New Staging Systems Can Predict Prognosis of Multiple Myeloma Patients Undergoing Autologous Peripheral Blood Stem Cell Transplantation as First-Line Therapy

Abstract

Staging systems for multiple myeloma (MM) include the Southwest Oncology Group (SWOG) staging system, the International Staging System (ISS), and the Durie-Salmon (DS) staging system. We evaluated whether staging at the time of diagnosis could predict survival in MM patients undergoing autologous peripheral blood stem cell transplantation (APBSCT) as first-line treatment. Between November 1996 and June 2005, 152 MM patients were treated with induction VAD (vincristine, adriamycin, dexamethasone) chemotherapy, followed by APBSCT at 6 institutions in Korea. Median follow-up times were 22.6 months (range, 5.4-101.9 months) from the day of diagnosis and 14.1 months (range, 0.4-96.1 months) from the day of APBSCT. Progression-free survival (PFS) from the day of diagnosis was predicted by the SWOG staging system ( P = .0129) and ISS ( P = .0299), but not by the DS staging system at diagnosis ( P = .1074). In addition, overall survival (OS) from the day of diagnosis could be predicted by the SWOG staging system ( P = .0207) and ISS ( P = .0105), but not by the DS staging system ( P = .2542). PFS from day of APBSCT was not predicted by the DS staging system ( P = .5731), SWOG staging system ( P = .2817), or ISS ( P = .1167). OS from day of APBSCT could be predicted by the SWOG staging system ( P = .0392) and ISS ( P = .0198), but not by the DS staging system ( P = .5426). Our findings indicate that PFS and OS in association with APBSCT can be predicted by stages assessed by the SWOG and ISS systems, but not by the DS system. Moreover, staging by the SWOG and ISS systems at the time of diagnosis was better correlated with survival than was staging at the time of APBSCT.