Valor pronóstico del nuevo sistema de etapificación internacional en mieloma múltiple. Comparación con el sistema de Durie-Salmon

Abstract

Background: Since 1975, the Durie-Salmon staging system (D&S) has been a widely accepted prognostic classification of multiple myeloma (MM) patients. Recently, the new International Staging System (ISS) was developed using only the values of albumin and beta2-microglobulin. Aim: To compare survival of patients with MM treated in six medical centers in Chile according to the D&S system and the new ISS. Material and methods: Retrospective analysis of demographic information, clinical features and survival rate of patients treated between 1998 and 2002, and grouped according to both systems. Results: Information 81 patients aged 38 to 90 years (43 women) was retrieved. According D&S system 11% were in stage I, 12% in stage II and 73% in stage III. According to ISS, 34% were in stage I, 35% in stage II and 31% in stage III. Median of survival of all patients was 32 months. Both staging systems bad a prognostic value. However median survival for the three stages of the ISS system was significantly different (67, 29 and 14 months in stages 1, II and III, respectively, p =0.02). Patients in advanced stages lI and III of the ISS, had a higher frequency of anemia, hypercalcemia, renal failure and hypoalbuminemia. In stages II and III of ISS the presence of renal failure was associated with a non significantly different lower survival. Conclusions: The ISS is a simple and effective grouping method for patients with MM, that predicts survival. The presence of renal insufficiency might identify a subgroup of patients included in stages II and III of ISS with a higher mortality.