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Prognosis and Staging

Module 1: Screening, Diagnosis, and Staging of Multiple Myeloma

Section 3: Prognosis and Staging

What factors influence the prognosis of multiple myeloma?

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Dr. David Roodman: Prognostic factors are important in assessing the patient with myeloma for several reasons. In addition to tailoring the therapy in some cases, it is important for the patient to have an idea of what his or her prognosis should be. This enables them to plan for their future, their families' future, and other financial and social concerns.

Dr. Seema Singhal: It would also help make certain treatment decisions. For instance, if a patient had several adverse prognostic factors and had an HLA-identical sibling, one could consider offering the patient an allogeneic transplant instead of an autologous transplant.

Dr. Brian Durie: Yes, I agree with that. At the other end of the spectrum, there are those patients who may meet the criteria for the diagnosis of myeloma but have unusually good prognostic factors. With those patients, it could be possible to follow them without systemic chemotherapy for a period of time sometimes a long period of time. [View Reference]

Dr. William Bensinger: Frequently I ll see patients in whom the beta2-microglobulin is missing from the initial evaluation or they won t have cytogenetics performed on their marrow. Being able to evaluate the other prognostic factors is often very helpful in addressing specific therapy. As Drs. Durie and Singhal have pointed out, having the other prognostic information could help predict which patients would need a more aggressive approach because the prognosis is so grave.

Dr. Robert Kyle: We find in our experience that the plasma cell labeling index and the beta2-microglobulin are two of the most important prognostic factors.

Dr. Brian Durie: As the labeling index is not necessarily available to everyone, although it can be mailed in, it is possible to substitute by using serum albumin, which is available for all patients. Using a combination of low serum albumin and high beta2, one can distinguish between a very poor prognostic group of patients and those who might have a much better prognosis. [View Reference]

Dr. David Roodman: Furthermore, the presence of anemia and renal insufficiency adds to the types of high-risk prognostic factors. Patients can be stratified for treatment decisions as well as for personal decisions based on some very straightforward and relatively inexpensive tests.

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Dr. Brian Durie: Absolutely. I think that we tend to focus on more sophisticated tests and higher technology, but coming back to basics, focusing on simpler tests, and actually focusing on the patient, something as simple as the performance status is still quite helpful and predictive of the need for therapy and the outcome.

Dr. Robert Kyle: In a recent study from the French Myeloma Group, they reported that the presence of monosomy or deletion of chromosome 13 and an elevation of the beta2-microglobulin level were the two most important prognostic factors. [View Reference] (Median and 5-Year Survival Central Lab Risk Groups)

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