Diagnosis Of Multiple Myeloma Patients Research Articles

Changes in income and employment after diagnosis among patients with multiple myeloma in The Netherlands

ObjectiveDue to new treatment options, survival rates in multiple myeloma (MM) are improving. Consequently, maintaining work and income is becoming more important for patients and society. Therefore, we aimed to explore the change in income and employment in patients with MM. MethodsData from the Netherlands Cancer Registry of MM patients diagnosed between 2012 and 2017 were merged with socioeconomic data from Statistics Netherlands. Descriptive statistics were used to analyse total income, income from employment, and accumulated income before and after diagnosis. ResultsIncome from employment decreased by 45% in MM patients, between 1 year before and 4 years after diagnosis Four years after diagnosis, 35% of the patients were still employed, with an accumulated 5-year productivity loss of €121 million. Higher income loss from employment and job loss was observed in female patients, patients with more extensive disease, or those not treated with autologous stem cell transplant. ConclusionLoss of (income from) employment among patients with MM was high, causing financial burden on the patient and society. With improving survival in MM, more research and awareness are needed to better assess the importance of income and work for MM patients and society.

Absolute Quantification of Pan-Cancer Plasma Proteomes Reveals Unique Signature in Multiple Myeloma.

Mass spectrometry based on data-independent acquisition (DIA) has developed into a powerful quantitative tool with a variety of implications, including precision medicine. Combined with stable isotope recombinant protein standards, this strategy provides confident protein identification and precise quantification on an absolute scale. Here, we describe a comprehensive targeted proteomics approach to profile a pan-cancer cohort consisting of 1800 blood plasma samples representing 15 different cancer types. We successfully performed an absolute quantification of 253 proteins in multiplex. The assay had low intra-assay variability with a coefficient of variation below 20% (CV = 17.2%) for a total of 1013 peptides quantified across almost two thousand injections. This study identified a potential biomarker panel of seven protein targets for the diagnosis of multiple myeloma patients using differential expression analysis and machine learning. The combination of markers, including the complement C1 complex, JCHAIN, and CD5L, resulted in a prediction model with an AUC of 0.96 for the identification of multiple myeloma patients across various cancer patients. All these proteins are known to interact with immunoglobulins.

CD229 (Ly9) a Novel Biomarker for B-Cell Malignancies and Multiple Myeloma.

Simple SummaryCD229 is a cell-surface molecule predominantly expressed on lymphocytes. Its expression in B-cell malignancies is poorly known. We tested the presence of this immunoreceptor on a large number of malignancies and normal tissue using a new monoclonal antibody and tissue microarrays. Our data show that CD229 expression is restricted to hematopoietic cells. It was strongly expressed in myeloma and marginal-zone lymphomas. Because of the high expression on multiple myeloma cells, we also analyze the presence of soluble CD229 in the sera of these patients. We showed that serum levels of soluble CD229 in myeloma patients, at the time of diagnosis, could be useful as a prognostic biomarker. Altogether, our results indicate that CD229 represents not only a useful disease biomarker but also an attractive therapeutic target.CD229 (Ly9) homophilic receptor, which belongs to the SLAM family of cell-surface molecules, is predominantly expressed on B and T cells. It acts as a signaling molecule, regulating lymphocyte homoeostasis and activation. Studies of CD229 function indicate that this receptor functions as a regulator of the development of marginal-zone B cells and other innate-like T and B lymphocytes. The expression on leukemias and lymphomas remains poorly understood due to the lack of CD229 monoclonal antibodies (mAb) for immunohistochemistry application (IHC). In this study, we used a new mAb against the cytoplasmic region of CD229 to study the expression of CD229 on normal tissues and B-cell malignancies, including multiple myeloma (MM), using tissue microarrays. We showed CD229 to be restricted to hematopoietic cells. It was strongly expressed in all cases of MM and in most marginal-zone lymphomas (MZL). Moderate CD229 expression was also found in chronic lymphocyte leukemia (CLL), follicular (FL), classic mantle-cell (MCL) and diffuse large B-cell lymphoma. Given the high expression on myeloma cells, we also analyzed for the presence of soluble CD229 in the sera of these patients. Serum levels of soluble CD229 (sCD229) at the time of diagnosis in MM patients could be useful as a prognostic biomarker. In conclusion, our results indicate that CD229 represents not only a useful biomarker but also an attractive therapeutic target.

Prognostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography at diagnosis in untreated multiple myeloma patients: a systematic review and meta-analysis.

