Myeloma Elderly Prognostic Score ( MEPS ): A Proposed Prognostic Score Integrating Age, Renal Function, Performance Status, and Ultra‐High‐Risk Cytogenetics

Established disease-centered prognostic systems may be less tailored to elderly/non-transplant-eligible (NTE) patients with multiple myeloma (MM), in whom host-related factors such as age, performance status, and renal function strongly influence all-cause outcomes. We developed and evaluated the Myeloma Elderly Prognostic Score (MEPS), a pragmatic four-factor score integrating age ≥ 75 years, renal function < 40 by eGFR or available creatinine clearance (CrCl), ECOG performance status ≥ 2, and ultra-high-risk cytogenetics, using baseline registry data from 881 newly diagnosed NTE MM patients from Greece, with OS analyses performed in the 878 patients with evaluable survival follow-up, and externally evaluated it in an independent Portuguese cohort. In the Greek OS-evaluable cohort, 485 deaths were observed. Median OS by MEPS group was 96, 65, 39, and 15.3 months for scores 0, 1, 2, and ≥ 3, respectively. In a baseline score-level Cox model, each ordinal MEPS category increase was associated with inferior OS (HR 1.74, 95% CI 1.58-1.92; p < 0.001). MEPS showed higher OS discrimination than R2-ISS in the Greek cohort (C-index 0.655 vs. 0.602; bootstrap delta 0.053, 95% CI 0.021-0.085). The Portuguese validation dataset included 300 patients, of whom 290 were evaluable for the primary OS analysis, with 151 deaths. Median OS was 59.6 months (95% CI 52.4-75.7), and MEPS again showed higher discrimination than R2-ISS (C-index 0.729 vs. 0.647; bootstrap delta 0.082, 95% CI 0.041-0.127). MEPS provides a simple all-cause prognostic tool for elderly/NTE MM, complementing biologically oriented staging with routinely available host-related variables.

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Journal
American Journal of Hematology
Published
2026-08-24
DOI
https://doi.org/10.1002/ajh.70479
Primary Topic
Multiple Myeloma Research and Treatments
Type
article
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article

Myeloma Elderly Prognostic Score ( MEPS ): A Proposed Prognostic Score Integrating Age, Renal Function, Performance Status, and Ultra‐High‐Risk Cytogenetics

Efstathios Kastritis, Emmanouil Spanoudakis, Cristina João, M Gavriatopoulou et al.
American Journal of Hematology
Multiple Myeloma Research and Treatments
article

Myeloma Elderly Prognostic Score ( MEPS ): A Proposed Prognostic Score Integrating Age, Renal Function, Performance Status, and Ultra‐High‐Risk Cytogenetics

Efstathios Kastritis, Emmanouil Spanoudakis, Cristina João, M Gavriatopoulou, Adriana Isabel Roque, Ioannis Ntanasis‐Stathopoulos, Meletios Α. Dimopoulos, Vasiliki Palaska, Eirini Katodritou, Evangelos Terpos, Elpiniki Rentzeperi, Aikaterini Daiou, Maria Kotsopoulou, Joana Vieira, Rui Bergantim, Dimitra Dalampira, Κonstantinos Κostikas, Foteini Theodorakakou, Bruna Ferreira, Maria Tsirogianni, Catarina Isabel Batista Geraldes dos Santos, Sosana Delimpasi, Vasiliki Douka, Dionysios Stoumpos, Vasiliki Tara, Xanthippi Dimitriadou, Elisabeth Karadrakonti, Graca Luiza O. P. Neto Vasconcelos Esteves, Helena Martins
article en

Abstract

Established disease-centered prognostic systems may be less tailored to elderly/non-transplant-eligible (NTE) patients with multiple myeloma (MM), in whom host-related factors such as age, performance status, and renal function strongly influence all-cause outcomes. We developed and evaluated the Myeloma Elderly Prognostic Score (MEPS), a pragmatic four-factor score integrating age ≥ 75 years, renal function < 40 by eGFR or available creatinine clearance (CrCl), ECOG performance status ≥ 2, and ultra-high-risk cytogenetics, using baseline registry data from 881 newly diagnosed NTE MM patients from Greece, with OS analyses performed in the 878 patients with evaluable survival follow-up, and externally evaluated it in an independent Portuguese cohort. In the Greek OS-evaluable cohort, 485 deaths were observed. Median OS by MEPS group was 96, 65, 39, and 15.3 months for scores 0, 1, 2, and ≥ 3, respectively. In a baseline score-level Cox model, each ordinal MEPS category increase was associated with inferior OS (HR 1.74, 95% CI 1.58-1.92; p < 0.001). MEPS showed higher OS discrimination than R2-ISS in the Greek cohort (C-index 0.655 vs. 0.602; bootstrap delta 0.053, 95% CI 0.021-0.085). The Portuguese validation dataset included 300 patients, of whom 290 were evaluable for the primary OS analysis, with 151 deaths. Median OS was 59.6 months (95% CI 52.4-75.7), and MEPS again showed higher discrimination than R2-ISS (C-index 0.729 vs. 0.647; bootstrap delta 0.082, 95% CI 0.041-0.127). MEPS provides a simple all-cause prognostic tool for elderly/NTE MM, complementing biologically oriented staging with routinely available host-related variables.

American Journal of Hematology
Champalimaud Foundation (PT), University of Lisbon (PT), Democritus University of Thrace (GR), Universidade do Porto (PT), National and Kapodistrian University of Athens (GR), Hospitais da Universidade de Coimbra (PT), Hospital de São João (PT), Theageneio General Hospital (GR), BC Platforms (Finland) (FI), Escola Superior de Tecnologia da Saúde de Coimbra (PT), Administração Regional de Saúde de Lisboa e Vale do Tejo (PT), Nova Medical (United States) (US), St Savas Hospital (GR), Metaxa Hospital (GR), Hospital de Santa Maria (PT), G. Papanikolaou General Hospital (GR), i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto (PT), University Hospital of Alexandroupolis (GR), Evangelismos Hospital (GR), University of Coimbra (PT), Universidade Nova de Lisboa (PT)
Peace, Justice and strong institutions, Reduced inequalities
Openalex Percentile: Top 10%
Multiple Myeloma Research and Treatments
DOISourceOpenAlex
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