Table 1 Prognostic factors and... | American Society of Hematology

Table 1

Prognostic factors and risk-stratification in myeloma

Prognostic determinant	Standard-risk	High-risk	Therapeutic implication
Host factors	ECOG performance status 0-2	ECOG performance status 3-4	High-risk patients typically require a decrease in treatment intensity
	Normal renal function	Renal failure (serum creatinine ≥ 2.0)
		Advanced age
Tumor burden	Durie-Salmon stage I, II	Durie-Salmon stage III	Limited; some stage I patients require no therapy (smoldering myeloma, and some require radiation only (if solitary bone lesion)
Tumor biology (disease aggressiveness)	Hyperdiploidy	t(4;14)*	Treatment of high-risk patients remains unsatisfactory, but bortezomib appears to overcome some high-risk features (t4;14)
	t(11;14)	t(14;16)
	t(6;14)	t(14;20)
		del17p
		High LDH
		High plasma cell proliferative rate
		High-risk signature on GEP

Prognostic determinant	Standard-risk	High-risk	Therapeutic implication
Host factors	ECOG performance status 0-2	ECOG performance status 3-4	High-risk patients typically require a decrease in treatment intensity
	Normal renal function	Renal failure (serum creatinine ≥ 2.0)
		Advanced age
Tumor burden	Durie-Salmon stage I, II	Durie-Salmon stage III	Limited; some stage I patients require no therapy (smoldering myeloma, and some require radiation only (if solitary bone lesion)
Tumor biology (disease aggressiveness)	Hyperdiploidy	t(4;14)*	Treatment of high-risk patients remains unsatisfactory, but bortezomib appears to overcome some high-risk features (t4;14)
	t(11;14)	t(14;16)
	t(6;14)	t(14;20)
		del17p
		High LDH
		High plasma cell proliferative rate
		High-risk signature on GEP

Modified from Rajkumar et al⁵ with permission.

ECOG indicates Eastern Cooperative Oncology Group; and LDH, lactate dehydrogenase.

t(4;14) is considered “intermediate-risk” based on improved results seen now with bortezomib-based initial therapy.