Multiple myeloma is a clonal B-lymphocyte tumor of terminally differentiated plasma cells. 18F-FDG PET/CT can provide valuable data for the diagnosis, restaging, and evaluate prognosis of multiple myeloma (MM). This meta-analysis aimed to evaluate the prognostic value of pre-treatment 18F-FDG PET/CT at diagnosis in MM patients. Related researches came from Embase, PubMed, and Cochrane Library databases through a systematic search, and the last one was updated on April 26, 2021. Cochran Q test and I-squared statistics were used to test for heterogeneity among the studies analyzed. The fixed model and random model were used to combine results when appropriate. Stata 12.0 was used to perform statistical analysis, and p < 0.05 was considered statistically significant. A total of 16 articles with 2589 patients were included in this study. Our results indicated PET/CT has an excellent prognostic role in MM, that higher SUVmax, more FL and EMD were associated with poor OS and PFS. SUVmax: OS (HR 1.89, 95% CI 1.47-2.44), PFS (HR 1.34, 95% CI 1.18-1.51); Fl: OS (HR 2.65, 95% CI 1.83-3.79), PFS (HR 1.61, 95% CI 1.40-1.86); EMD: OS (HR 2.11, 95% CI 1.41-3.16), PFS (HR 2.18, 95% CI 1.69-2.81). Furthermore, similar results were observed in most subgroup analyzes. Conclusion Pre-treatment 18F-FDG PET/CT examination has prognostic value for myeloma patients and has guiding significance for clinical treatment.

Evaluation of Correlation between Serum Free Light-Chain Assay and Bone Marrow Study in Multiple Myeloma Patients.

Background: Multiple myeloma is a hematologic malignancy manifested by the secretion of abnormal immunoglobulin. Different methods have been described for diagnosis and patient response to management. Serum free light-chain assay is recently approved in the diagnosis of multiple myeloma patients. This study aimed to evaluate the diagnostic accuracy of serum free light-chain assay and its agreement to bone marrow findings. Materials and Methods: Forty-six patients with the diagnosis of multiple myeloma were enrolled in the study. The patients were grouped into newly diagnosed cases (22 patients,47.8%) and known cases who were under treatment (24 patients,52.2%). Bone marrow study was done and percentage and clonal status of plasma cells were evaluated by a combination of immunohistochemistry and flow cytometry. Free light-chain assay was done in all patients and sensitivity, specificity, positive predictive value, and negative predictive value were analyzed. Results: Thirty of 46 patients showed monoclonal plasma cell infiltration and 16 patients showed polyclonal plasma cell infiltration based on bone marrow findings. An abnormal κ/λ ratio was seen in 15(68.18%) of new cases and 16(66.6%) of known cases. Sensitivity, specificity, PPV and NPV for κ⁄λ ratio were 72.73%, 46.15%, 71%, and 50%, respectively. Conclusion: In conclusion, due to high false positive and false negative results, the presence of an abnormal serum FLC ratio was not equal to the presence of monoclonal gammopathy, and observation of a normal ratio does not exclude the presence of monoclonal gammopathy.

Economic Model Shows That Guideline Recommended Testing of Patients with Early Symptoms of Myeloma Results in Improved Patient Outcomes and Decreased Hospital Costs

