Staging Systems and Prognostic Factors as a Guide to Therapeutic Decisions in Multiple Myeloma

Kyrtsonis, Marie-Christine; Maltezas, Dimitrios; Tzenou, Tatiana; Koulieris, Efstathios; Bradwell, Arthur R.

doi:10.1053/j.seminhematol.2009.02.004

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Volume 46, Issue 2 , Pages 110-117, April 2009

Staging Systems and Prognostic Factors as a Guide to Therapeutic Decisions in Multiple Myeloma

Marie-Christine Kyrtsonis
- First Department of Propedeutic Internal Medicine and Hematology Department, National and Kapodistrian University of Athens Medical School, Laikon General Hospital, Athens, Greece
- Address correspondence to Marie-Christine Kyrtsonis, MD, First Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens' School of Medicine, Laikon University Hospital, Agiou Thoma 17, Athens 11727, Greece
Dimitrios Maltezas
- First Department of Propedeutic Internal Medicine and Hematology Department, National and Kapodistrian University of Athens Medical School, Laikon General Hospital, Athens, Greece
Tatiana Tzenou
- First Department of Propedeutic Internal Medicine and Hematology Department, National and Kapodistrian University of Athens Medical School, Laikon General Hospital, Athens, Greece
Efstathios Koulieris
- First Department of Propedeutic Internal Medicine and Hematology Department, National and Kapodistrian University of Athens Medical School, Laikon General Hospital, Athens, Greece
Arthur R. Bradwell
- Department of Immunology, University of Birmingham, Birmingham, UK

Multiple myeloma (MM) patients have a highly variable disease course and survival varies from a few months to more than 10 years. Numerous prognostic factors have been identified, including age, performance status (PS), serum albumin, β₂-microglobulin (β₂M), lactate dehydrogenase (LDH), renal function, genetic factors, and serum free light chains (sFLCs) or their ratio (sFLCR). Several models have been built to separate patients into various risk groups with different outcomes. Staging systems need to be simple, accurate, and readily available in order to effectively guide treatment decisions now that effective treatments exist that prolong survival. The International Staging System (ISS) is currently in use; it is highly prognostic but presents some limitations. We suggest that the ISS prognostic potential could be improved with the addition of sFLCR and eventually LDH.