Prognostic Factors of Weber et al for Progression in Asymptomatic Multiple Myeloma

 

Patient population:

• Most patients had bone marrow plasmocytosis > 10% with serum monoclonal protein > 2.5 g/dL. Some patients had bone marrow plasmocytosis of 5-10% with myeloma protein > 3 g/dL and/or Bence Jones protein > 150 mg/d.

• Patients did not include those with monoclonal protein of unknown significance (MGUS): bone marrow plasmocytosis > 5%, serum monoclonal protein < 2 g/dL, and Bence Jones protein excretion < 50 mg/d.

• Patients with one or more lytic bone lesions were excluded, since this is finding is associated with early progression.

 

Features indicating progression:

(1) rise in myeloma protein to > 5 g/dL

(2) appearance of lytic bone lesions

(3) presence of complications such as pathologic fracture, renal impairment, hypercalcemia or progressive anemia

(4) rise in Bence Jones protein excretion to > 2 g/day

 

Parameters identified on multivariate analysis:

(1) serum myeloma protein in g/dL

(2) heavy chain immunoglobulin type

(3) urinary Bence Jones protein excretion in mg/day

Parameter	Finding	Points
serum myeloma protein	<= 3 g/dL	0
	> 3 g/dL	1
heavy chain immunoglobulin type	not IgA	0
	IgA	1
Bence Jones protein excretion	<= 50 mg/day	0
	> 50 mg/day	1

 

risk score =

= SUM(points for all 3 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 3

• The more risk factors present the worse the prognosis.

 

Number of Factors	Risk Group	Median Time to Progression	Median Survival	MRI of spine useful?
2 or 3	high	17 months	51 months	no
1	intermediate	39 months	87 months	yes
0	low	95 months	89 months	no

 

Treatment recommendations:

• Some members of the high risk group can benefit from early chemotherapy.

• Patients in the low risk group can be followed for long intervals without treatment.