Prognostic factors in low tumour mass asymptomatic multiple myeloma: A report on 91 patients

Facon, Thierry; Ménard, Jean-François; Michaux, Jean Louis; Euller‐Ziegler, Liana; Bernard, Jérôme; Grosbois, B.; Daragon, A.; Azaïs, I.; Courouble, Y; Kaplan, G; Laporte, J; Gramont, Armand de; Duclos, B.; Leonard, Arnold S.; Mineur, Philippe; Delannoy, André; Jouet, Jean‐Pierre; Bauters, F; Monconduit, M

doi:10.1002/ajh.2830480201

Cited by 34 publications

(30 citation statements)

References 20 publications

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“…To date, none of the previous studies on asymptomatic MM focused on B2M, [3][4][5][6][7][8][9][10][11][12][13][14][15] and only 2 reports included B2M among baseline variables. 7,10 In the study by Moulopoulos et al, 7 patients with asymptomatic MM who presented with B2M >2.5 mg/L had a short time to progression to symptomatic disease.…”

Section: Discussionmentioning

confidence: 99%

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Beta‐2‐microglobulin is an independent predictor of progression in asymptomatic multiple myeloma

Rossi

Fangazio

Paoli

et al. 2010

Cancer

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BACKGROUND: Although serum beta-2 microglobulin (B2M) represents a key variable for symptomatic multiple myeloma (MM) prognostication, its role in predicting the risk of progression of asymptomatic MM to symptomatic disease has not been explored. METHODS: This study was bases on a consecutive series of 148 patients with asymptomatic MM and explored the cumulative probability of progression to symptomatic MM as the primary endpoint. RESULTS: In univariate analysis, a serum B2M level >2.5 mg/L was associated with an increased probability of disease progression (5-year risk, 64.5%; P < .001) along with serum monoclonal component (sMC) (P < .001), urinary monoclonal component (uMC) (P < .001), and bone marrow plasma cells (BMPCs) (P < .001). In multivariate analysis, serum B2M was selected as an independent predictor of progression (hazard ratio, 3.30; P ¼.002). Serum B2M was combined with sMC, uMC, and BMPC to create a risk-stratification model based on 4 groups with different risk of progression: very low (5-year risk, 0%), low-intermediate (5-year risk, 19.6%), high-intermediate (5-year risk, 60.7%), and high (5-year risk, 80.7%). The model that included serum B2M along with sMC, uMC, and BMPC was able to predict disease progression better than the model that was based on sMC, uMC, and BMPC without serum B2M (C statistics, 0.760 vs 0.726). CONCLUSIONS: The current results indicated that 1) serum B2M is an independent predictor of asymptomatic MM progression, and 2) serum B2M adds prognostic information when combined with the most widely used prognosticators of asymptomatic MM progression.

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Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10][11][12][13][14][15] Therefore, in the current study, we investigated a cohort of patients who had asymptomatic MM to verify 1) whether B2M levels predict progression to symptomatic MM and 2) how B2M interacts with currently known predictors of progression to symptomatic MM.…”

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confidence: 99%

Beta‐2‐microglobulin is an independent predictor of progression in asymptomatic multiple myeloma

Rossi

Fangazio

Paoli

et al. 2010

Cancer

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“…All patients with stage I according to DS had two or three risk factors of early progression according to Facon et al 13 and some of them had one, but symptomatic bone lesion.…”

Section: Patients and Treatmentmentioning

confidence: 99%

Prognostic factors for survival after autologous transplantation: a single centre experience in 133 multiple myeloma patients

