Hajek et al reported risk scores for a patient with relapsed multiple myeloma. The total risk score is based on the disease aggressiveness risk score and frailty risk scores. The authors are from multiple institutions in Europe.
Patient selection: relapsed multiple myeloma
Parameters:
(1) serum beta-2 microglobulin (SB2M) at diagnosis in mg/L
(2) current serum beta-2 microglobulin in mg/L
(3) cytogenetic abnormalities at diagnosis
(4) serum total calcium in mmol/L
(5) current serum LDH in IU/L
(6) upper limit of normal (ULN) for serum LDH
(7) serum LDH at diagnosis in IU/L
(8) extramedullary myeloma
(9) new bone lesion
(10) serum albumin in g/dL
(11) platelet count in 10^9/L
(12) bone marrow plasma count in percent
(13) time to next treatment in months
(14) refractory status
(15) severe toxicities (Grade 3 or 4) in first line therapy
|
Parameter |
Finding |
Poitnts |
|
SB2M at diagnosis |
< 5.5 mg/L |
EXP(0.086 * (SB2M)) |
|
|
>= 5.5 mg/L |
EXP(0.086 * 5.5) |
|
SB2M current |
< 5.5 mg/L |
EXP(0.061 * (SB2M)) |
|
|
>= 5.5 mg/L |
EXP(0.061 * 5.5) |
|
cytogenetic abnormality |
standard risk |
1 |
|
|
high risk |
1.643 |
|
|
NA |
1.081 |
|
serum calcium |
<= 2.75 mmol/L |
1 |
|
|
> 2.75 mmol/L |
1.406 |
|
current serum LDH |
<= ULN |
11 |
|
|
> ULN |
2.08 |
|
serum LDH at diagnosis |
<= ULN |
1 |
|
|
> ULN |
1.297 |
|
extramedullary disease |
no |
1 |
|
|
yes |
2.331 |
|
new bone lesion |
no |
1 |
|
|
yes |
1.271 |
|
serum albumin |
|
EXP(-0.168 * (albumin)) |
|
platelet count |
< 150 * 10^9 |
EXP(-0.005 * (PC)) |
|
|
>= 150 * 10^9/L |
EXP(-0.005 * 150) |
|
BM plasma cell percent |
|
EXP(0.008 * (percent)) |
|
time to next treatment |
<= 24 months |
1.112 |
|
|
> 24 months |
1 |
|
refractory status |
non-refractory |
1 |
|
|
refractory to bortezomib |
1.533 |
|
|
refractory to thalidomide |
1.186 |
|
|
refractory new agents |
1.427 |
|
severe toxicities |
no |
1 |
|
|
yes |
1.145 |
where:
• Serum beta-2 microglobulin and platelet count show thresholds in Table II. The usage is based on the platelet count in Table III.
• Refractory to new agents: bortezomib plus thalidomide; lenalidomide, bortezomib plus lenalidomide, thalidomide plus lenalidomide.
• New bone lesions includes accelerated osteoporosis and > 2 lesions at diagnosis and at second line therapy.
disease aggressiveness risk score =
= PRODUCT(points for all of the parameters)