Introduction : Multiple myeloma (MM) is a hematologic cancer of the plasma cells, which are found in the bone marrow. The early symptoms of MM are often vague and non-specific, such as fatigue, bone pain and back pain. These vague symptoms lead patients to present first to their primary care physician and often delay diagnosis resulting in progressive disease [MayoClinic.org]. The median time for MM diagnosis (163 days) is longer than for most other hematologic cancers including leukemias and lymphomas [Howell et al, BMC Hematol, 2013]. Delayed diagnosis of MM is commonly associated with the development of chronic complications such as renal impairment, infections, neurological disease, bone disease and anemia [Kariyawasan et al, Q J Med, 2007]. Therefore, early detection and diagnosis of MM are essential to avoid downstream complications, and may significantly reduce the treatment costs associated with these complications. In the assessment of symptomatic patients, National Comprehensive Cancer Network (NCCN) practice guidelines recommend using three tests to maximize sensitivity and specificity: serum protein electrophoresis (SPE), serum immunofixation electrophoresis (SIFE) and serum free light chains (SFLC) [NCCN Multiple Myeloma Guidelines Version 3.2017]. However, physician compliance with these guidelines is hampered by the many different test options available and the low visibility of Myeloma on the list of possible causes for the primary care physician. In the current study, we modeled the effect of converting a hospital system over to guideline compliance in testing for Multiple Myeloma.Methods : A decision analytic model was developed to estimate the total costs and annual budget impact when using the guideline recommended panel for early diagnosis of MM patients. Using a US hospital (i.e., integrated delivery network [IDN]) model perspective, a decision algorithm was developed based on NCCN and IMWG clinical practice guidelines and further validated by clinicians [Rajkumar et al, Lancet Oncol. 2014]. Comparators include SPE alone, SPE+SFLC, SPE+UPE (urine protein electrophoresis), SPE+SIFE and SPE+SFLC+SIFE. Epidemiology estimates were from the SEER database [Surveillance, Epidemiology, and End Results (SEER) Program SEER*Stat]. Test sensitivity and specificity and downstream complication rates were based on published sources [Katzmann et al, Clin Biochem Rev, 2009 and McTaggart et al. Am J Clin Pathol, 2013]. Lab and imaging costs were collected from the CMS laboratory fee schedule and downstream complication treatment costs from the HCUP National Inpatient Sample database.Results : For an average IDN, a total of 967 patients are estimated to undergo evaluation for MM each year. Conversion from typical current practice to guideline compliance is estimated to reduce the time to MM diagnosis from 159 days to 45 days per patient (64% reduction). The number of correct MM diagnoses increases from 949 to 967 per year. Hospital laboratories would expect to invest $37,680 per year in additional diagnostic costs in order to save the hospital system a total of $74,135 annually in averted complications (24% reduction in complications) resulting from earlier diagnosis. From a cost-benefit perspective, this translates to a reduced cost/correct diagnosis of about $48 and savings per averted complication of $3,975 for the hospital system.Conclusions: Guideline recommended testing of patients with early symptoms of Multiple Myeloma can help reduce costs, improve patient outcomes and increase efficiency of care. Hematologists, as stewards of the guidelines, should help in educating primary care physicians on warning signs of MM and appropriate diagnostic tests. [Display omitted] DisclosuresWu:Celator/Jazz: Consultancy. Jensen:Celator/Jazz: Consultancy. Cyr:Celator/Jazz: Consultancy.

A Single Autologous Stem Cell Transplant (ASCT) Followed By Two Years of Post-Transplant Therapy Is Safe in Older Recently Diagnosed Multiple Myeloma (MM) Patients. Preliminary Results from the Prospective Phase II Trial (NCT01849783)

Introduction: The median age at diagnosis of MM patients is around 70. The current standard of treatment for younger eligible MM patients is ASCT after initial induction chemotherapy. Multiple studies have shown that age by itself is not necessarily an exclusion criterion for transplant and that elderly eligible patients derive benefits from ASCT. While melphalan 200mg/m2 has been the standard preparative regimen for ASCT, more studies are currently evaluating the role of including novel agents along with melphalan to improve outcomes. We previously reported the safety and efficacy of VDT-Mel in patients mostly younger than 65 years. Here we report the tolerability of the same regimen in elderly patients.Methods and patients: A total of 41 eligible patients above the age 65 were prospectively enrolled in the IRB approved phase II trial beginning in June 2013. After an induction chemotherapy and stem cell collection, ASCT was performed with a preparative chemotherapy consisting of VDT-Melphalan 200mg/m2. Early after engraftment, patients were started on maintenance for 2 years with triple agent therapy. Primary end points include PFS, frequency of severe toxicities, ICU admissions, and percentage of patients able to complete the full course of maintenance.Results: Of the 41 patients enrolled, 37 patients had at least day 100 follow up post-transplantation and were included in this analysis. Six have been removed from study due to relapse (N=2), development of acute leukemia (N=1), failure to collect stem cells (N=1) or failure to comply with therapy (N=2). Toxicity and best response were assessed at day 100. Median age was 68 (range: 65 to 75). Median follow up was 21 months (3.5 months - 3.7 years). Major non-hematologic toxicities ≥ grade 3 were related to infections (25%), diarrhea (16%) and mucositis (11%). Median time to ANC and platelet engraftment was 11 and 17 days, respectively. 18 patients achieved a stringent CR (sCR) by day 100 restaging (50%). There was one death within day 100 related to candida sepsis. Only 2 patients were re-hospitalized within 100 days. Thirty-five patients started maintenance therapy. Median time to start post-transplant therapy was 66 days (range: 42 to 174 days).Conclusion: This is the first trial to prospectively evaluate the feasibility of combined intensified preparative regimen with two years of maintenance using triple agent therapy in elderly MM patients. Toxicity and mortality were not increased compared to the younger patients (median age 59) receiving a similar regimen. It is too early to comment on the efficacy of this approach, but we are encouraged by the high frequency of sCR, early after transplantation. DisclosuresNo relevant conflicts of interest to declare.

