Prognostic factors and staging in multiple myeloma: a reappraisal.

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Abstract
To assess the important factors in the prognosis and staging of multiple myeloma (MM), we have correlated the presenting clinical features of 147 previously untreated patients with MM with the survival duration using multiple regression analyses. We have included the three major available myeloma-staging systems (MSS), ie, Durie-Salmon (DS), Medical Research Council (MRC), and Merlini-Waldenstrom-Jayakar (MWJ), plus two new variables related to disease activity: the serum .beta.2-microglobulin level (S.beta.2M) and the instantaneous rate of bone resorption. Our study confirms the validity of the three MSS in the prediction of survival duration, with a slight but significant advantage for the DS MSS. Among single variables, S.beta.2M was the most powerful indicator of prognosis (P < .0001), serum albumin level being the only variable adding to this significantly (P = .02). Of major interest, S.beta.2M alone was a better indicator than MRC and MWJ MSS. Finally, S.beta.2M and the serum albumin level, variables not included in the three MSS, were better indicators than the classical DS MSS and could be combined simply to give a very powerful system of stratification.