Prognostic factors and risk stratification in myeloma
| Prognostic determinant . | Standard risk . | High risk . | Therapeutic implication . |
|---|---|---|---|
| Host factors | ECOG performance status 0-2 Normal renal function | ECOG performance status 3 or 4 Renal failure (serum creatinine ≥ 2.0) Advanced age | High-risk patients typically require a decrease in treatment intensity |
| Tumor burden | Durie-Salmon stage I, II | Durie-Salmon stage III | Limited; some stage I patients require no therapy (smoldering myeloma), and some require radiation only (if solitary bone lesion) |
| Tumor biology (disease aggressiveness) | Hyperdiploidy t(11;14) t(6;14) | t(4;14)* t(14;16) t(14;20) 17p- High LDH plasma cell proliferative rate High-risk signature on gene-expression profiling | Treatment of high-risk patients remains unsatisfactory, but bortezomib appears to overcome some high-risk features (t4;14) |
| Prognostic determinant . | Standard risk . | High risk . | Therapeutic implication . |
|---|---|---|---|
| Host factors | ECOG performance status 0-2 Normal renal function | ECOG performance status 3 or 4 Renal failure (serum creatinine ≥ 2.0) Advanced age | High-risk patients typically require a decrease in treatment intensity |
| Tumor burden | Durie-Salmon stage I, II | Durie-Salmon stage III | Limited; some stage I patients require no therapy (smoldering myeloma), and some require radiation only (if solitary bone lesion) |
| Tumor biology (disease aggressiveness) | Hyperdiploidy t(11;14) t(6;14) | t(4;14)* t(14;16) t(14;20) 17p- High LDH plasma cell proliferative rate High-risk signature on gene-expression profiling | Treatment of high-risk patients remains unsatisfactory, but bortezomib appears to overcome some high-risk features (t4;14) |
ECOG indicates Eastern Cooperative Oncology Group; and LDH, lactate dehydrogenase.
t(4;14) is considered “intermediate-risk” based on improved results seen now with bortezomib-based initial therapy.