Prognosis refers to the likely outcome of a disease and the chance of it recurring.
Several factors influence the prognosis of myeloma. These include prognostic indicators, survival statistics, myeloma staging, minimal residue disease, and relapsed and refractory disease.
Prognostic indicators include results of diagnostic testing that give an idea about the nature of the disease, its rate of spread, response to therapy, and the overall health of the patient. Some indicators of a favorable prognosis for myeloma include:
- Less than 3 mg/mL of a tumor marker called beta 2-microglobulin (beta-2 M) in the blood.
- Greater than or equal to 3.5 g/dL of albumin in the blood.
- 100–190 U/L of serum lactate dehydrogenase (LDH) for patients age 60 and younger, and 110–210 U/L for those older.
- Results of the serum-free light chain assay — increased levels of free light chains indicate monoclonal gammopathy of undetermined significance.
- Absence of chromosomal abnormalities.
- Presence of genes that can predict a low risk of early relapse as determined by gene expression profiling.
The survival of a patient with myeloma is dependent on several factors including the type and stage of cancer at diagnosis, the patient’s age and fitness levels, and treatment. While survival rates cannot predict an individual’s longevity, they can indicate how successful a treatment may be.
An important indicator is the five-year survival rate. This is the percentage of patients who live at least five years after a myeloma diagnosis. For example, a five-year survival rate of 95% indicates that 95 out of 100 people who have myeloma are alive five years after diagnosis. Many people with myeloma continue to live much longer than this.
Apart from five-year survival rates, one-year and 10-year survival rates are also accounted for in survival statistics. For instance, myeloma patients in England and Wales have a one-year survival rate greater than 75%, a five-year survival rate of about 50%, and a 10-year survival rate of about 35%.
An improvement in survival rates indicates early diagnosis, better detection, and better efficacy of treatments. For example, the five-year survival rate was 49.6% for multiple myeloma for 2007 to 2013 in the U.S., which is a significant improvement compared to the 34.5% five-year survival rate that was the norm about 13 years ago.
Similarly, the one-year net survival in men increased from 37% in 1971–1972 to 78% during 2010–2011 in England and Wales while in the case of women, it increased from 38% to 75% in the same period.
Staging of myeloma during diagnosis determines the extent of cancer progression and is important when devising an effective treatment plan. There are two systems of myeloma staging: the international staging system and the Durie-Salmon staging system.
International staging system
The international staging system (ISS) is the most common staging system for myeloma, and is primarily based on levels of beta-2 M and albumin in the blood. The revised ISS has the following stages:
- Stage 1: less than 3.5 mg/L of beta-2 M and greater than or equal to 3.5 g/dL of albumin, absence of high-risk DNA abnormalities, normal LDH levels
- Stage 2: defined as not stage 1 or stage 3
- Stage 3: greater than or equal to 5.5 mg/L of beta 2-M, presence of high-risk DNA abnormalities, high LDH levels
Durie-Salmon staging system
The Durie-Salmon staging system is an older system that uses the correlation between the amount of myeloma and the extent of damage it has caused, which is measured in terms of the amount of hemoglobin and calcium in the blood, number of bone lesions, and the production rate of M-protein. It is then further categorized based on kidney function.
Minimal residual disease
Minimal residual disease (MRD) refers to the number of myeloma cells that are still present in the bone marrow after completion of treatment and the beginning of disease remission. The leftover myeloma cells after treatment may go on to divide and eventually cause disease relapse.
The determination of MRD is an indicator of the success of treatment. MRD-negative patients (those who achieve a complete response to therapy with no detectable MRD) have higher survival rates.
Researchers are developing a number of techniques for the accurate assessment of MRD in myeloma patients. However, the U.S. Food and Drug Administration must first approve these methods before doctors can use them in clinical tests.
Relapsed and refractory disease
Doctors say that myeloma has relapsed when cancer returns after a period of remission. Refractory disease indicates that the disease does not respond to therapy either initially or following a relapse. Relapsed or refractory multiple myeloma (RRMM) is treated with various treatment combinations such as a proteasome inhibitor and/or an immunomodulatory treatment.
Researchers are evaluating new treatment combinations along with the use of autologous hematopoietic stem cell transplant and HDAC inhibitors in clinical trials to improve progression-free survival in RRMM patients.
Last updated: March 17, 2020
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