","sequence":"additional","affiliation":[{"name":"Clinic of Hematology, University Clinical Center of Serbia","place":["Belgrade, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoran","family":"Bukumiric","sequence":"additional","affiliation":[{"name":"Institute of Statistics and Bioinformatics, Medical Faculty, University of Belgrade","place":["Belgrade, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Tanovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic of Hematology, University Clinical Center of Serbia","place":["Belgrade, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikola","family":"Vukosavljevic","sequence":"additional","affiliation":[{"name":"Department for Hemato-oncology, University Clinical Hospital Center \u201cZvezdara\u201d","place":["Belgrade, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelica","family":"Jovanovic","sequence":"additional","affiliation":[{"name":"Clinic of Hematology, University Clinical Center of Serbia","place":["Belgrade, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marija","family":"Dencic Fekete","sequence":"additional","affiliation":[{"name":"Laboratory for Molecular Pathology, Institute for Pathology, Medical Faculty, University of Belgrade","place":["Belgrade, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelena","family":"Bila","sequence":"additional","affiliation":[{"name":"Clinic of Hematology, University Clinical Center of Serbia","place":["Belgrade, Serbia"]},{"name":"Medical Faculty, University of Belgrade","place":["Belgrade, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.04.242","article-title":"International staging system for multiple myeloma","volume":"23","author":"Greipp","year":"2005","journal-title":"J Clin Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.61.2267","article-title":"Revised international staging system for multiple myeloma: A report from international myeloma working group","volume":"33","author":"Palumbo","year":"2015","journal-title":"J Clin Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.02614","article-title":"Second revision of the International Staging System (R2-ISS) for overall survival in multiple myeloma: A European Myeloma Network (EMN) report within the HARMONY 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