Prognostic factors
A number of factors predict prognosis, particularly serum beta (β)-2 microglobulin, lactate dehydrogenase (LDH) levels and the presence of specific chromosomal abnormalities as detected by fluorescence in situ hybridisation (FISH). These factors are currently used to stage myeloma (via the revised International Staging System)
Other prognostic factors include renal function, serum albumin, calcium and haemoglobin levels and together with the presence of co-morbidities. Initial response to treatment has also been shown to correlate with future prognosis.
Prognosis can be a difficult area for many nurses to discuss with patients and particularly in myeloma as it is known to be incurable at diagnosis. As a nurse, it is important to be aware of the factors that can affect prognosis as patients may ask about them. However, it is equally important to put the clinical significance of prognostic factors into perspective: in the majority of cases it remains unclear whether, and how, the presence of prognostic factors genuinely affect outcomes in individual patients.
Response to treatment is one of the most important factors predicting long-term outcome.
Prognosis is covered in more detail in Module 4 – Staging and prognosis of myeloma.