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Prognostic value of pretreatment serum beta 2 microglobulin in myeloma: a
Southwest Oncology Group Study [see comments]
BG Durie, D Stock-Novack, SE Salmon, P Finley, J Beckord, J Crowley and CA Coltman
Department of Medicine, University of Arizona, Tucson.
Six hundred twelve eligible, previously untreated patients with active
multiple myeloma and at least some data available for analysis were entered
into a randomized trial (Southwest Oncology Group [SWOG] Phase III myeloma
study 8229/30), in which the prognostic significance of pretreatment serum
beta 2 microglobulin levels was evaluated. Because there was no
statistically significant survival difference between the alternating and
syncopating VMCP/VBAP regimens, it was possible to evaluate serum beta 2
microglobulin for the total population all together. The serum beta 2
microglobulin measurements showed the highest significance of any
prognostic factor, both in the bivariate and multivariate regression
analyses. The median survival was 36 months for the 322 patients with
pretreatment serum beta 2 microglobulin values of less than 6
micrograms/mL, as compared with a median survival of 23 months for the 225
patients with a beta 2 level of greater than or equal to 6 mcg/mL (P less
than .0001). The stepwise multiple regression model first contained serum
beta 2 microglobulin, followed by serum albumin, serum calcium, age, and
serum creatinine. Serum beta 2 microglobulin was highly correlated with
stage: median values ranged from 3.7 micrograms/mL for stage IA, to 10.1
for stage IIIB. It was possible to stratify myeloma patients based on
combinations of serum beta 2 microglobulin with both albumin and age,
producing excellent separation of patients into low-, intermediate-, and
high-risk categories. It is concluded that serum beta 2 microglobulin is
the most powerful prognostic factor currently available for multiple
myeloma and that it can be used alone or in combination with other
variables for pretreatment stratification.
Volume 75,
Issue 4,
pp. 823-830,
02/15/1990
Copyright © 1990 by The American Society of Hematology
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