Prognostic Factors in Multiple Myeloma : National Cancer Institute Experience

Background: Multiple myeloma (MM) is a plasma-cell neoplasm in which several prognostic factors have been reported. Aim: The aim of this study is to evaluate the different prognostic factors of our MM patients and to correlate them with response to therapy, progression free survival (PFS) and overall survival (OS). Patients and Methods: This study was performed retrospectively on 60 MM patients diagnosed at our Institution in the 4 year’s time from January 2005 to December 2008. All patients were evaluated for different prognostic factors: Age, sex, patient ECOG performance status, ISS, number of lytic bone lesions, plasma cells percentage in bone marrow, serum calcium, creatinine, albumin, LDH, B2M and paraproteins in serum and urine, which correlated with response to treatment, OS and PFS. Results: Most of the patients (80%) were under 60 years. Male to female ratio is 3 to 2 and most of them had PS-1 (56.7%). Median age of patients was 55 years (42-70), median hemoglobin 10 (4.7-15), median serum albumin was 3.2 (1.4.1), median B2M was 4.6 (1.3-13). Median LDH was 466 (245-3726), calcium 9.9 (8-16), creatinine 1 ( 0.6-13). Median plasma cells % in the BM was 20% (1-78). Median Follow up time was 21 months (0-58). 54/60 (90%) patients received 1st line treatment: 34 received VAD, 17 (28%) received MP and 3 (5%) dexamethasone. Six patients (10%) were referred to pain clinic and received best supportive treatment. 8.5% of cases developed complications from the treatment of 1st line, 15.1% of cases achieved CR, while good PR was achieved in 11.7% of cases, 6.7% achieved PR, progression occurred in 35% and stable disease in 22.1%. Patients <60 years had a better median OS, 37 months versus 12 months in patients >60 years (p 0.001). OS was 39 months in female patients versus 14 months in male patients (p 0.025). Median OS was 9 months for patients with comorbid disease while 27 months for patients with no comorbidity (p 0.01). Patients with ECOG, PS-I had 39 months median survival compared to 12 months median survival for patients with PS ECOG-II (p 0.005). Patients with multiple skeletal lesions ( >!3) had median OS of 19 months (p 0.03). Patients who presented with plasmacytoma had better OS Correspondence to: Dr. Yasser Sallam E-mail: ysallam@hotmail.com than those presented without (median 38 months versus 14 months) (p 0.05). Median OS was 39 months for those with non detected paraproteinuria versus 18 months for those patients who experienced paraproteinuria (p 0.045). For stage II disease median OS was 18 months and was 12 months for stage III disease (p 0.001). Median OS for patients with elevated serum LDH was 12 months versus 39 months for those who experienced normal levels of serum LDH ( p 0.001). Median OS was better in patients presented with normal serum calcium level than those presented with hypercalcemia (27 months vs. 10 months) (p 0.03). Median OS for patients with normal serum creatinine level was 27 months versus 13 months for patients presented with elevated serum creatinine level (>1.4mg/dl) p 0.005. Median PFS was 7 months for stage I disease, 6 months for stage II disease and 5 months for stage III disease (p 0.02). Median PFS was better in patients with normal calcium level than those presented with hypercalcemia (7 months vs. 4 months) p-0.009. Conclusions: A specific risk-stratification model is proposed to stratify patients into standard-risk and high-risk. Cytogenetic analysis should be performed in order to help in risk stratification. Validate and develop the stringent CR category as a marker of true complete response. Ensure that TTP and PFS are both reported in clinical trials. Develop a molecular cytogenetic classification for myeloma that is accepted internationally. Very good partial response rates should be uniformly reported. Validate the free-light-chain response criteria. Recent treatments and targeted therapy should be given as treatment lines at NCI.