A predictive tool particularly designed for elderly myeloma patients presenting with spinal cord compression.
BACKGROUND
This study was performed to design a predictive tool that allows the estimation of overall survival (OS) of elderly myeloma patients (aged ≥ 65 years) presenting with myeloma-induced spinal cord compression (SCC).


METHODS
One-hundred-and-sixteen patients irradiated for motor deficits of the legs due to myeloma-induced spinal cord compression were retrospectively evaluated. Ten characteristics were analyzed for OS including age, interval between myeloma diagnosis and radiotherapy, other osseous myeloma lesions, myeloma type, gender, time developing motor deficits, number of affected vertebrae, ECOG-PS, pre-radiotherapy ambulatory status, and fractionation regimen. Characteristics that achieved significance on multivariate analysis were included in the predictive tool. The score for each characteristic was obtained from the 1-year OS rate divided by 10. The sum of these scores represented the prognostic score for each patient.


RESULTS
On multivariate analysis, myeloma type (hazard ratio 3.31; 95%-confidence interval 1.75-6.49; p < 0.001), ECOG-PS (HR 5.33; 95%-CI 2.67-11.11; p < 0.001), ambulatory status (HR 2.71; 95% CI 1.65-4.57; p < 0.001), and age (HR 1.95; 95% CI 1.03-3.78; p = 0.040) were significantly associated with survival. Sum scores ranged from 18 to 32 points. Based on the sum scores, three prognostic groups were designed: 18-19, 21-28 and 29-32 points. The corresponding 1-year survival rates were 0, 43 and 96%, respectively (p < 0.001).


CONCLUSIONS
This new predictive tool has been specifically designed for elderly myeloma patients with SCC. It allows estimating the survival prognosis of this patient group and supports the treating physicians when looking for the optimal treatment approach for an individual patient.
Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, D-23538, Lubeck, Germany. rades.dirk@gmx.net.
Dirk
D
Rades
Department of Radiation Oncology, Consorcio Hospital Provincial de Castellón, Castellón, Spain.
Antonio Jose
AJ
Conde-Moreno
Department of Radiation Oncology, Cruces University Hospital, Barakaldo, Vizcaya, Spain.
Jon
J
Cacicedo
Department of Radiotherapy, Dr. Bernard Verbeeten Institute, Tilburg, Netherlands.
Theo
T
Veninga
Department of Hematology & Oncology, University of Lubeck, Lubeck, Germany.
Niklas
N
Gebauer
Department of Hematology & Oncology, University of Lubeck, Lubeck, Germany.
Tobias
T
Bartscht
Mayo Clinic, Scottsdale, AZ, USA.
Steven E
SE
Schild
D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009101:Multiple Myeloma / Q000150:complications / Q000503:physiopathology / Q000532:radiotherapy*; D011379:Prognosis; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000503:physiopathology / Q000532:radiotherapy*
Elderly patients; Myeloma; Overall survival; Predictive tool; Radiotherapy; Spinal cord compression