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Multiple myeloma

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Prognosis and survival for multiple myeloma

People with multiple myeloma may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person's medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.

A prognosis is the doctor's best estimate of how cancer will affect a person, and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.

The following are prognostic and predictive factors for multiple myeloma.

Stage

As with most cancers, the lower the stage of multiple myeloma, the better the outcome.

Kidney function

Kidney function and the level of creatinine in the blood are used to subdivide multiple myeloma stages into substages A and B. Substage B indicates kidney failure and an elevated level of creatinine, which are poor prognostic factors.

Age

Younger people have a better prognosis than older people.

Labelling index

The labelling index indicates how fast the cancer cells are growing. A high plasma cell labelling index (PCLI) or proliferation (reproduction) rate is a poor prognostic factor.

Chromosome changes

Some chromosomal changes indicate a poorer prognosis, including:

  • a missing chromosome 13 (deletion)
  • a rearranged chromosome 14 (translocation)

Performance status

Performance status is ranked on a 0–4 scale. The lower the number, the healthier and more active the person is, and the better the prognosis. Performance status is important in multiple myeloma because people who are healthier can withstand more intensive treatment.

Blood tests

Blood tests play an important role in determining prognosis in people with 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 predicts a poorer prognosis. The level of this protein increases:

  • as the stage gets higher
  • if kidney damage is present

Albumin

Albumin is the main protein found in plasmaplasmaThe liquid part of blood that carries the blood cells. Plasma contains many proteins and minerals. that helps to maintain blood volume. A higher level of albumin predicts a better prognosis.

Lactate dehydrogenase

Lactate dehydrogenase (LDH) can be used as a measure of tumour burden (the amount of cancer in the body). A higher level of lactate dehydrogenase (LDH) predicts a poorer prognosis.

Response to treatment

People whose cancer responds to treatment and goes into complete remissioncomplete remissionA decrease in or the disappearance of signs and symptoms of a disease (such as cancer). have a better prognosis than people whose cancer does not respond to the initial treatment.

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