Facteurs pronostiques du myélome utilisables en pratique courante : suivi sur dix ans de 148 malades âgés de plus de 55 ans

Abstract

Objective. – The objective of this study was to identify prognostic factors in a uniform population of older patients with myeloma. Methods. – Thirty-one study centers in France included 148 patients who were older than 55 years at diagnosis and were followed up until death or for at least ten years. The following tests were available for all patients: blood cell counts; serum and urinary protein electrophoresis; and serum levels of creatinine, calcium, β2-microglobulin (β2-m), lactic dehydrogenase (LDH), and C-reactive protein (CRP). Results. – Mean age was 71.9 years, median survival was 34 months, and mean survival was 47 months. In the univariate analysis, factors significantly associated with higher mortality were male gender (odds ratio [OR], 1–2.12), age older than 70 years (OR, 1.10–2.28), serum albumin lower than 30 g/l (OR, 1.16–3.28), serum creatinine greater than 100 μmol/l (OR, 1.34–2.81), β2-m greater than 6 mg/l (OR, 1.78–4), CRP greater than 6 mg/l (OR, 1.44–3.06), hemoglobin lower than 10 g/dl (OR, 1.8–2.23). In the multivariate analysis, only two factors significantly predicted a higher risk of death: β2-m greater than 6 mg/l (OR =2.439 [1.59–3.76]) and CRP greater than 6 mg/l (OR =1.76 [1.18–2.63]). β2-m level was greater than 6 mg/l in 41 (27.7%) patients and CRP was greater than 6 mg/l in 61 (43.6%) patients. Other potential prognostic factors such as chromosome 13 deletion were not investigated because they were not available for all study patients. Conclusions. – The strength of this study is the ten-year follow-up in a uniform patient cohort. β2-m and CRP independently predicted the risk of death.