Prognostic features of asymptomatic multiple myeloma

Abstract

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.

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

“…8,12,15 Our results document that B2M improves the risk stratification model defined by sMC, uMC, and BMPC percentage by adding information both in the low-risk stratum and in the high-risk stratum of patients with asymptomatic MM. In fact, B2M contributes to identifying a group of patients who have asymptomatic MM with a very favorable prognosis who are not expected to progress and a group of high-risk patients with asymptomatic MM virtually all of whom are projected to progress.…”

“…8,12,15 Consistent with previous observations, sMC, uMC, and BMPC percentage were selected as predictors of progression in our asymptomatic MM cohort. When combined into a model, sMC, uMC, and BMPC percentage allowed us to stratify patients into 3 risk categories (Fig.…”

“…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.…”

“…8,15 Because serum FLC levels have entered the routine clinical practice only recently, this information was not available for the current analysis. On this basis, in our cohort, the baseline serum FLC burden was estimated indirectly by measuring BJ proteinuria.…”

“…[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.…”