MULTIPLE-MYELOMA INDEX - VERIFICATION OF A NEW PROGNOSTIC APPROACH WITH EVALUATION OF TREATMENT RESPONSE

Background and Objective. Currently adopted prognostic criteria for mu ltiple myeloma (MM) still lack reliable predictive ability to select s ubsets of patients for different therapies, in particular for intensiv e treatment protocols. In this work we aimed to test the prognostic va lue of the MM Prognostic Index (MMPI), developed in 1996 by Grignani e t al. from Pavia University as a clinical and investigational tool. De sign and Methods. Ninety-three MM patients were eligible for the study . All received initial induction therapy based on a standard 6-month m elphalan + prednisone (M+P) protocol. Clinical and laboratory paramete rs, conventional staging and bone marrow infiltration percentage and c ytopathology (BMIC) were assessed at diagnosis, while treatment respon se (TR) was evaluated using criteria after induction therapy. Cox's mu ltivariate survival analysis was applied on prognostic data. Results. In our patients independent prognostic value was confirmed for British Medical Research Council staging, BMIC and TR, the three factors cons idered in MMPI. Risk classes obtained via MMPI identify patients with different outcomes; moreover, the index discriminates significantly am ong Stage II patients. Interpretation and Conclusions. This new approa ch to MM prognosis is simple and reliable from the prognostic point of view; it refers not only to neoplastic mass, but also to intrinsic pr oliferative capacity of the malignant clone and to tumor-host interact ions. We recommend its adoption in clinical practice and in the evalua tion and design of therapeutic trials. (C) 1998, Ferrata Storti Founda tion.