Routine laboratory trajectories encode the onset of organ-level complications in cancer

Jannik Lübberstedt; Krischan Braitsch; Jacqueline Lammert; Christof Winter; Florian Gabriel; Tristan Lemke; Christopher Zirn; Markus Graf; Friedrich Puttkammer; Hartmut Häntze; Johannes Moll; Anirudh Narayanan; Andrei Zhukov; Fabian Drexel; Zeineb Ben Chaaben; Sebastian Ziegelmayer; Su Hwan Kim; Marion Högner; Jan Kirschke; Florian Bassermann; Marcus Makowski; Christian Wachinger; Lisa Adams; Keno Bressem

arXiv · 2606.08538

Routine laboratory trajectories encode the onset of organ-level complications in cancer

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Abstract

Routine laboratory panels drawn during cancer treatment constitute longitudinal physiological recordings of organ function, yet their temporal structure is discarded by single-timepoint prognostic tools. A transformer trained on 2,777,595 laboratory measurements from 3,905 patients with multiple myeloma or ovarian cancer predicted the two-year onset of 162 treatment-associated complications, including therapy-related myelodysplastic syndromes, spanning eight clinical categories, achieving 1.5- to 6.1-fold enrichment above prevalence at the group level. It matched or outperformed non-sequential baselines across grouped endpoints (AUROC gains up to +0.11), demonstrating that longitudinal laboratory trajectories capture evolving complication-specific physiology inaccessible from isolated measurements. Predictions generalised across both cancers, divergence concentrating in disease-specific complications, and biomarker masking recovered signatures consistent with established pathophysiology. External validation on MIMIC-IV and MMRF CoMMpass confirmed transferability across independent healthcare systems (AUROC up to 0.85). Routine oncological laboratory data encode organ deterioration weeks to months before clinical onset, enabling complication-specific surveillance without additional testing infrastructure.

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Jannik Lübberstedt, Krischan Braitsch, Jacqueline Lammert, Christof Winter, Florian Gabriel, Tristan Lemke, Christopher Zirn, Markus Graf, Friedrich Puttkammer, Hartmut Häntze, Johannes Moll, Anirudh Narayanan, Andrei Zhukov, Fabian Drexel, Zeineb Ben Chaaben, Sebastian Ziegelmayer, Su Hwan Kim, Marion Högner, Jan Kirschke, Florian Bassermann, Marcus Makowski, Christian Wachinger, Lisa Adams, Keno Bressem. 2026-06-07. Routine laboratory trajectories encode the onset of organ-level complications in cancer. https://arxiv.org/abs/2606.08538

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