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The Merlini, Waldenström, Jayakar staging system revisited
Author(s) -
Merlini Giampaolo,
Gobbi Paolo G.,
Ascari E.
Publication year - 1989
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/j.1600-0609.1989.tb01501.x
Subject(s) - medicine , multiple myeloma , creatinine , beta 2 microglobulin , gastroenterology , bone marrow , population , stage (stratigraphy) , proportional hazards model , paleontology , environmental health , biology
At present, none of the routinely used staging systems is entirely satisfactory, since all of them require some reconsideration to account for the most recent prognostic factors. Among these, serum β‐2 microglobulin (S‐β‐2M) has proved to be a powerful prognostic test assessable in most centers. In order to improve the Merlini, Waldenström, Jayakar (MWJ) staging system, we have determined the prognostic significance of several factors in an independent population of 345 retrospective myeloma patients seen at our institution from 1973 to 1988. The Cox regression hazards method showed that S‐Creatinine, S‐Albumin levels and percentage of bone marrow plasma cells accounted for 94% of total χ 2 achieved with all eight variables (including also: paraprotein index, S‐Calcium, S‐M‐component, bone lesions and hemoglobin). The same analysis, applied to patients in whom S‐β‐2M was available at presentation, selected S‐β‐2M, S‐Creatinine and percentage of bone marrow plasma cells (accounting for 92% of total χ 2 ), followed by platelet count, S‐Albumin and S‐M‐component. The best discriminatory level of S‐β‐2M was found to be 4 mg/***l. However, the prognostic power of S‐β‐2M when used with binary values was remarkably reduced with respect to its application as a continuous variable. In patients with MWJ stage 1 and 2 disease, S‐β‐2M had an independent prognostic significance. Grouping stage I and II patients with S‐β‐2M less than or more than 4 mg/1 presented a median survival of 70 and 40 months, respectively. In stage 3 patients S‐β‐2M did not contribute additional prognostic information. The integration of S‐β‐2M, as a continuous variable, into the MWJ staging system may allow a better assessement of individual death risks.