Predictors Of Progression

Assessment of predictors of progression in smoldering multiple myeloma is hampered by varying diagnostic criteria used to define the condition. Several studies include patients with asymptomatic lytic lesions as well. Future studies of smoldering multiple myeloma will need to use more uniformly accepted criteria so that results can be compared.

Patients with an increase in the number of circulating peripheral blood monoclonal plasma cells are at higher risk for progression to myeloma. An increased plasma cell labeling index of the bone marrow indicates that symptomatic multiple myeloma is present or will develop in the near future.

The three most important prognostic factors for progression in one series included a serum monoclonal protein concentration more than 3.0 g/dL, IgA subtype, and urinary M-protein excretion of more than 50 mg/day. Patients with more than two of these features had a median time to progression of 17 months; those with two factors had a median time to progression of 40 months; and patients who had none of these features had a median time to progression of 95 months.48 Other studies have found that abnormalities on magnetic resonance imaging can predict disease progression in patients with smoldering multiple myeloma.1 Whether patients who have abnormalities on magnetic resonance imaging should be considered as having smoldering multiple myeloma is debatable. Nevertheless, these patients can be considered to have low-grade multiple myeloma and can be observed without therapy, similar to those with smoldering multiple myeloma.

0 0

Post a comment