Krejčí

Büchler

Hájek

et al. 2004

Bone Marrow Transplant

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Summary:Autologous stem cell transplantation (ASCT) has an established role in the treatment of symptomatic multiple myeloma (MM). Our aim was to analyse the impact of selected prognostic parameters on the survival of patients with MM after ASCT. The new International Staging System (ISS) was also evaluated. A total of 133 MM patients were transplanted in our centre between 1995 and 2002. Following ASCT, 35% of patients were in complete remission (CR) and 60% were in partial remission (PR). The median progression-free (PFS) and overall (OS) survival from transplantation were 29.5 and 68.8 months, respectively. Transplant-related mortality (TRM) was 3%. On multivariate analysis, factors associated with significantly shorter OS were lack of CR after transplant (P ¼ 0.002, hazard ratio (HR): 3.1), stage 3 according to ISS (P ¼ 0.001, HR: 3.0) and age at transplant over 60 years (P ¼ 0.035, HR: 2.0). The status of disease before ASCT did not significantly affect PFS and OS after transplantation. We conclude that ASCT is a safe and effective procedure in MM patients, associated with low TRM. The survival after ASCT was dependent on response after ASCT, stage according to ISS and age. Reliable and simple staging of MM is important for accurate prognostic evaluation and for the comparison of data from different clinical trials. Attempts to improve the widely accepted Durie-Salmon (DS) staging system 2 have led to the development of numerous new prognostic systems, 3-5 which have not been universally accepted. Recently, Greipp et al 6,7 presented a new International Staging System (ISS) for MM. It has shown promise in patients treated by conventional as well as high-dose chemotherapy and is based on a simple combination of serum b 2 -microglobulin and albumin values (stage 1 ¼ b 2 -microglobulin o3.5 mg/l and albumin X3.5 g/dl; stage 2 ¼ b 2 -microglobulin o3.5 mg/l and albumin o3.5 g/dl, or b 2 -microglobulin X3.5 mg/l to o5.5 mg/l; stage 3 ¼ b 2 -microglobulin X5.5 mg/l).When compared with standard-dose chemotherapy for MM, high-dose chemotherapy with autologous stem cell transplantation (ASCT) has been found to be significantly superior in terms of complete remission (CR), CR duration, progression-free survival (PFS) and overall survival (OS). [8][9][10][11][12] We have retrospectively analysed 133 patients with MM undergoing ASCT in our centre. The aims of our analysis were (1) to evaluate both ISS and DS systems in our set of patients; (2) to ascertain the feasibility and toxicity of the transplant procedure; (3) to evaluate the influence of some clinically important parameters (age, gender, type of MM, stage of MM, responses before and after ASCT, selected laboratory values at transplant) on PFS and OS after transplant in order to define the subgroups of patients with different prognosis. Patients and methods Patients and treatmentFrom January 1995 to December 2002, 133 patients with newly diagnosed symptomatic MM with stages I-III according to DS underwent ASCT at the Department of Internal Medicine -Haematooncol...

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“…These features have included the presence of a lytic bone lesion, a high level of serum myeloma protein, the presence of Bence Jones protein, and an abnormal bone marrow pattern on magnetic resonance (MR) imaging (Wisloff et al, 1991;Dimopoulos et al, 1993;Hjorth et al, 1993;Facon et al, 1995); some have claimed that the haemoglobin level and the degree of bone marrow plasmacytosis were also useful (Facon et al, 1995). Because of conflicting conclusions in regard to the most important features and in order to justify the value of an expensive procedure, such as an MR imaging study, we updated our experience and defined more clearly those patients who required early therapy from those in whom treatment could be delayed safely for many years.…”

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confidence: 99%

Prognostic features of asymptomatic multiple myeloma

et al. 1997

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Summary. Approximately 20% of patients with multiple myeloma are recognized by chance without significant symptoms. In order to prevent morbidity with timely therapy, reliable criteria are needed that distinguish those likely to show early or late disease progression. Multiple clinical features were assessed in 101 consecutive, asymptomatic and previously untreated patients. Patients with one or more lytic bone lesions were excluded because this feature had been found previously to be associated with early progression. Multivariate analysis indicated that only serum myeloma globulin >30 g/l, IgA protein type, and Bence Jones protein excretion >50 mg/d remained as significant independent variables. The presence of two or more of these features signified high-risk disease with early progression (median 17 months) whereas the absence of any adverse variable was associated with prolonged stability (median 95 months) ðP < 0·01Þ. Magnetic resonance (MR) imaging of the spine was useful only in patients with one adverse feature and an intermediate time to progression (median 39 months). An abnormal pattern (40% of patients) helped to distinguish patients with an imminent complication from those with more stable disease. Because a serious complication (fracture, hypercalcaemia) occurred in 35% of patients with early disease progression, chemotherapy seems justified for selected patients with asymptomatic disease at diagnosis. The remaining patients were at such low risk for progression (median 6 years) that they may be followed safely at long intervals without treatment.

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Prognostic factors in low tumour mass asymptomatic multiple myeloma: A report on 91 patients

Cited by 34 publications

References 20 publications

Beta‐2‐microglobulin is an independent predictor of progression in asymptomatic multiple myeloma

Beta‐2‐microglobulin is an independent predictor of progression in asymptomatic multiple myeloma

Prognostic factors for survival after autologous transplantation: a single centre experience in 133 multiple myeloma patients

Prognostic features of asymptomatic multiple myeloma

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