Prognostic factors adverse prognostic factors at diagnosis

• Performance status 3 or 4.

• High paraprotein levels (IgG >70g/L; IgA >50g/L; BJP >12g/24h).

• Hypercalcaemia.

• Advanced lytic bone lesions.

• Abnormal renal function (creatinine >180|i.mol/L).

• Plasmablast morphology.

• Adverse cytogenetics (see above).

• Circulating plasma cells in PB.

• High serum IL-6 (measured in only a few centres).

• High plasma cell labelling index (measured in only a few centres).

Skull x-ray in myeloma showing multiple lytic lesions.

Myeloma: humerus shows marked osteoporosis, lytic lesions and healing pathological fracture.

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