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Hematology/Oncology Clinics of North America

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PROGNOSTIC FACTORS IN MULTIPLE MYELOMA - 08/09/11

Doi : 10.1016/S0889-8588(05)70128-3 
S. Vincent Rajkumar, MD **, Philip R. Greipp, MD *

Resumen

Multiple myeloma accounts for 10% of all malignant hematologic neoplasms.13, 77 In 1999, approximately 13,700 new cases of myeloma will be diagnosed, and more than 11,000 persons will die of the disease in the United States.77 Therapy for myeloma is not curative. The overall response rate with standard melphalan and prednisone therapy is 53%.92 With this regimen, the complete response rate is less than 10%, and median survival is about 3 years.72 The 5-year survival rate in patients treated with standard therapy for myeloma is 24%.92

Combination chemotherapy with regimens such as vincristine, carmustine, melphalan, cyclophosphamide, and prednisone leads to superior response rates (60% to 70%), but there is no survival benefit.3, 92, 97 High-dose therapy followed by autologous blood cell transplantation is being used in an attempt to improve response rate and survival.7, 8, 52, 66 Response rates with transplantation exceed 75% to 90%,3, 72 and complete response rates range from 20% to 40%.5, 8 A French randomized trial in previously untreated patients with myeloma showed improved survival with autologous marrow transplantation compared with conventional chemotherapy, with 5-year survival rates of 52% and 12%, respectively.5

There is significant variation in the survival of patients with myeloma, and approximately 3% of patients live longer than 10 years.74 Prognostic factors are needed to identify groups of patients with widely different survival rates to assist in counseling, therapeutic strategies, and stratification in clinical trials. Several important prognostic factors identify patients with poor outcomes: serum beta2-microglobulin (β2M), bone marrow plasma cell labeling index (PCLI), cytogenetics, plasmablastic morphology, lactate dehydrogenase (LDH), and C-reactive protein (CRP).54, 75 Some factors such as cytogenetics appear to have particular value in patients undergoing stem cell transplantation.127 Others such as the PCLI have yielded consistent results but are not readily available at most centers. Combinations of independent prognostic factors provide more information than any one factor alone. There is no consensus, however, on the ideal combination of factors that is best suited for widespread clinical use.

This article reviews the major prognostic factors in myeloma and the evidence supporting their usefulness in clinical practice and research.

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 Address reprint requests to Philip R. Greipp, MD, Division of Hematology and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, e-mail: greipp.philip@mayo.edu
Supported by Program Project Grant CA 62242 from the National Cancer Institute, National Institutes of Health, Bethesda, Maryland.


© 1999  W. B. Saunders Company. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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Vol 13 - N° 6

P. 1295-1314 - décembre 1999 Regresar al número
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  • HEAVY-CHAIN DISEASES
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  • CRYOGLOBULINEMIA
  • Angela Dispenzieri, Peter D. Gorevic

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