Researchers in China have developed a nomogram that incorporates pleural effusion to accurately classify patients with multiple myeloma into high-risk and low-risk groups and predict expected survival, according to the results of a study published in the Annals of Hematology.

According to the investigators, pleural effusion commonly occurs in “real-world” patients with myeloma, but its prognostic value on the disease course is unknown.

In this single-center study, the researchers retrospectively assessed outcomes from patients with myeloma diagnosed from 2000 to 2017. Of the included 861 patients, 368 developed pleural effusion.

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Those patients who developed pleural effusion were found to have worse overall survival compared with those who did not (57.7 vs 98.8 months; P <.0001). The 3-year overall survival rate was 67.1% for patients with pleural effusion compared with 85.5% for those without.

The researchers then created a nomogram incorporating pleural effusion, plasma cell proportion, international staging system (ISS) stage, Charlson comorbidity index, 1q21 gain, and autologous hematopoietic stem cell transplantation.

The nomogram showed satisfactory discrimination in both the derivation and validation cohorts, and outperformed the Durie-Salmon and ISS staging systems. The researchers noted that pleural effusion was an important component of the nomogram. When it was removed, the concordance index dropped from 0.729 to 0.709 in the derivation cohort and from 0.684 to 0.634 in the validation cohort.

Using the nomogram, the researchers were able to stratify patients into low-risk and high-risk groups. The median overall survival was significantly shorter in the high-risk group (56.8 vs 104.3 months; P <.001) in the derivation cohort and the validation cohort (62.4 vs 113.6 months; P <.001) compared with the low-risk group.

Based on these results, the researchers concluded that “…clinicians should recognize the implication of pleural effusion on clinical outcome.”


Hou Z-L, Kang Y, Yang G-Z, et al. Pleural effusion-based nomogram to predict outcomes in unselected patients with multiple myeloma: a large single center experience. Annals of Hematology. Published online March 14, 2021. doi:10.1007/s00277-021-04484-1