Examinando por Autor "Rodriguez Robayo, Diego Mauricio"

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    Outcome prediction in newly diagnosed multiple myeloma: a comparison meta-analysis between ISS and R-ISS in 8536 patients
    (2021) Rodriguez Robayo, Diego Mauricio; Martinez Cordero, Rolando Humberto; Rico Mendoza, Franklin Alejandro
    Prognostic stratification for multiple myeloma (MM) has changed dramatically in the last two decades. Various groups worldwide, as well as international guidelines, recommends the treatment orientation according to risk. Since 2015, the international MM working group (IMWG) recommends complementing the ISS scale with cytogenetic studies in both eligible and ineligible patients for autologous bone marrow transplantation; however, many countries do not have the technology to carry out these studies properly. There is uncertainty about whether the R-ISS (classification Revised International Staging System) offers a better risk stratification over the ISS, in patients younger than 65 with newly diagnosed MM. Objective Determine whether the application of the R-ISS staging system compared to ISS better discriminates risk and establishes better prognostic discrimination in terms of survival in patients younger than 65 years with a new diagnosis of MM. Search methods A systematic search was made for articles published between 2010-2020 in English and Spanish in Pubmed, Embase, Lilacs. DeCS and MeSH terms were used as well as free text. The search for studies was carried out by two independent reviewers. The study’s Prospero registration number CRD42021230257 Eligibility criteria Randomized and non-randomized clinical trials and observational studies compared the ISS and R-ISS scales in terms of survival in patients aged 65 years or less, of both sexes, with a new MM diagnosis. Methods of evaluation and synthesis of data Study selection was carried out by two independent reviewers; Discrepancies were resolved by consensus by performing data extraction using a form developed according to the template proposed in the Cochrane Collaboration Manual. Risk of bias was assessed using the Newcastle-Ottawa Scale for cohort studies. A descriptive analysis of the characteristics of the included studies and their results was carried out. Results A total of 10 studies met the inclusion criteria; all were retrospective cohort and included a total of 8. 536 patients. A meta-analysis with a random-effects model was performed with 5 studies for the overall survival outcome, finding a combined HR of 6. 26 (4.08 - 9.61) for RISS3 vs. 2.92 (1.48 - 5.73) for ISS-3. For the outcome of progression-free survival, a combined HR of 2.84 (1.86 - 4.33) vs. HR 1.89 (1.53 - 2.33) of ISS-3 was found. Interpretation The R- ISS classification has a better discriminating power for high-risk groups than standard risk; however, with the current evidence, it is impossible to ensure that the discriminatory capacity is significant in the survival rates and the prognosis of patients with low or intermediate risk. Funding This study has no funding source.