The significance of staging and prognostic factors
Staging of myeloma helps to determine the disease activity and burden and can help to assess patient prognosis. Staging information together with the presence or absence of other prognostic factors may be used to help guide the choice of treatment and help predict outcome, particularly for those classed as having high-risk disease.
The significance of staging and prognostic factor information must be viewed in the context of health technology assessment (HTA) guidance, which can stipulate the treatment pathway and options for patients.
Response to treatment is one of the most important factors predicting long-term outcome. For instance, an indicator of good prognosis would be a patient obtaining a complete response from treatment, with no increase in myeloma cells at three months following high-dose treatment. Another would be a reduction in the amount of plasma cells and stabilisation of paraprotein for more than three months following treatment. Conversely, a primary refractory or short first remission is associated with a poorer prognosis.
Putting an average survival based on stage of disease remains difficult for myeloma patients, in part because there are many other factors affecting treatment choice and response. These include those described above, alongside for example barriers to healthcare access, immune fitness, tumour burden and overall health. Based on stage alone, estimated 5-year overall survival rates are:
- R-ISS stage I – 80%
- R-ISS stage II – 60%
- R-ISS stage III – 40%
Careful communication about staging and prognosis and its implications is very important. Nurses are often the primary care givers, or key workers, for people living with myeloma. They therefore have an important role in managing any undue or excessive hope, expectation or fear brought about through a discussion about staging.