Exploring the Clinicopathological Parameters Affecting the Outcome in Egyptian Patients with Multiple Myeloma

Multiple myeloma (MM) is a plasma-cell neoplasm in which the interplay of several clinical, pathological and genetic parameters affects the patient's prognosis and response to treatment and survival.

The aim of this study was to evaluate the different clinicopathological parameters of MM patients in correlation with response to therapy, progressionfree survival (PFS) and overall survival (OS).

This retrospective study was performed on 60 MM patients diagnosed at NCI, Cairo University from January 2005 to December 2008. The patients were evaluated for different clinicopathological parameters which were correlated to their response to treatment, OS and PFS.

Sixty patients were followed up for a median period of 21 months wherein about 90% received 1st line treatment: 34 VAD, 17 MP and 3 dexamethasone. Six patients (10%) were referred for BSC. CR was achieved by 15%, 11.7% achieved good PR, 6.7% achieved PR, 22.1% have stable disease, 35% experienced disease progression. ECOG PS-I patients have 39 months median survival compared to 12 months for patients with PS ECOG-II (P 0.005). Patients with multiple skeletal lesions (≥3) have median OS of 19 months (P 0.03). Patients who presented with plasmacytoma have better OS than those without (38 months versus 14 months) (P<0.05). Patients <60 years old have a better median OS compared to patients <60 years (37 months versus 12 months) (P 0.001). OS was 39 months in female patients versus 14 months in male patients (P0.025). Median OS was 9 months for patients with comorbidities versus 27 months for those without (P0.01), 39 months for patients with non-detected paraproteinuria versus 18 months for those with paraproteinuria (P 0.045), 18 months for stage II disease versus 12 months for stage III disease (P0.001), 12 months for patients with elevated serum LDH versus 39 months for those with normal levels (P 0.001), 27 months for patients with normal serum creatinine level versus 13 months for those with elevated levels (>1.4 mg/dl) (P 0.005), 27 months for patients with normal serum calcium levels versus 10 months for those with hypercalcemia (P 0.03).

Besides FISH-guided molecular cytogenetic classification of myeloma abnormality, a specific risk-stratification model based upon the patient's age, sex, performance status, lytic bone lesions, plasma cells labeling index, serum creatinine, calcium, LDH, B2M and paraproteins in serum and urine, can depict the response to treatment, OS and PFS of patients with MM.