PROGNOSTIC FEATURES OF ASYMPTOMATIC MULTIPLE-MYELOMA

Approximately 20% of patients with multiple myeloma are recognized by chance without significant symptoms. In order to prevent morbidity wit h timely therapy, reliable criteria are needed that distinguish those likely to show early or late disease progression. Multiple clinical fe atures were assessed in 101 consecutive, asymptomatic and previously u ntreated patients. Patients with one or more lytic bone lesions were e xcluded because this feature had been found previously to be associate d with early progression. Multivariate analysis indicated that only se rum myeloma globulin >30 g/l, IgA protein type, and Bence Jones protei n excretion >50mg/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 mo nths) (P < 0.01). Magnetic resonance (MR) imaging of the spine was use ful only in patients with one adverse feature and an intermediate time to progression (median 39 months). An abnormal pattern (40% of patien ts) helped to distinguish patients with an imminent complication from those with more stable disease, Because a serious complication (fractu re, hypercalcaemia) occurred in 35% of patients with early disease pro gression, chemotherapy seems justified for selected patients with asym ptomatic disease at diagnosis. The remaining patients were at such low risk for progression (median 6 years) that they may be followed safel y at long intervals without treatment.