Prognostic factors in multiple myeloma.
The median duration of survival for patients with multiple myeloma ranges from 2.5 to 3 years. However, there is considerable variability from one patient to another. Renal function as determined from blood urea nitrogen or serum creatinine values, hemoglobin value, calcium level and performance status have been recognized as prognostic factors for more than 20 years. A study of 107 patients with newly diagnosed multiple myeloma at the Mayo Clinic showed that plasma cell labeling index (PCLI); levels of thymidine kinase, beta 2-microglobulin (beta 2-M), serum albumin, and C-reactive protein; and age were all significant univariate prognostic factors. Only PCLI and beta 2-M levels had independent prognostic significance. Among nine patients younger than 65 years with low PCLI and low beta 2-M levels, eight were alive almost six years after starting chemotherapy. Interleukin 6 (IL-6) is a significant univariate predictor of survival in myeloma. An elevated lactate dehydrogenase content is associated with a poor prognosis. An elevated soluble IL-6 receptor (sIL-6R) level is an independent factor associated with shorter survival. In one study, the addition of sIL-6R to PCLI and beta 2-M to the analysis doubled the proportion of patients identified as high-risk. In this study, the two-year survival was 41% at two years if the PCLI was > or = 2%, beta 2-M was > or = 4.0 micrograms/dl, or sIL-6R was > 300 ng/ml. When none of these three factors were increased, the estimated two-year survival was 83%.(ABSTRACT TRUNCATED AT 250 WORDS)
Kyle
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RA
Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
D000367:Age Factors; D000368:Aged; D015703:Antigens, CD / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008875:Middle Aged; D008940:Mitotic Index; D009101:Multiple Myeloma / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D010950:Plasma Cells / Q000473:pathology; D011379:Prognosis; D018123:Receptors, Interleukin / Q000378:metabolism; D019947:Receptors, Interleukin-6; D012709:Serum Albumin / Q000378:metabolism; D013937:Thymidine Kinase / Q000097:blood; D001613:beta 2-Microglobulin / Q000378:metabolism
D015703:Antigens, CD; D015850:Interleukin-6; D018123:Receptors, Interleukin; D019947:Receptors, Interleukin-6; D012709:Serum Albumin; D001613:beta 2-Microglobulin; D002097:C-Reactive Protein; D013937:Thymidine Kinase