Presentation and survival of multiple myeloma patients in Ghana: a review of 169 cases.

Africans have an increased risk for multiple myeloma (MM) compared to other races. Reports from Africa are few and involve small cohorts, but suggest significant epidemiological and clinical differences from Caucasian patients. This report describes the clinic-pathological features of MM patients in Ghana at diagnosis, and the factors affecting their survival. A retrospective review of 169 MM cases diagnosed in a Ghanaian tertiary hospital from 2002-2016. Median age was 58 years, with 29% ≤50 years. One-third presented >12 months after onset of symptoms, which included bone pain (96%), anaemia (67%), weight loss (55%) and fractures (44%). Myeloma-related tissue impairment included hypercalcaemia (36%), renal impairment (33%), severe anaemia (52%) and osteolytic lesions (76%); 51.3% of patients were diagnosed in ISS Stage III. Median survival was 33 months; 1-year and 5-year overall survival were 51.6% and 15.5%, respectively. Neither the age at diagnosis nor the duration of symptoms prior to diagnosis correlated with prognosis. Median survival improved with early ISS stage, haemoglobin >8g/dL, plasmacytosis <20%, and normal creatinine and calcium levels. Early onset and late stage presentation are common at diagnosis of MM patients in Ghana, but do not affect survival. Studies into genetic associations are recommended. None.

Prognostic or predictive value of circulating cytokines and angiogenic factors for initial treatment of multiple myeloma in the GIMEMA MM0305 randomized controlled trial

BackgroundSeveral new drugs are approved for treatment of patients with multiple myeloma (MM), but no validated biomarkers are available for the prediction of a clinical outcome. We aimed to establish whether pretreatment blood and bone marrow plasma concentrations of major cytokines and angiogenic factors (CAFs) of patients from a phase 3 trial of a MM treatment could have a prognostic and predictive value in terms of response to therapy and progression-free and overall survival and whether these patients could be stratified for their prognosis.MethodsBlood and bone marrow plasma levels of Ang-2, FGF-2, HGF, VEGF, PDGF-β, IL-8, TNF-α, TIMP-1, and TIMP-2 were determined at diagnosis in MM patients enrolled in the GIMEMA MM0305 randomized controlled trial by an enzyme-linked immunosorbent assay (ELISA). These levels were correlated both reciprocally and with the type of therapy and patients’ characteristics and with a group of non-MM patients as controls.ResultsNo significant differences were detected between the blood and bone marrow plasma levels of angiogenic cytokines. A cutoff for each CAF was established. The therapeutic response of patients with blood plasma levels of CAFs lower than the cutoff was better than the response of those with higher levels in terms of percentage of responding patients and quality of response.ConclusionFGF-2, HGF, VEGF, and PDGF-β plasma levels at diagnosis have predictive significance for response to treatment. The stratification of patients based on the levels of CAFs at diagnosis and their variations after therapy is useful to characterize different risk groups concerning outcome and response to therapy.Trial registrationClinical trial information can be found at the following link: NCT01063179

In silico screening of proteins targeting circulating miRNAs for improved diagnosis of multiple myeloma

Multiple Myeloma (MM) is a B-cell malignancy, which is characterized by the expansion of clonal plasma cells in the bone marrow, leading to abnormal accumulation of monoclonal antibodies in circulation. Certain circulating miRNAs are deregulated in MM and their differential expression profiles in body fluids can be quantified and used to discriminate between the premalignant and malignant stages of MM. Our study identifies protein which would show affinity for a selected panel of circulating miRNAs deregulated in MM. Human RNA binding proteins were identified based on their unique RNA binding domains and their interacting probabilities with the panel of miRNAs deregulated in MM. miR-26 was used as a negative control for interaction studies. 3-D structure of candidate proteins were determined and molecular docking was performed to confirm the results. Five RNA binding proteins TROVE2, CUGBP2, DHX8, PUM2 and DKC1 were used for molecular docking studies. DKC1 showed significant hydrogen bonding as well as remarkable binding affinity values of −17.4 kcal/mol with miR-720 (2 H-bonds), −16 kcal/mol with miR-1246 (1 H-bond) and −16.9 kcal/mol with miR-1308 (3 H-bonds). Identified protein-miRNA interaction could be used to develop an economical and reliable ELISA based methodology for improved and sensitive diagnosis of MM patients.

