@article{a59aaf19290e432f91b8b722f104b419,
title = "Is the international staging system superior to the Durie-Salmon staging system? A comparison in multiple myeloma patients undergoing autologous transplant",
abstract = "The international staging system (ISS) for multiple myeloma (MM) is a validated alternative to the Durie-Salmon staging system (DSS) for predicting survival at diagnosis. We compared these staging systems for predicting outcomes after upfront autologous stem cell transplantation by analyzing the outcomes of 729 patients between 1995 and 2002. With a median follow-up of 56 months, the univariate probabilities (95% CI) of non-relapse mortality (NRM), relapse, progression-free survival (PFS) and overall survival (OS) at 5 years were 7, 68, 25 and 52%, respectively. The median OS for stages I, II, III by DSS and ISS were 82, 68, 50 and 64, 68, 45 months, respectively. The concordance between the two staging systems was only 36%. Staging systems were formally compared using Cox models fit with DSS and ISS stages. The relative risks of PFS and OS were significantly different for stages I vs II and II vs III for DSS, but only for stages II vs III for ISS. Although both systems were predictive of PFS and OS, the DSS was superior in formal statistical comparison using Brier score. However, neither system was strongly predictive of outcomes, indicating the need for newer schemes incorporating other prognostic markers.",
author = "Hari, {P. N.} and Zhang, {M. J.} and V. Roy and P{\'e}rez, {W. S.} and A. Bashey and To, {L. B.} and G. Elfenbein and Freytes, {C. O.} and Gale, {R. P.} and J. Gibson and Kyle, {R. A.} and Lazarus, {H. M.} and McCarthy, {P. L.} and Milone, {G. A.} and S. Pavlovsky and Reece, {D. E.} and G. Schiller and J. Vela-Ojeda and D. Weisdorf and D. Vesole",
note = "Funding Information: 1Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA; 2Department of Medicine, Mayo Clinic Jacksonville, Jacksonville, FL, USA; 3Department of Medicine, The Blood and Marrow Transplant Group of Georgia, Atlanta, GA, USA; 4Department of Haematology, Hanson Center for Cancer Research, Institute of Medical and Veterinary Science, Adelaide, Australia; 5Department of Medicine, Boston University, Boston, MA, USA; 6Veterans Health Care System, University of Texas Health Science Center, San Antonio, TX, USA; 7Department of Haematology and Oncology, Celgene Corporation, Summit, NJ, USA; 8Department of Haematology, Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; 9Department of Hematology and Internal Medicine, College of Medicine, Mayo Clinic Rochester, Rochester, MN, USA; 10 Ireland Cancer Center, University Hospital Case Medical Center, Cleveland, OH, USA; 11Blood and Marrow Transplant Program, Roswell Park Cancer Institute, Buffalo, NY, USA; 12Angelica Ocampo-Hospital and Research, Fundaleu, Buenos Aires, Argentina; 13Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, ON, Canada; 14Department of Hematology and Oncology, School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; 15Department of Hematology and Internal Medicine, The American British Cowdray Medical Center IAP, Mexico DF, Mexico, USA; 16Department of Hematology and Oncology, University of Minnesota Medical Center, Minneapolis, MN, USA and 17Department of Hematology and Oncology, Loyola University Medical Center, Chicago, IL, USA",
year = "2009",
doi = "10.1038/leu.2009.61",
language = "English (US)",
volume = "23",
pages = "1528--1534",
journal = "Leukemia",
issn = "0887-6924",
publisher = "Nature Publishing Group",
number = "8",
}