Background: Multiple myeloma (MM) is a very heterogeneous disease requiring a choice of individual therapy with intensity respecting the prognostic evaluation of the patient. Type of study and group of patients: In the group of 237 patients with MM treated between 1991-2002 by conventional therapy prognostic value and practical utility of seven selected staging systems were assessed. Methods and results: Prognostic significance was assessed using the overall survival curves according Kaplan-Meier and log rank test (p<0.05). The practical utility and prognostic value of Durie-Salmon system was confirmed with different overall survival (OS) medians (stages I-III, medians OS 88, 41 and 16 months, p=0.0000). Unlikely to former observations and probably due to the progress in the basic as well as supportive therapy just a limited predictive value of the D-S subclasification (A and B) based on the presence of significant renal failure (st. III-A vs III-B, medians OS 20 and 13 months p=0.052) was found. The simple staging systems based on measurement of S-β2microglobulin and S-albumin were proved to be advantageous e.g. Bataille system (stages 1-3, medians OS 68, 27 and 11 months, p=0.0000) and Hussein system (stages 1-4, medians OS 89, 68, 24 and 11 months, p=0.0000). Regardless the short 5 years duration of the study scoring system according San Miguel, which encloses apart from other markers also the propidium-iodide proliferative index (PI/CD138) of myeloma plasmocytes, seems to be very promising (stages 1-3, medians OS x, 33 and 13 months, p=0.0002). If the examination of PI/CD138 is not accessible, we suggest to use our simple staging system based on measurement of levels of S-β2microglobulin and S-thymidinkinase (stages 1-3, medians OS x, 24 and 11 months, p=0.0000). The staging system according to GATLA demonstrated but a limited prognostic value and practical utility (stages 2 vs 3, medians 88, 19 and 15 months, p=0.043) and modified Pulkki system combining measurement of S-β2 microglobulin and S-sIL-6R system was lacking prognostic significance at all (stages 1-3, medians OS 30, 23 and 6 months, p=0.436). Twenty-seven existing staging systems are discussed including the information about the preparation of IPI („International Prognostic Index“). Conclusion: This study has confirmed prognostic significance of standard staging systems according to Durie-Salmon, Bataille and Hussein, staging systems based on measurement of proliferative parameters of myeloma cells seem to be very advantageous too (according to San Miguel and system based on S-TK constructed by authors of this study).
- Klíčová slova
- nové nezávislé prognostické faktory, International Prognostic Index,
- MeSH
- financování organizované MeSH
- Kaplanův-Meierův odhad MeSH
- klasifikace metody MeSH
- lidé MeSH
- mnohočetný myelom diagnóza farmakoterapie MeSH
- nádorové biomarkery MeSH
- přežití bez známek nemoci MeSH
- prognóza MeSH
- protokoly protinádorové kombinované chemoterapie normy terapeutické užití MeSH
- staging nádorů metody využití MeSH
- statistika jako téma MeSH
- Check Tag
- lidé MeSH
Backgrounds: The current renaissance of the interest in prognostic factors (PF) in multiple myeloma (MM) is determined by the extended possibilities of intensive treatment regimes, which require individual stratification of patients with a need of independent highly predictive prognostic factors. Design and Subjects: The prognostic significance of 7 selected staging systems and some cytokines and adhesive molecules was evaluated in the group of 237 patients with MM treated between 1991-2002 by conventional therapy. Methods and results: The prognostic significance was assessed using survival curves (according to Kaplan-Meier) and log rank test (p<0.05). The prognostic meaning of the age was proved (with borderline for 65 years p=0.0005). The high predictive power (p=0.0000) with significant differences in overall survival medians of defined subgroups was found for Hb, S-creatinin, S-albumin, S-beta2microglobulin, S-thymidinkinase and plasmocytes count in the bone marrow. In the case of propidium-iodide index PI/CD138 (percentage of myeloma cells in S-phase of the cell cycle) with identification of plasmocytes using anti-CD138 monoclonal antibody the prognostic „turning point“ was set for the values of 3.0% with survival medians 48 vs. 15 months (p=0.0023). Serum levels of cytokines IL-6, IL-2 and their receptors, TNF-α and adhesive molecules VCAM-1 and ICAM-1 measured by ELISA method at the time point of MM diagnosis did not show any prognostic significance (p=0.15- 0.84), just the normal and increased sIL-6R serum levels predicted quite different medians of overall survival (30 vs. 11 months). Conclusions: This study proved the prognostic meaning of classical PF (age, Hb, creatinin, beta2-mikroglobulin and bone marrow plasmocytes) and also a very good predictive significance and practical clinical utility of PI/CD138 index and S-album
- Klíčová slova
- jodidový proliferační index plazmocytů, cytoadhezivní molekuly,
- MeSH
- analýza přežití MeSH
- cévní buněčněadhezivní molekula-1 imunologie izolace a purifikace MeSH
- cytokiny imunologie izolace a purifikace MeSH
- financování organizované MeSH
- klinické laboratorní techniky metody využití MeSH
- lidé MeSH
- mezibuněčná adhezivní molekula-1 imunologie izolace a purifikace MeSH
- mnohočetný myelom farmakoterapie terapie MeSH
- plazmatické buňky imunologie patologie transplantace MeSH
- prognóza MeSH
- proliferace buněk MeSH
- propidium MeSH
- prospektivní studie MeSH
- protokoly protinádorové kombinované chemoterapie normy terapeutické užití MeSH
- renální insuficience komplikace MeSH
- rizikové faktory MeSH
- staging nádorů metody využití MeSH
- statistika jako téma MeSH
- thymidinkináza izolace a purifikace škodlivé účinky MeSH
- věkové faktory MeSH
- Check Tag
- lidé MeSH
