Risk stratification of newly diagnosed multiple myeloma patients
DOI:
https://doi.org/10.18203/2320-6012.ijrms20241219Keywords:
Myeloma, Risk stratification, Cytogenetic, ISS, R-ISS, mSMARTAbstract
Background: Multiple Myeloma is a neoplastic proliferation of plasma cells, associated with an M (monoclonal) protein in serum and/or urine and evidence of organ damage. Despite advances in treatment, the disease remains heterogeneous, necessitating a comprehensive understanding of its risk stratification. Risk-adapted initial therapy, maintenance therapy, refractory disease management and prognosis varies according to risk group. The aim of our study is to categorize the newly diagnosed MM patients according to their risk groups.
Methods: This cross-sectional observational study was conducted at the Department of Haematology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from August 2019 to July 2020. A total of 31 newly diagnosed MM patients were enrolled based on specific inclusion and exclusion criteria. Risk stratification was performed using ISS, R-ISS, mSMART criteria and Avets risk group categorization.
Result: The majority of the patients were male (64.52%) and aged between 55-64 years (45.16%). Clinical features predominantly included low back pain (74.19%) and general weakness (38.71%). Cytogenetic abnormalities were noted in 38.7% of the patients, with del (13q) being the most common (32.30%). Most patients were in ISS Stage III (70.97%) and R-ISS Stage II (48.39%). According to mSMART criteria, 80.65% were at standard risk while Avet's risk stratification identifies 58.06% were at intermediate risk.
Conclusion: The study reveals a high prevalence of patients in advanced ISS stages and intermediate to high-risk categories, emphasizing the need for early and personalized intervention strategies.
Metrics
References
Rajkumar SV. Multiple myeloma: 2014 Update on diagnosis, risk-stratification, and management. Am J Haematol. 2014;89(10):998-1009.
Corre J, Munshi N, Avet-Loiseau H. Genetics of multiple myeloma: another heterogeneity level? Blood. 2015;125(12):1870-6.
Robiou-Du-Pont S, Cleynen A, Fontan C, Attal M, Munshi NC, Corre J, et al. Genomics of Multiple Myeloma. J Clin Oncol. 2023;35(9):963-7.
Durie BGM, Salmon SE. A clinical staging system for multiple myeloma correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer. 2023;36(3):842-54.
Greipp PR, Miguel JS, Durie BG, Crowley JJ, Barlogie B, Bladé J, et al. International staging system for multiple myeloma. lin Oncol. 2005;23(15):3412-20.
Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L, et al. Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group. J Clin Oncol. 2015;33(26):2863-9.
Avet-Loiseau H, Durie BG, Cavo M, Attal M, Gutierrez N, Haessler J, et al. Combining fluorescent in situ hybridization data with ISS staging improves risk assessment in myeloma: an International Myeloma Working Group collaborative project. Leukemia. 2013 Mar;27(3):711-7.
Hossain MS, Iqbal MS, Khan MA, Rabbani MG, Khatun H, Munira S, et al. Diagnosed hematological malignancies in Bangladesh - a retrospective analysis of over 5000 cases from 10 specialized hospitals. BMC Cancer. 2014 Jun 14 [cited 2023;14(1):438.
Hussain SMA. Comprehensive update on cancer scenario of Bangladesh. South Asian J Cancer. 2013; 2(4):279-84.
O’Connor C. Fluorescence in situ hybridization (FISH). Nature Edu. 2008;1(1):171.
Rajkumar SV. Multiple myeloma: 2022 update on diagnosis, risk stratification, and management. Am J Hematol. 2022;97(8):1086-107.
Kim JE, Yoo C, Lee DH, Kim SW, Lee JS, Suh C. Serum albumin level is a significant prognostic factor reflecting disease severity in symptomatic multiple myeloma. Ann Hematol. 2010;89(4):391-7.
Rossi D, Fangazio M, De Paoli L, Puma A, Riccomagno P, Pinto V, et al. Beta-2-microglobulin is an independent predictor of progression in asymptomatic multiple myeloma. Cancer. 2010; 116(9):2188-200.
Govindasamy P, Pandurangan P, Tarigopula A, Mani R, Samuel CR. Cytogenetic Abnormalities in Multiple Myeloma Patients at a Tertiary Healthcare Center in India. Asian Pac J Cancer Prev. 2019;20(1):235-41.
Sawyer JR. The prognostic significance of cytogenetics and molecular profiling in multiple myeloma. Cancer Genet. 2011;204(1):3-12.
Billecke L, Murga Penas EM, May AM, Engelhardt M, Nagler A, Leiba M, et al. Cytogenetics of extramedullary manifestations in multiple myeloma. Br J Haematol. 2013;161(1):87-94.
Du J, Zhang Y, Liu D, Zhu G, Zhang Q. Hodgkin’s lymphoma with marked granulomatous reaction: a diagnostic pitfall. Int J Clin Exp Pathol. 2019;12(7): 2772-4.
Shaikh SP, Irfan SM, Sheikh SS. Disease staging according to international scoring system in newly diagnosed patients with multiple myeloma. Pak J Med Sci. 2019;35(1):90-4.
Tandon N, Rajkumar SV, LaPlant B, Pettinger A, Lacy MQ, Dispenzieri A, et al. Clinical utility of the Revised International Staging System in unselected patients with newly diagnosed and relapsed multiple myeloma. Blood Cancer J. 2017;7(2):e528.
Rahman M, Keegan A, Mateus J, Kim C. Real-world assessment of the treatment patterns and outcomes among patients with multiple myeloma across different risk stratification criteria in the United States: a retrospective cohort study. Leuk Lymphoma. 2023;64(2):388-97.
Downloads
Published
How to Cite
Issue
Section
