Newly Diagnosed Patients:

Several clinical and laboratory findings provide important prognostic information (see table). These prognostic indicators help determine how fast the tumor is growing, the extent of disease, tumor cell biology, response to therapy, and overall health status of the patient. Prognostic indicators may also help determine when treatment should begin.

Early laboratory results help establish the disease level at diagnosis and provide a baseline against which disease progression and response to therapy can be measured. Many tests can be performed routinely in any laboratory, whereas others are performed only in specialized laboratories or a research setting.

Prognostic Indicators in Myeloma

Test Description Values indicating a more favorable prognosis Beta 2-microglobulin (ß2-microglobulin orß2-M) A protein normally found on the surface of cells; serum levels reflect the extent of disease <3 µg/mL Albumin Level Serum levels often an indication of general health status; higher levels may indicate better prognosis =3.5 g/dL Plasma cell labeling index (PCLI) The relative percentage of plasma cells actively growing; a low PCLI may indicate longer survival < 1% C-reactive protein (CRP) Increased levels of this protein may indicate poorer prognosis <6 µg/mL Lactate dehydrogenase (LDH) Measures tumor-cell burden Age =60 y: 100-190 U/L Age >60 y: 110-210 U/L Plasmablastic morphology The general appearance of plasma cells; increased numbers of immature plasma cells (plasmablasts) indicates poor prognosis Absence of plasmablastic morphology Chromosome analysis (cytogenetic testing) Assesses the number and normalcy of chromosomes; for example, fluorescence in situ hybridization (FISH) is a test that detects abnormalities of specific chromosomes Normal chromosome 13

Genetic Expression Profiling in Myeloma

The response to therapy in multiple myeloma is highly varied, which suggests a genetic component to the disease, although the connection is not well understood. Gene expression profiling (GEP) in multiple myeloma may be used to identify prognostic categories associated with risk levels that can help guide physicians in providing the most effective treatment options for each case.

GEP may hold important keys to effective therapies for individual patients, as we learn that some subtypes respond particularly poorly or well to specific treatments and strategies. For instance, approximately 50% of myeloma cases may be linked to a deletion of chromosome 13, a subtype associated with poor outcomes that necessitates more aggressive treatment. Most recently, an international study of 39 families in which more than one member had multiple myeloma, showed a high probability of a genetic link, which offers some hope of identifying causes.

A number of other genetic abnormalities known as translocations (mismatching of chromosome parts) have been identified in myeloma. Up to 40% of myelomas are linked to one of five specific translocations. The translocation known as t(4;14) is associated with a lower response in patients receiving high-dose therapy and single or double autologous stem cell transplants. Such correlations between genetics and response to various therapies are now beginning to be identified.

A genetic analysis is not routinely performed for newly-diagnosed patients, but a number of institutions are willing to perform the tests. Ask your doctor to recommend an appropriate testing site near you and your family. Genetic analysis may provide you with more information to fight your disease in targeted ways. At the same time, undergoing genetic analysis can add to the growing body of genetic research concerning myeloma. Ultimately, it is hoped that genetic profiling will lead to highly individualized-and more effective-treatment regimens.