The Merlini, Waldenström, Jayakar staging system revisited

Abstract

At present, none of the routinely used staging systems is entirely satisfactory, since all of them require some reconsideration to account for the most recent prognostic factors. Among these, serum P-2 microglobulin (S-P-2M) has proved to be a powerful prognostic test assessable in most centers. In order to improve the Merlini, Waldenstrom, Jayakar (MWJ) staging system, we have determined the prognostic significance of several factors in an independent population of 345 retrospective myeloma patients seen at our institution from 1973 to 1988. The Cox regression hazards method showed that S-Creatinine, S-Albumin levels and percentage of bone marrow plasma cells

Prognostic factors in multiple myeloma in a population‐based trial

“…Significantly shorter survival for the oldest patients has been reported (4-6), but different cutoffs defining the high-risk age group were established; 60 yr (4,6) or 70 yr (5). In addition, trends of shorter survival for patients > 70 and > 65 yr have been reported (2,7). The study of Merlini et al from Sweden (2) was also population-based and supports our threshold of 70 yr.…”

“…Elevated serum calcium levels have been found in several studies as an important prognostic factor (1,2,7). In the present study the multivariate analyses selected either lytic lesion/fractures or elevated calcium as additional prognostic factors.…”

“…The proportional assumption in the Cox model was tested with plots (17). Continuous variables were first grouped with cutpoints as reported by others (1)(2)(3)(4)(5)(6)(7)(8)(9). When searching for more reasonable cut-offs, the continuous variables were divided into four groups with thresholds at the 20, 50 and 80 percentiles.…”

“…Three different staging systems for multiple myeloma have been published, by Durie & Salmon (l), Merlini et al (2) and by the Medical Research Council (MRC) (3). Age (4)(5)(6), Hb and renal function (1-3), skeletal destructions (l), calcium (1,2,7), type and level of M-component (1,2,7,8), bone-marrow plasma cell percentage (2), uric acid (9) and beta-2 microglobulin (10) are relevant prognostic factors in multiple myeloma. We have tested seven of these prognostic factors recorded in multiple myeloma patients participating in a population-based trial (1 l), and searched for new predictors using the Cox regression model.…”

Relevant prognostic features of multiple myeloma and the new International Staging System

“…When seven staging systems were evaluated (Acute Leukemia B [10], Eastern Cooperative Oncology Group [11], Southeastern Cancer Study Group [10], Durie -Salmon [1], Alexanian [12], Merlini [13], and the British Medical Research Council [14]), the observed differences were statistically significant but small [15]. Although the Durie -Salmon staging system was validated, no system was clearly superior when compared to individual risk factors such as creatinine or hemoglobin levels.…”