title: Risk stratification model in elderly patients with multiple myeloma: clinical role of magnetic resonance imaging combined with international staging system and cytogenetic abnormalities.
abstract: The International Staging System (ISS) does not take into consideration the clinical role of imaging modalities in multiple myeloma (MM), even though these are important. Some studies have indicated a lack of impact of ISS in MM patients who receive novel agents. Therefore, accessible novel risk stratification might be needed in elderly MM patients receiving conventional therapy or novel agents. We analyzed 198 newly diagnosed and symptomatic MM patients who were not eligible for transplantation. The initial treatment regimen was therapy with melphalan-prednisone (MP, n = 44), thalidomide-cyclophosphamide-dexamethasone (n = 89) or bortezomib-MP (VMP, n = 65). The magnetic resonance imaging (MRI) pattern was normal in 34 patients, focal in 30 and diffuse/variegated in 134. High-risk cytogenetic abnormalities were not associated with the diffuse/variegated MRI pattern (p = 0.182). ISS stage III [progression-free survival (PFS) p = 0.005; overall survival (OS) p = 0.027], high-risk cytogenetic abnormalities (PFS p = 0.001; OS p < 0.001) and diffuse/variegated MRI pattern (PFS p < 0.001; OS p < 0.001) were independently associated with poorer PFS and OS. Patients were further stratified according to the 3 prognostic factors. The PFS and OS of the 3 groups differed significantly. The addition of the diffuse/variegated MRI pattern may improve the prognostic potential of the current staging system which includes ISS and cytogenetic abnormalities.
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital Medical Research Institute, Busan, Korea.
authors.forename: Moo-Kon
authors.initials: MK
authors.lastname: Song
authors.forename: Joo-Seop
authors.initials: JS
authors.lastname: Chung
authors.forename: Je-Jung
authors.initials: JJ
authors.lastname: Lee
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Ik-Chan
authors.initials: IC
authors.lastname: Song
authors.forename: Sang-Min
authors.initials: SM
authors.lastname: Lee
authors.forename: Dong-Yeop
authors.initials: DY
authors.lastname: Shin
authors.forename: Gyeong-Won
authors.initials: GW
authors.lastname: Lee
authors.forename: In-Sook
authors.initials: IS
authors.lastname: Lee
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D002869:Chromosome Aberrations; D003520:Cyclophosphamide / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D018572:Disease-Free Survival; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D008954:Models, Biological; D009101:Multiple Myeloma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality*; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage; D011719:Pyrazines / Q000008:administration & dosage; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013792:Thalidomide / Q000008:administration & dosage
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone; D003520:Cyclophosphamide; D008558:Melphalan; D011241:Prednisone