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C-reactive protein and beta-2 microglobulin produce a simple and powerful
myeloma staging system
R Bataille, M Boccadoro, B Klein, B Durie and A Pileri
Laboratorie d'Oncogenese Immunohematologique, Institut de Biologie,
Hopitaux de Nantes, France.
Multiple myeloma (MM) staging procedures are still inadequate for detection
of the optimal therapeutic procedure for an individual patient. The Durie
& Salmon staging system and serum beta 2- microglobulin (beta 2M) are
used worldwide because of their easy clinical application. Other prognostic
parameters, such as myeloma cell proliferative activity, are of exceeding
importance, but are not as simple as standard methods. Recently,
interleukin-6 (IL-6) has been shown to be a major growth factor for MM.
IL-6 is a pleiotropic cytokine acting on several cell lineages, and, at the
hepatocyte level, stimulates the synthesis of acute phase proteins, such as
the well known C-Reactive Protein (CRP). Serum CRP concentration actually
reflects the IL-6 activity. A survival analysis carried out in 162 MM
patients at diagnosis showed that serum CRP level is a highly significant
prognostic factor. Moreover, serum CRP was independent of serum beta 2M.
This feature allowed stratification of MM patients into 3 groups according
to CRP and beta 2M serum levels: (1) low risk group, CRP and beta 2M less
than 6 mg/L (50% of patients); (2) intermediate risk group, CRP or beta 2M
greater than or equal to 6 mg/L (35% of patients); (3) high risk group, CRP
and beta 2M greater than or equal to 6 mg/L (15% of patients). Survival was
54, 27, and 6 months, respectively (P less than .0001). We thus propose a
new and powerful myeloma staging system based on simple and reliable
laboratory evaluations.
Volume 80,
Issue 3,
pp. 733-737,
08/01/1992
Copyright © 1992 by The American Society of Hematology
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