{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:08:52Z","timestamp":1788930532022,"version":"build-2803163510"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"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>Patients with multiple myeloma (MM) exhibit elevated thrombotic risk and variable disease outcomes. D-dimer, a fibrin degradation product, may serve as a biomarker reflecting both hypercoagulability and disease severity. This systematic review and meta-analysis compared D-dimer levels between MM patient subgroups defined by either poor prognostic features (e.g., advanced ISS stage) or thrombotic events and reference groups, with detailed discussion of how D-dimer integration reshapes routine thromboprophylaxis strategies and upgrades classic prognostic staging tools (ISS, R-ISS, IMPEDE-VTE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically searched PubMed, Embase, Web of Science, and Cochrane Library from 2010 to 2025 for studies comparing plasma D-dimer levels between high-risk MM patients, defined by advanced ISS stage, occurrence of venous thromboembolism (VTE), or as a predictor of mortality, and reference groups. The primary outcome was the standardized mean difference (SMD) in D-dimer levels. Random-effects meta-analysis was performed using the inverse-variance method. Subgroup analyses examined differences by sample type and assay methodology. Risk of bias was assessed using domains adapted from ROBINS-I.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six studies comprising 697 patients (171 high-risk, 526 reference) met inclusion criteria. High-risk MM patients demonstrated significantly elevated D-dimer levels compared to reference groups (SMD 1.60, 95% CI 0.72\u20132.48, p&amp;lt;0.0001, I\u00b2=88.2%). The effect remained consistent across subgroup analyses by sample type (all plasma: SMD 1.60, 95% CI 0.72\u20132.48) and assay method (immunoturbidimetric: SMD 1.59, 95% CI 0.44\u20132.75; fluorescent immunoassay: SMD 1.64, 95% CI 0.78\u20132.49). Sensitivity analysis confirmed robustness of findings. Funnel plot asymmetry was minimal, although formal tests were not conducted given the limited number of studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MM patients with poor prognostic features or who experience VTE exhibit substantially elevated D-dimer levels compared to lower-risk populations (SMD &amp;gt;1.5). Beyond confirming statistical significance, our results deliver actionable clinical insights: D-dimer supplementation optimizes risk stratification workflows built on ISS\/R-ISS and refines personalized thromboprophylaxis regimens derived from the IMPEDE-VTE scoring model. D-dimer may serve as a useful biomarker for risk stratification in MM, though prospective validation studies are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1899079","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T04:42:52Z","timestamp":1788928972000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Elevated D-dimer levels in high-risk multiple myeloma patients: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Changming","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, Affiliated Hospital of Chengde Medical University","place":["Chengde, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiqun","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Affiliated Hospital of Chengde Medical 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