Modified Glasgow Prognostic Score Incorporating CRP/Albumin Ratio and LDH Levels as Prognostic Indicators in Patients with Multiple Myeloma: A Retrospective Study

Abstract

Purpose: This study aimed to evaluate whether integrating the CRP/Albumin Ratio (CAR) and Lactate Dehydrogenase (LDH) levels into the Modified Glasgow Prognostic Score (mGPS) enhances its prognostic accuracy in patients with multiple myeloma (MM). Patients and Methods: A single-center retrospective study was conducted on patients diagnosed with multiple myeloma (MM) at Afyonkarahisar Health Sciences University between 2017 and 2023. Demographic, clinical, and laboratory data including mGPS, CAR, LDH, and ISS staging were collected. Survival outcomes were assessed using Kaplan-Meier curves, and Cox regression models were used to determine prognostic factors. Results: Among the 130 patients, the ISS score was the strongest predictor of mortality (HR = 1.63, 95% CI: 1.27–2.09, p = 0.0001). mGPS 2 combined with LDH > 250 IU (HR = 1.96, 95% CI: 1.32–2.92) and CAR > 0.51 (HR = 1.71, 95% CI: 1.16–2.53) were independent risk factors. mGPS alone remained a consistent prognostic marker (HR = 1.42, 95% CI: 1.14–1.77). One-year survival was 50.0% in the mGPS 2 group, dropping to 30.3% at two years. The mGPS 2 + LDH > 250 IU group had the poorest survival (39.5% to 23.3%), followed by the mGPS 2 + CAR > 0.51 group (44.9% to 28.6%). Median PFS was 28.0, 47.0, and 9.0 months in mGPS0, mGPS1, and mGPS2, respectively (p < 0.001), with mGPS2 showing significantly shorter PFS. mGPS2, CAR, LDH, and their combinations were independent predictors of progression. In mGPS2, OS and PFS declined steadily over 36 months, with the lowest long term PFS in the CAR elevated subgroup. Conclusion: Integrating CAR and LDH into the mGPS offers a cost-effective and accessible approach to improve risk stratification in patients with MM. This enhanced model provides a comprehensive assessment of systemic inflammation and tumour burden, supporting its potential use in clinical decision making.