In: NEOPLASMA, vol. 53, no. 4
V. Scudla - M. Zemanova - J. Minarik - J. Bacovsky - M. Ordeltova - K. Indrak - M. Budikova - L. Dusek - V. Farbiakova
Details:
Year, pages: 2006, 277 - 284
About article:
In the group of 270 patients with multiple myeloma (MM) treated
during 1991—2004 by conventional chemotherapy, the
prognostic value and practical utility of IPI (International
Prognostic Index) was assessed and compared with five other actual
staging systems. Prognostic significance was assessed using the
curves of overall survival (OS) according to
Kaplan-Meier and log rank test (p<0.05). Good practical utility
and prognostic significance of Durie-Salmon (D-S) system
was confirmed (p<0.001). Good overall prognostic significance was
observed in simple staging systems based on the measurement
of beta2-microglobulin and albumin serum levels according to Bataille
(p<0.001), SWOG (South West Oncology
Group, p<0.001) and IPI (p<0.001). Regardless of a short 5-year
duration of the study, the scoring system according to San
Miguel enclosing apart from other parameters also propidium iodide
proliferation index (PC-PI) of myeloma plasmocytes
seems to be promising with very different characteristics of
curves of overall survival (p<0.001). Very good prognostic
value and easy practical utility were examined in Olomouc staging
system (OSS) based on the measurement of
beta2-microglobulin and thymidinekinase serum levels (p<0.001). With
regard to detection of patients of stage 1, i. e. "low
risk", not requiring an immediate initiation of conventional
chemotherapy ("wait and see" approach), the most suitable was
the system according to D-S, SWOG and IPI (median OS 77, 76 and 77
months). To select a cohort of "high risk" patients,
i.e. stage 3, with very unfavourable disease prognosis, the most
advantageous was the system OSS and San Miguel (median
OS was 5 and 6 months) and/or SWOG system selecting patients of
stage 4, i.e. "worst prognosis", with median OS 8
months. It was found that IPI did not meet expectations for
effective identification of "high risk" patients (median OS of
stage 3 was 20 months) nor for the distinction of different
prognosis of patients during initial 25 months of MM course at
stage 2 vs. 3.
The study indicates that under conditions of common clinical
practice and conventional chemotherapy, the staging system
according to D-S is still useful, while practical application of
SWOG and IPI as simpler alternative to the assessment of
clinical stage should be verified by further comparative studies.
In harmony with the progress in cytogenetics and molecular
biology as well as a prospective requirement of individual target
therapy, a future suitable stratification system should be
based on parameters of internal biological properties of myeloma
tissue and microenvironment of bone marrow, allowing in
addition a continuous evaluation of the disease course and the
effect of therapy.
How to cite:
ISO 690:
Scudla, V., Zemanova, M., Minarik, J., Bacovsky, J., Ordeltova, M., Indrak, K., Budikova, M., Dusek, L., Farbiakova, V. 2006. International prognostic index (IPI) — a critical comparison with five multiple myeloma staging systems in the group of 270 patients treated by conventional chemotherapy. In NEOPLASMA, vol. 53, no.4, pp. 277-284. 0028-2685.
APA:
Scudla, V., Zemanova, M., Minarik, J., Bacovsky, J., Ordeltova, M., Indrak, K., Budikova, M., Dusek, L., Farbiakova, V. (2006). International prognostic index (IPI) — a critical comparison with five multiple myeloma staging systems in the group of 270 patients treated by conventional chemotherapy. NEOPLASMA, 53(4), 277-284. 0028-2685.