Table 5 Risk Stratification Models and Staging Systems for AL Amyloidosis.
From: Current risk stratification and staging of multiple myeloma and related clonal plasma cell disorders
Risk Stratification and Variables | Stages and proportion of patients | HR and Median OS for Mortality (95% CI) |
|---|---|---|
Mayo Clinic 2004 Risk Stratification with European Modification • Troponin T ≥ 0.035 ng/mL (1 point) • NT-proBNP ≥332 pg/mL (1 point) • NT-proBNP >8500 pg/mL for Stage IIIB | Stage I (Score 0): Both Troponin T and NT-proBNP below threshold Stage II (Score 1): One of two markers above threshold Stage III (Score 2): both markers above cutoff European Modification (Stage IIIB): Troponin T ≥ 0.035 ng/mL and NT-proBNP>8500 pg/mL | Stage I: HR: 1.0 (reference) Median OS: 26.4 months Stage II: HR: 2.5 Median OS: 10.5 months Stage III: HR: 6.7 Median OS: 3.5 months [Stage IIIA- NT-proBNP ≤8500 pg/mL: HR of 4.9] Stage IIIB: HR: 11.1 |
Mayo Clinic 2012 Model • dFLC≥18 mg/dL (1 point) • cTnT ≥ 0.025 ng/mL (1 point) • NT-proBNP ≥ 1800 pg/mL (1 point) | Stage I (Score 0): None of the marker above cutoff Stage II (Score 1): One of the three markers above cutoff Stage III (Score 2): any two markers above cutoff Stage IV (Score 3): All three markers above cutoff | Stage I: HR:1.0 (reference) Median OS: 94.1 months [5-year OS: 59%] Stage II: HR: 1.7 Median OS: 40.3 months [5-year OS: 42%] Stage III: HR: 4.1 Median OS: 14 months [5-year OS: 20%] Stage IV: HR: 6.3 Median OS: 5.8 months[5-year OS: 14%] |
Renal AL staging | Stage | 3-year risk of dialysis dependence |
Risk Factors: • eGFR >50 ml/min/1.73 m2 (normalized body surface area) • 24 h proteinuria >5 g | Stage I: neither risk factor present Stage II: one of the two risk factors present Stage III: both risk factors present | 0% in the derivation cohort 4% in the validation cohort 15% in the derivation cohort 30% in the validation cohort 60% in the derivation cohort 85% in the validation cohort |
