A PROGNOSTIC INDEX FOR MULTIPLE-MYELOMA

The current prognostic systems have failed to identify multiple myelom a (MM) patients who require aggressive therapy. These staging systems do not reliably distinguish patients with different prognoses. This pa per explores the possibility of improving the prognostic forecast in M M by considering some clinical characteristics at diagnosis together w ith response to first-line chemotherapy. A total of 231 patients were prospectively randomised in a multicentre trial to no therapy vs melph alan + prednisone(MP) for stage I, MP in stage II, and MP vs peptichem io, vincristine and prednisone for stage III. The clinical features of these groups were evaluated for prognostic variables predictive of ov erall survival by means of univariate and multivariate analysis. The i ndependently significant variables were incorporated into a model that identified three groups of patients with different risks of death and different overall survival. Three variables retained statistical sign ificance: the staging system proposed by the British Medical Research Council, a composite parameter integrating the percentage of bone marr ow plasma cells with cytological features of the infiltrating elements (plasma cell vs plasmablast), and response to 6 months of first-line chemotherapy. These three variables led the proposal of a scoring syst em able to identify three different risk classes (with median overall survival of 52, 28 and 13 months respectively) and to estimate individ ual patient prognosis more flexibly. The proposed risk classes, drawn from both diagnostic and therapeutic parameters. are thought to be a c linical and investigational instrument for separating MM patients into comparable groups, for selecting the best available therapy and for e valuating response with respect to the disease of each new patient.