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There is significant variation in the survival of patients with multiple myeloma.
Based on the ISS, the median survival of patients with stage I, II, or III disease is estimated at 62, 44, and 29 months, respectively.
Although serum β2-microglobulin and albumin levels combine in the ISS to provide a powerful prognostic tool, a number of independent prognostic markers have been described that may further assist in predicting outcome. Many established prognostic markers allowing identification of high-risk patients early in the disease course have been derived from studies of conventional chemotherapy and include age, β2-microglobulin level, World Health Organization (WHO) performance status, serum calcium, interleukin-6 (IL-6) level, bone marrow plasma cell labeling index, and morphological features.
However, in the current era of high-dose chemotherapy, novel immunomodulatory agents, and new small molecule inhibitors, a number of other prognostic markers relating to mechanisms of disease progression are now considered to be important.
Abnormal cytogenetics play a dominant role in predicting the outcome of patients with acute leukemia, and the evidence now suggests that cytogenetics have a similar role in multiple myeloma. Tricot and colleagues observed, using standard cytogenetic techniques, that in patients with newly diagnosed or previously treated disease, the presence of partial or complete deletions of chromosome 13 (del13q) and 11q abnormalities were associated with inferior event-free survival (EFS) and OS. In addition, they noted a significant association between the unfavorable karyotypes and immunoglobulin A (IgA) isotype, elevated levels of β2-microglobulin, and age >60 years.
