OSMR is a strong prognostic feature in newly diagnosed AML. (A) Cox multivariable model for OS using known prognostic clinical variables and the 8 LIRS serum proteins. (B) LIRS proteins ranked by coefficient and cumulative C-index. (C) Model performance of OSMR, the ELN2022, and ELN2022 combined with OSMR by C-index in the training cohort. (D) Response rate (complete response [CR] or CR with incomplete hematologic recovery) to induction therapy by high or low OSMR level (split by median). (E) Four- and 8-week early mortality rate by high or low OSMR level (split by median). (F) Kaplan-Meier OS curve split by high and low OSMR in the prospectively collected internal validation cohort. (G) Kaplan-Meier OS curve split by high and low OSMR in the external validation cohort of intensively treated patients. All patients in this cohort were selected who had received the standard 7+3 induction and had survival of at least 1 year to test for the ability to prognosticate long-term survival outcomes independent of early mortality.