Diagnostic Performance of 18F-FDG PET or PET-CT in Multiple Myeloma: A Systematic Review and Meta-analysis

Objectives: Conduct a systematic review and meta-analysis to assess the diagnostic performance of 18Ffluorodeoxyglucose positron emission tomography (18F-FDG PET) or PET-computed tomography (PET-CT) in multiple myeloma (MM). Methods: A comprehensive literature search about studies that published till July 2015 was performed. Methodological quality of each study was assessed. The meta-regression and subgroup analysis was applied to assess the heterogeneity of between-study. A meta-analysis was used to state sensitivity, specificity, diagnostic odds ratio (DOR), area under the curve (AUC), summary receiver operating characteristic (SROC) curve and Ca* indexes with statistical software. Results: Eleven studies met the inclusion criteria in this meta-analysis, which comprise a total of 492 patients. The pooled sensitivity and specificity of 18F-FDG PET or PET-CT in multiple myeloma were 0.870 (95% CI, 0.825-0.907), 0.937 (95% CI, 0.892-0.967), and the AUC and the Ca* index were 0.9332, 0.869, respectively. The pooled sensitivity and specificity of PET in multiple myeloma were 0.94495% CI, 0.887-0.977) and 0.990 (95% CI, 0.947-1.000), and the AUC and the Ca* index were 0.98, 0.95, respectively. The pooled sensitivity and specificity for PET-CT in multiple myeloma were 0.813 (95% CI, 0.743-0.870) and 0.875 (95% CI, 0.787-0.936), and the AUC and the Ca* index were 0.88, 0.82, respectively. The funnel plots suggested the publication bias may exist. Conclusions: The whole-body 18F-FDG PET or PET-CT were imaging methods with high accuracy in differential diagnosis of multiple myeloma patients.

Serum Kappa/Lambda Ratio, An Independent Prognostic Factor at Diagnosis and Serum Free-Light Chains Level, An Early Indicator of Relapse/Progression In Multiple Myeloma

AbstractAbstract 2954 Background:The serum free light chain (sFLC) analysis has been used for the diagnosis and monitoring of plasma cell dyscrasias and has proved its usefulness in disease treatment response in multiple myeloma (MM). Some studies have evaluated the prognostic value of the sFLC levels expressed as K/L ratio (sFLCR) at diagnosis. In contrast, performing this analysis during patient's follow up and on therapy is still not very well defined yet. Aim:Our first objective was to evaluate the impact of sFLCR, measured at diagnosis in MM patients, on the progression free survival (PFS) and overall survival (OS); the second objective was to assess the importance of sFLC analysis during the follow-up especially for relapse/progression detection comparing to concomitant monoclonal-protein (M-p) traditional serum protein electrophoresis (sPE). Methods:Between years 2002 and 2008, we have analysed 174 MM patients for which a concomitant measurement of sFLC and sPE was done during follow-up. Only 118 patients had the sFLCR analysis performed at diagnosis. The sFLC analysis was performed using the Freelite™ test from the Binding site on a BNIIÒ, Dade BehringÓ, and for sPE, analysis was done using a Paragon CZE 2000Ò, Beckman CoulterÓ. There were 92 (53%) males and 82 (47%) females, median age at diagnosis 57 years (34-72), 120 (69%) were IgG (87K&33L), 52 (30%) IgA (41K&11L) and 2 (1%) IgD (1K&1L). According to the ISS, there were 16 (9%) in stage I, 17 (10%) in stage II and 141 (81%) in stage III. Among 61 (35%) FISH analysis done, 31 (51%) detected a chromosome 13 deletion. Twenty six (15%) patients had renal insufficiency. According to the distribution of the different ratios at diagnosis, we have defined three groups: group1 (n=25): patients with 0.13<sFLCR<3.3 which represents the double of the normal range (0.26-1.65); group2 (n=63): patients with sFLCR>3.3 and group3 (n=30): patients with sFLCR<0.13.We also monitored the behaviour of sFLC and sPE in a way to early detect relapse/progression independently of treatment type. Kaplan Meier and cox regression analysis were performed to study the PFS and OS in different groups, slopes of the increase period corresponding to each measurement were compared using the student t-bilateral test with R statistical software. Results:After a median follow-up of 38 months [3.3-93.7], the 5-years OS for groups 1, 2 and 3 was 75% [56-100], 60% [47-76] and 40% [23-69] respectively; and the 5-years PFS was 69% [49-96], 43% [31-60] and 29% [15-54] respectively. The multivariate analysis studying age, ISS, sex, cytogenetics and sFLCR, showed that both OS and PFS are worslty affected with a more abnormal sFLCR, hazard ratios (HR) in Figure1. After monitoring all patients, we observed 117 (67%) patients with relapse/progression and 57 (33%) patients were still in response to treatment. In 77 (66%) cases, relapse or progression was detected by concomitant increase of both sFLC and the M-p with a significant earlier increase for sFLC (Figure2A). In 17 (15%) patients, the relapse or progression was characterised by the only increase of sFLC without any increase of the M-p (Figure2B). Contrarily, in 5 (4%) patients there was only an increase of the M-p without increasing the sFLC (Figure2D). Finally, in 18 (15%) patients, the relapse or progression was revealed by the increase of M-p faster than the concerned sFLC (Figure2C). When comparing slopes of increasing sFLC to increasing M-p, we found a very high significant difference (p<0.001), thus showing that sFLC have a faster detection of relapse or progression. Conclusion:Our study has showed that abnormal sFLCR at diagnosis affects OS and more strongly the PFS independently of any other concomitant variable. In 81% of patients, sFLC analysis enabled an earlier detection of relapse/progression compared to sPE, this could be very important for early treatment intervention especially for high risk patients. Since there are no uniform recommendations for the use of this analysis during follow-up, we recommend its concomitant use with sPE, waiting for guidelines and we suggest that the sFLCR at diagnosis deserves more focus for its validation as a prognostic factor in MM. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Mieloma múltiplo: características clínicas e laboratoriais ao diagnóstico e estudo prognóstico

