Question

Poor prognostic marker in Multiple Myeloma (MM) is:

• A. S. creatinine
• B. Hypercalcemia
• C. B2 microglobulins
• D. Telomerase

Hint:

Recall which low molecular weight protein used in the International Staging System reflects tumour burden in Multiple Myeloma.

Answer 1

The Correct Option is C

Step 1: Understand Multiple Myeloma (MM) staging and prognosis. MM prognosis is assessed using the ISS (International Staging System) and Revised ISS (R-ISS). The key prognostic biomarkers are well validated.

Step 2: Role of Beta-2 microglobulin. Beta-2 microglobulin (B2M) is a low molecular weight protein that forms the light chain of MHC class I molecules. In MM, B2M is shed from proliferating myeloma cells into the blood. Elevated serum B2M directly correlates with tumour burden and is the single most important independent poor prognostic marker in MM. The ISS uses B2M and albumin to stage MM into three groups (Stage I: B2M < 3.5 mg/L + albumin at least 3.5 g/dL; Stage III: B2M at least 5.5 mg/L).

Step 3: Evaluate other options.
- S. creatinine: Elevated in renal failure (CRAB criteria) but not the primary staging/prognostic marker.
- Hypercalcemia: Part of CRAB criteria, indicates disease activity but not a staging/prognostic biomarker.
- Telomerase: Not a validated prognostic marker for MM staging.

Conclusion: B2 microglobulin is the best established poor prognostic marker in Multiple Myeloma.