Risk Stratification in Multiple Myeloma in Indian Settings

Area of Science:

• Hematology
• Oncology
• Genetics

Background:

• Multiple myeloma (MM) is a significant hematological malignancy with evolving therapeutic options.
• While incurable, median survival has improved to approximately 10 years with newer therapies.
• Conventional karyotyping detects abnormalities in 20-30% of MM patients, whereas array Comparative Genomic Hybridization (aCGH) reveals widespread cytogenetic abnormalities.

Purpose of the Study:

• To review current risk stratification markers and tools for multiple myeloma (MM).
• To discuss adapting these tools for resource-limited settings, focusing on minimal prognostic panels.
• To promote standardization of prognostic protocols in Indian Hematology centers.

Main Methods:

• Review of existing literature on MM risk stratification tools, including cytogenetic analyses (Fluorescent in-situ hybridization, aCGH, Next Generation Sequencing) and traditional markers (albumin, β2 microglobulin, LDH).
• Analysis of the Revised International Staging System (R-ISS) for prognostic scoring.
• Discussion on adapting these methods for cost-effectiveness in resource-constrained environments.

Main Results:

• Array Comparative Genomic Hybridization (aCGH) identifies cytogenetic abnormalities in nearly all MM patients, impacting pathophysiology and outcomes.
• The R-ISS integrates cytogenetic and traditional markers, offering improved prognostic accuracy over previous tools.
• There's a trend towards comprehensive genetic evaluation, increasing costs and patient expenditure, particularly in resource-limited settings.

Conclusions:

• Optimizing risk stratification in MM requires balancing comprehensive genetic information with cost-effectiveness.
• Adapting prognostic panels for resource-limited settings is essential for equitable and standardized patient care.
• Minimal prognostic panels can maximize prognostic information, guiding risk-adapted therapy in diverse clinical settings.