O mieloma multiplo (MM) caracteriza-se por expansao clonal plasmocitaria na medula ossea e producao de imunoglobulina monoclonal, promovendo progressivamente destruicao ossea, falencia renal, supressao da hematopoietica e infeccoes. A identificacao de fatores clinicos e laboratoriais ao diagnostico e importante para predizer sobrevida. O sistema de estadiamento de Durie e Salmon (1975) e o mais utilizado e baseia-se na correlacao entre parâmetros clinico-laboratoriais a massa tumoral. A combinacao de β2 microglobulina e albumina serica resultou em um sistema de estadiamento simples e confiavel, conhecido como Sistema Internacional de Estadiamento (ISS), que tem sido reconhecido atualmente. O objetivo deste trabalho foi analisar as caracteristicas clinicas e laboratoriais, ao diagnostico, de pacientes portadores de MM e estudo de sobrevida. Realizou-se estudo de coorte nao concorrente de 101 pacientes portadores de MM atendidos no Servico de Hematologia do Hospital das Clinicas da UFMG, que receberam diagnostico no periodo de abril de 1994 a 31 de outubro de 2006, atraves da coleta de dados contidos em prontuarios medicos. Os pacientes foram acompanhados ate maio de 2007. Foi feita analise descritiva das caracteristicas ao diagnostico e estudo de sobrevida, utilizando-se analise univariada pela tecnica do produto-limite de Kaplan & Meier e teste de Log-Rank para comparacao das curvas; ja na analise multivariada, utilizou-se regressao multipla de Cox. A mediana de idade dos pacientes foi de 63 anos de idade, 47,5% eram homens e 52,5% mulheres, sendo 50,6% brancos, 33,3% negros e 16,1% pardos. Manifestacoes clinicas mais comuns foram: dor ossea (83,2%), fraqueza (70,3%) e perda de peso (40,6%). Radiografia de esqueleto mostrou alteracoes em 83,8% dos casos. Em relacao ao sistema de estadiamento proposto por Durie & Salmon, 63 (62,4%) pacientes encontravam-se em estadio III, 32 (31,7%) em estadio II e apenas 6 (5,9%) no estadio I ao diagnostico. Utilizando a classificacao do Sistema Internacional de Estadiamento (ISS) obtiveram-se 22 (30,1%) pacientes no estadio III, 31 (42,5%) no estadio II e 20 (27,4%) no estadio I ao diagnostico. Sobrevida global media foi de 66,52 meses, com mediana de seguimento de 20 meses. Na analise univariada foram significantes: creatinina (p=0,006), hemoglobina (p=0,001), estadiamento de Durie & Salmon (p=0,009) e ISS (p=0,014); e na multivariada somente a hemoglobina (p=0,012) correlacionou-se a sobrevida. A maior parte dos pacientes apresentava estadio clinico avancado ao diagnostico com repercussao na sobrevida.