Abstract
The acronym CRAB summarizes the most typical clinical manifestations of multiple myeloma, these being hypercalcemia, renal failure, anemia, and bone disease. CRAB can be used to distinguish between active, symptomatic multiple myeloma and monoclonal gammopathy of undermined significance or smoldering myeloma. The distinction is relevant not only for classification and diagnosis but also for therapy. CRAB factors influence the prognosis of multiple myeloma. However, it is unclear whether the presence of CRAB factors has an influence on the prognosis of myeloma treated with novel agents. In the current study, patients with hypercalcemia and bone disease showed a significantly worse prognosis, whereas anemia and renal failure showed no difference in survival. Novel agents used for treatment of patients with renal failure suggested a favorable outcome compared with conventional therapy. Bone disease was the most common factor and may have the strongest prognostic value in symptomatic myeloma patients using novel agents.
Highlights
Patients with hypercalcemia and bone disease showed significantly worse survival (Figure 1A,D), whereas those patients with anemia or renal failure showed no difference in survival (Figure 1B,C)
Patients with hypercalcemia and bone disease showed a significantly worse prognosis, whereas anemia and renal failure showed no difference in survival
Novel agents used to treat patients with renal failure appeared to have a favorable outcome compared with conventional therapies, suggesting that renal failure might have been overcome by novel agents
Summary
Patients treated with novel agents included (69%), IgA (14%), and Bence Jones protein those who started with conventional thera- (14%). The acronym CRAB was defined in cri- pies and switched to novel agents. The con- Scoring System, stage 1 was seen in 45% of teria of the International Myeloma Working ventional therapy group was treated only patients, stage 2 in 21%, and stage 3 in. Group in 2003 to simplify the most typical with conventional therapies and with no 34%. Forty-one percent of patients were clinical manifestations of multiple myelo- novel agents. Treated with conventional therapies, and ma, these being hypercalcemia, renal failure, anemia, and bone disease.[1] CRAB fac-. 13% of patients were treated with tors can be used to distinguish between
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