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AUTHORS: J. Bladé, L. Rosiñol, Mª T. Cibeira
Hematology Department, Institut of Hematology and Oncology, IDIBAPS, Hospital Clínic, Barcelona, Spain
by Lynne Lederman, PhD
Forty years ago, when the first publication described prognostic factors in myeloma, performance status, hemoglobin, calcium levels, and blood urea nitrogen were identified as associated with survival. The list of potential prognostic factors has increased, but Dr. Blade believes that they will lose their impact as novel agents overcome poor risk factors. It should also be possible to develop new therapies that will target specific molecular pathways that confer poor outcome. Gene expression profiling (GEP) and array comparative genomic hybridization (aCGH) have allowed patients to be divided into subclasses with different prognoses. Dr. Blade noted that one of the best prognostic factors is an individual’s response to chemotherapy, and that stabilization of disease with conventional chemotherapy represented lower risk disease. He pointed out that MGUS is already a clone that may be stable for years, so it is an important model for disease progression once it escapes the regulatory mechanisms that maintain the stable state.