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Hermann Einsele, MD
Medizinische Klinik und Poliklinik I, Bayerische
by Lynne Lederman, PhD
Prognostic factors can be divided into three categories related to disease, therapy, or patient characteristics. Disease-related factors include ISS stage, cytogenetics, beta-2-microglobulin, albumin, lactate dehydrogenase, and altered signaling pathways, e.g., activation of PI3/Akt signaling pathways. Novel therapies affect prognostic factors, e.g., by overcoming cytogenetics formerly associated with poor risk; however, longer follow-up with these drugs is needed. In the DSMMV study, allogeneic SCT with reduced intensity conditioning appeared overcome high risk cytogenetics with a better outcome than ASCT, with a higher CR rate, although this was obtained at the price of higher mortality (currently 12%, which may be reduced by eliminating one HLA mismatch), and no difference in OS has been seen yet. Patient-related factors include age, comorbidities, renal function, pharmacogenomics, and rapidity of immune reconstitution following SCT. Some pharmacogenomic factors include polymorphisms in DNA repair genes and folate transporter genes, as well as polymorphisms that affect susceptibility to opportunistic infections.