title: A new staging system to predict prognosis of patients with multiple myeloma in an era of novel therapeutic agents.
abstract: Various prognostic markers for multiple myeloma (MM) have been identified, and stratification using these markers is considered important to optimize treatment strategies. The international staging system (ISS) is now a widely accepted prognostic staging system for MM patients; however, its validity is controversial in the era of new therapeutic regimens, since ISS had been established before introduction of new agents. We retrospectively reviewed prognostic factors in order to seek out an alternative staging system more suitably applied to MM patients treated with novel agents. We analyzed 178 newly diagnosed MM patients who received either conventional chemotherapy without novel agents (CT; n = 79) or chemotherapy with novel agents (NT; n = 99). Although median overall survival (OS) of patients treated with CT is significantly different depending on stages of ISS, ISS had no effect on OS among patients treated with NT. Meanwhile, we identified hemoglobin (Hb) and plasmacytoma as independent risk factors for OS in patients who received NT. Using these two parameters, we stratified NT patients into three stages; stage 1 (Hb≥10 g/dL and absence of plasmacytoma), stage 2 (not stage 1 or 3), and stage 3 (Hb <10 g/dL and presence of plasmacytoma). We found that there were significant differences in median OS among the three stages (8.13, 5.95, and 2.45 yr for stages 1, 2, and 3, respectively). This preliminary study suggests that this alternative staging system based on Hb and plasmacytoma is a simple and useful way to predict prognosis of MM patients in the novel agent era.
authors: Department of Medicine and Clinical Science, Gunma University, Maebashi, Japan.
authors: Hirono
authors: H
authors: Iriuchishima
authors: Takayuki
authors: T
authors: Saitoh
authors: Hiroshi
authors: H
authors: Handa
authors: Atsushi
authors: A
authors: Isoda
authors: Morio
authors: M
authors: Matsumoto
authors: Morio
authors: M
authors: Sawamura
authors: Atsushi
authors: A
authors: Iwasaki
authors: Chiaki
authors: C
authors: Ushie
authors: Hikaru
authors: H
authors: Hattori
authors: Yoshiko
authors: Y
authors: Sasaki
authors: Takeki
authors: T
authors: Mitsui
authors: Akihiko
authors: A
authors: Yokohama
authors: Norifumi
authors: N
authors: Tsukamoto
authors: Hirokazu
authors: H
authors: Murakami
authors: Yoshihisa
authors: Y
authors: Nojima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016130:Immunophenotyping; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D009367:Neoplasm Staging; D011379:Prognosis; D016896:Treatment Outcome
keywords: anemia; international staging system; multiple myeloma; novel agent era; plasmacytoma; prognostic factors