Table 1.
Prognostic factors and risk-stratification in myeloma
| Prognostic determinant | Standard-risk | High-risk | Therapeutic implication |
|---|---|---|---|
| Host factors | ECOG performance status 0-2 | ECOG performance status 3-4 | High-risk patients typically require a decrease in treatment intensity |
| Normal renal function | Renal failure (serum creatinine ≥ 2.0) | ||
| Advanced age | |||
| 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(4;14)* | Treatment of high-risk patients remains unsatisfactory, but bortezomib appears to overcome some high-risk features (t4;14) |
| t(11;14) | t(14;16) | ||
| t(6;14) | t(14;20) | ||
| del17p | |||
| High LDH | |||
| High plasma cell proliferative rate | |||
| High-risk signature on GEP |
Modified from Rajkumar et al5 with permission.
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.