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In a retrospective study of 5259 patients with multiple myeloma (MM) at the University of Arkansas for Medical Sciences undergoing ASCT with a median 57-month follow-up, we divided the dataset into training (70%) and validation (30%) subsets. Employing univariable and multivariable Cox analyses, we systematically assessed 29 clinical variables, identifying crucial adverse prognostic factors, such as extended duration between MM diagnosis and ASCT, elevated serum ferritin, and reduced transferrin levels. These factors could enhance existing prognostic models. Additionally, we pinpointed significant poor prognosis markers like high serum calcium and low platelet counts, though they are applicable to a smaller patient population. Utilizing seven easily accessible high-risk variables, we devised a four-stage system (ATM4S) with primary stage borders determined through K-adaptive partitioning. This staging system underwent validation in both the training dataset and an independent cohort of 514 ASCT-treated MM patients from the University of Iowa. We also explored cytogenetic risk factors within this staging system, emphasizing its potential clinical utility for refining prognostic assessments and guiding personalized treatment approaches.<\/jats:p>","DOI":"10.3390\/cancers16061116","type":"journal-article","created":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T04:51:12Z","timestamp":1710132672000},"page":"1116","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A Risk Stratification System in Myeloma Patients with Autologous Stem Cell Transplantation"],"prefix":"10.3390","volume":"16","author":[{"given":"Wancheng","family":"Guo","sequence":"first","affiliation":[{"name":"Myeloma Center, Department of Internal Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot# 508, Little Rock, AR 72205, USA"},{"name":"Department of Haematology, Second Xiangya Hospital, Central South University, Changsha 410011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4964-167X","authenticated-orcid":false,"given":"Christopher","family":"Strouse","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Iowa, Iowa City, IA 52242, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8327-9777","authenticated-orcid":false,"given":"David","family":"Mery","sequence":"additional","affiliation":[{"name":"Myeloma Center, Department of Internal Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot# 508, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9824-6612","authenticated-orcid":false,"given":"Eric R.","family":"Siegel","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manit N.","family":"Munshi","sequence":"additional","affiliation":[{"name":"Myeloma Center, Department of Internal Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot# 508, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy Cody","family":"Ashby","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Cheng","sequence":"additional","affiliation":[{"name":"Myeloma Center, Department of Internal Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot# 508, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumou","family":"Sun","sequence":"additional","affiliation":[{"name":"Myeloma Center, Department of Internal Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot# 508, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2243-3838","authenticated-orcid":false,"given":"Visanu","family":"Wanchai","sequence":"additional","affiliation":[{"name":"Myeloma Center, Department of Internal Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot# 508, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zijun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Myeloma Center, Department of Internal Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot# 508, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clyde","family":"Bailey","sequence":"additional","affiliation":[{"name":"Myeloma Center, Department of Internal Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot# 508, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daisy V.","family":"Alapat","sequence":"additional","affiliation":[{"name":"Department of Pathology Clinical, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongling","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Haematology, Second Xiangya Hospital, Central South University, Changsha 410011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4297-8042","authenticated-orcid":false,"given":"Samer","family":"Al Hadidi","sequence":"additional","affiliation":[{"name":"Myeloma Center, Department of Internal Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot# 508, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharmilan","family":"Thanendrarajan","sequence":"additional","affiliation":[{"name":"Myeloma Center, Department of Internal Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot# 508, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2699-1741","authenticated-orcid":false,"given":"Carolina","family":"Schinke","sequence":"additional","affiliation":[{"name":"Myeloma Center, Department of Internal Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot# 508, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurizio","family":"Zangari","sequence":"additional","affiliation":[{"name":"Myeloma Center, Department of Internal Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot# 508, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frits","family":"van Rhee","sequence":"additional","affiliation":[{"name":"Myeloma Center, Department of Internal Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot# 508, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guido","family":"Tricot","sequence":"additional","affiliation":[{"name":"Myeloma Center, Department of Internal Medicine, Winthrop P. 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Markham St. Slot# 508, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1182\/blood.2020005288","article-title":"Daratumumab, lenalidomide, bortezomib, and dexamethasone for transplant-eligible newly diagnosed multiple myeloma: The GRIFFIN trial","volume":"136","author":"Voorhees","year":"2020","journal-title":"Blood"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1038\/s41408-022-00645-1","article-title":"Induction therapy prior to autologous stem cell transplantation (ASCT) in newly diagnosed multiple myeloma: An update","volume":"12","author":"Bazarbachi","year":"2022","journal-title":"Blood Cancer J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1182\/asheducation-2017.1.518","article-title":"Emerging options in multiple myeloma: Targeted, immune, and epigenetic therapies","volume":"2017","author":"Kumar","year":"2017","journal-title":"Hematol. 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