Abstract

MULTIPLE MYELOMA- ANALYSIS OF DIAGNOSTIC CRITERIA AND PROGNOSTIC FACTORS

Author(s): Prema K. R, Prabhalakshmi K. K, Merin Jose

BACKGROUND Multiple myeloma is a plasma cell neoplasm that accounts for about 10% of haematological malignancies. It is characterised by a single clone of plasma cells producing a monoclonal protein (M protein), which results in end-organ damage resulting in hypercalcemia, renal insufficiency, anaemia, and skeletal lesions. Multiple myeloma is classified as high-risk or standard–risk disease based on fluorescence in situ hybridisation (FISH), metaphase cytogenetics and the plasma cell labelling index. MATERIALS AND METHODS A prospective study was conducted at Government Medical College, Thrissur, India during the period 2014-2015 with a total of 30 patients with newly diagnosed multiple myeloma. All patients were subjected to investigations like complete haemogram, ESR, serum calcium level, renal function tests, serum protein electrophoresis, β2 microglobulin level, bone marrow trephine biopsy and skeletal survey. RESULTS Thirty patients enrolled in this study were analysed and compared with the existing studies. The commonest symptom was bone pain due to lytic bone lesions, seen in 73.3% of patients. Only ten patients (33%) presented with stage 1 disease, while about 60% of the patients were in the third stage of the disease, having poor prognosis, which indicates the multiple myeloma is in the late stage of the disease. β2 microglobulin was increased in 60% of patients. CONCLUSION In this study, about 60% of the patients are having poor prognostic features such as stage 3 disease, raised β2 microglobulin, more than three lytic bone lesions. The initial staging can be quantitatively related to follow up, using tumour cell mass changes and changes in M component production. So, use of the clinical staging system provides better initial assessment and follow up of individual patients. The current approach to the diagnosis, staging, and prognosis is reviewed.