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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Stewart, A. K. Search for Related Content PubMed Articles by Stewart, A. K. Related Collections Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 1 August 2003, Vol. 102, No. 3, pp. 778-779 Prognostic staging in myeloma: in search of biology For 30 years, clinicians relied on the Durie-Salmon staging system (Durie and Salmon, Cancer. 1975;36:842-854) to define risk in multiple myeloma (MM). In recent years the 2-microglobulin (2M) and C-reactive protein (CRP) have added to the prognostic arsenal (Bataille et al, Blood. 1992;80:733-737). Despite their longevity, both staging systems are limited by an inability to segregate risk accurately in all cases, a particular problem in such a heterogeneous disease. Indeed, until recently prognostic prediction has been something of an irrelevance since all patients with symptomatic disease received essentially the same therapy. Lately, however, the landscape has changed and identification of accurate prognostic biomarkers has assumed increasing importance since therapeutic options may now vary widely according to disease biology. In this issue, Terpos and colleagues (page 1064) take a step in this direction by examining the roles of the receptor activator of nuclear factor B ligand (RANKL) and RANK/osteoprotegerin (OPG), which play a dominant role in osteoclast activation and probably in the bone disease common to MM patients (Mundy, Nat Rev Cancer. 2002;2:584-593). The authors demonstrate that in 121 MM patients serum levels of sRANKL were elevated and correlated with bone disease. The sRANKL/OPG ratio was also increased and correlated with markers of bone resorption, osteolytic lesions, and markers of disease activity. More impressively perhaps, sRANKL/OPG ratio, CRP, and 2M were the only independent prognostic factors in multivariate analysis and, used together, defined a low-risk group having a 96% probability of survival at 5 years, as compared with 52% and 0% for the intermediate- and high-risk groups, respectively: a remarkable discriminatory power. The results suggest that the RANKL/OPG system is not only associated with MM bone disease but also impacts the biology of plasma cell growth as reflected by its influence on survival. Predicting prognosis and defining therapy using novel biomarkers (as described herein), chromosome translocation status and gene expression profiles point the way to the future of MM care, but all require further study. Until confirmed in large prospective studies, user-friendly and sensitive prognostic tools such as the recently devised MM International Staging System (ISS), which employs 2M and albumin, deserve wide implementation, albeit with future refinement (Greipp et al, Hematol J. 2003;4:S42-S44). A. K. Stewart Princess Margaret Hospital, Toronto, Canada CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: Soluble receptor activator of nuclear factor B ligand–osteoprotegerin ratio predicts survival in multiple myeloma: proposal for a novel prognostic index Evangelos Terpos, Richard Szydlo, Jane F. Apperley, Evdoxia Hatjiharissi, Marianna Politou, John Meletis, Nora Viniou, Xenophon Yataganas, John M. Goldman, and Amin Rahemtulla Blood 2003 102: 1064-1069. [Abstract] [Full Text] [PDF] This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Stewart, A. K. Search for Related Content PubMed Articles by Stewart, A. K. Related Collections Related Article in Blood Online Social Bookmarking                   What's this?

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