Beyond ISS staging: the prognostic value of the Inflammation Prognostic Score Index (IPSI) in multiple myeloma.

Objectives: To establish a novel Inflammation Prognostic Score Index (IPSI) and evaluate its prognostic value and complementary role to the International Staging System (ISS) in newly diagnosed multiple myeloma (MM).

Methods: This retrospective study analyzed 98 newly diagnosed MM patients. ROC-derived cutoffs stratified patients by RDW, PLT, NMLR, SII, and SIRI. The IPSI was constructed by assigning 1 point each to elevated RDW, low PLT, and high NMLR, defining three risk groups: 0-1, 2, and 3 risk factor groups. Survival and ISS correlations were evaluated using Kaplan-Meier, Cox, and Spearman's tests.

Results: Multivariate analysis confirmed RDW, PLT, and NMLR as independent predictors of overall survival (OS) (all P < 0.05). Based on these, IPSI stratified patients into three risk groups: 0-1, 2, and 3 risk factor groups, with median OS of 24, 21.5, and 14 months, respectively (log-rank P < 0.001). IPSI was an independent prognostic factor (2-risk-factors group: HR = 8.74; 3-risk-factors group: HR = 18.98 vs 0-1-risk-factors group; both P < 0.001) and correlated with ISS stage (r_s = 0.35, P < 0.001). Critically, IPSI refined risk stratification within all ISS subgroups (P < 0.001). SII and SIRI correlated with ISS but were not independent prognostic factors.

Conclusions: As an independent prognostic index that integrates RDW, PLT, and NMLR, IPSI optimizes ISS staging and provides a cost-effective risk stratification tool. It may be a good measure indice of identifying high-risk MM patients in resource constraint setting where access to molecular testing is not available.