Exploration Of The Risk Factors And Assessment On The Clinical Staging Systems Of Patients With Multiple Myeloma

Objective:To explore the risk factors influencing the survival time of the patients with multiple myeloma(MM) by analysing the presenting features and the prognostic factors. And to compare and analyse the Durie Salmon(DS) and International Staging System(ISS) staging systems of the patients with MM.Methods:Retrospective study was applied to analyze the clinical data of 81 MM cases in Guizhou Provincial Hospital from January 1999 to July 2010. Clinical and laboratory indexes were analyzed by univariate and multivariate analysis. Ultra high-risk patients (died within 24 months) were compared with other cases in order to identify the prognostic factors of ultra high-risk patients.59 cases detectingβ2 microglobulin((32M) were classified into the DS and ISS staging systems in order to compare their survival times.Results:Of the 81 patients,47 were male and 34 were female, the ration is 1.38:1, the median age was 63 years. IgG was the most common type(51.85%). Of the 81 patients, stageⅢaccording to DS were 60(74.08%),59 patients detectingβ2M in which 37(62.71%) were diagnosed on stageⅢaccording to ISS and 44(74.59%) to DS. Univariate analysis showed that factors such as hemoglobin, serum creatinine(Scr), lactate dehydrogenase(LDH), serum albumin(ALB),β2M, corrected serum calcium and percentage of plasma cell in bone marrow were related with the prognosis. And multivariate analysis showed only Scr, ALB,β2M and corrected serum calcium were independent prognostic factors. Of the 81 patients,37(45.68%) were ultra high-rish MM in which 19(79.17%) were diagnosed on stageⅢaccording to ISS and 32(86.49%) to DS. Level of blood platelet, Scr,β2M, ALB corrected serum calcium and percentage of plasma cell in bone marrow had statistical significance between the two groups(P<0.05). In ISS, there were statistically significance in survival time between stageⅠandⅡ(P=0.039),ⅠandⅢ(P=0.010), but not betweenⅡandⅢ(P=0.116). In DS, there were statistically significance in survival time between stageⅡA andⅢB(P=0.002),ⅢA andⅢB(P=0.036), but not in other stages.Conclusion:Scr, ALB,β2M and corrected serum calcium are considered as risk factors in survival time of MM. Level of Scr,β2M, ALB, blood platelet, corrected serum calcium, percentage of plasma cell in bone marrow and in stageⅢwhen diagnosed are the risk factors in ultra high-rish patients. The ISS could be a simple alternative to DS stage for patients. But in ISSⅡandⅢcouldn't be distinguished well for the patients in China. However, DS stage appears to be optimal for the advanced patients compared with ISS. In clinical, we could use both ISS and DS staging system and make up for each other's deficiencies.