Prognosis and survival for multiple myeloma
A prognosis is the doctor's best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors.
The doctor will look at certain aspects of the cancer as well as characteristics of the person. These are called prognostic factors. The doctor will also look at predictive factors, which influence how a cancer will respond to a certain treatment and how likely it is that the cancer will come back after treatment.
Prognostic and predictive factors are often discussed together. They both play a part in deciding on a prognosis and a treatment plan just for you. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis and chances of survival.
The following are prognostic and predictive factors for multiple myeloma.
Stage
Multiple myeloma that is at a lower stage at the time of diagnosis has a better prognosis.
Age
People 80 years of age and older have a worse prognosis than younger people.
Blood test results
The results of certain blood tests are important in determining the prognosis for multiple myeloma.
Beta-2-microglobulin
Beta-2-microglobulin is a protein found on the surface of myeloma cells that plays a role in the immune response.
A higher level of beta-2-microglobulin in the blood predicts a poor prognosis.
Albumin
Albumin is the main protein in
A higher level of albumin in the blood predicts a better prognosis.
Lactate dehydrogenase
Lactate dehydrogenase (LDH) is an enzyme involved in energy production in cells. LDH is used to help understand how much cancer is in the body (called tumour burden).
A higher level of LDH in the blood predicts a poor prognosis.
Creatinine
Creatinine is a waste product of muscle breakdown that is removed from the blood by the kidneys. Measuring the creatinine level shows how well the kidneys are working.
A high creatinine level in the blood predicts a worse prognosis.
Chromosome changes
Chromosomes hold your genetic information. Doctors look at cells removed from the bone marrow to see if there are changes to the chromosomes in the myeloma cells. Some changes to chromosomes are linked to a poor prognosis, including:
- a missing chromosome 13 (called a deletion)
- a missing part of chromosome 17 (called a 17p deletion)
- a rearranged chromosome 14 (called a translocation)
- an extra copy of part of chromosome 1 (called a 1q gain or amplification)
- a missing part of chromosome 1 (called a 1p deletion)
Plasma cell labelling index
The plasma cell labelling index (PCLI) measures how fast myeloma cells are growing in a sample of cells removed from the bone marrow.
A high PCLI predicts that the myeloma cells are growing quickly and is linked to a poor prognosis.
Plasma cell leukemia
If there are 5% or more plasma cells found in a blood smear test (called plasma cell leukemia), this predicts a poor prognosis.
C-reactive protein
C-reactive protein is made in the liver and is released into your blood when you have inflammation in your body.
A high level of C-reactive protein in the blood predicts a poor prognosis.
Performance status
Performance status is ranked on a scale of 0 to 4. A lower number indicates that a person is in better health and is able to be more active than a person with a higher number.
Performance status is important in multiple myeloma because people who have a good performance status are able to withstand intensive treatments that may have a better outcome but have more side effects.
Response to treatment
Multiple myeloma that responds well to initial treatment and goes into a
Genetic signatures
Gene expression profiling is a way for doctors to analyze many genes at the same time to see which genes are turned on and which are turned off. Doctors have found several abnormal gene patterns (called a genetic signature) in people with multiple myeloma. These genetic signatures are helpful in making a prognosis.
Some genetic signatures are linked to a better prognosis and better response to treatment while other signatures are associated with a worse prognosis.
Spread to the central nervous system
Multiple myeloma that has spread to the brain and spinal cord (called the central nervous system) predicts a poor prognosis.
Risk stratification
Survival statistics for multiple myeloma
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