Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group

Antonio Palumbo, Hervé Avet-Loiseau, Stefania Oliva, Henk M. Lokhorst, Hartmut Goldschmidt, Laura Rosinol, Paul Richardson, Simona Caltagirone, Juan J osé Lahuerta, Thierry Facon, Sara Bringhen, Francesca Gay, Michel Attal, Roberto Passera, Andrew Spencer, Massimo Offidani, Shaji K Kumar, Pellegrino Musto, Sagar Lonial, Maria T. PetrucciRobert Z. Orlowski, Elena Zamagni, Gareth Morgan, Meletios A. Dimopoulos, Brian G M Durie, Kenneth C. Anderson, Pieter Sonneveld, Jésus San Miguel, Michele Cavo, S Vincent Rajkumar, Philippe Moreau

Research output: Contribution to journalArticle

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Abstract

PURPOSE: The clinical outcome of multiple myeloma (MM) is heterogeneous. A simple and reliable tool is needed to stratify patients with MM. We combined the International Staging System (ISS) with chromosomal abnormalities (CA) detected by interphase fluorescent in situ hybridization after CD138 plasma cell purification and serum lactate dehydrogenase (LDH) to evaluate their prognostic value in newly diagnosed MM (NDMM).

PATIENTS AND METHODS: Clinical and laboratory data from 4,445 patients with NDMM enrolled onto 11 international trials were pooled together. The K-adaptive partitioning algorithm was used to define the most appropriate subgroups with homogeneous survival.

RESULTS: ISS, CA, and LDH data were simultaneously available in 3,060 of 4,445 patients. We defined the following three groups: revised ISS (R-ISS) I (n = 871), including ISS stage I (serum β2-microglobulin level <3.5 mg/L and serum albumin level ≥ 3.5 g/dL), no high-risk CA [del(17p) and/or t(4;14) and/or t(14;16)], and normal LDH level (less than the upper limit of normal range); R-ISS III (n = 295), including ISS stage III (serum β2-microglobulin level > 5.5 mg/L) and high-risk CA or high LDH level; and R-ISS II (n = 1,894), including all the other possible combinations. At a median follow-up of 46 months, the 5-year OS rate was 82% in the R-ISS I, 62% in the R-ISS II, and 40% in the R-ISS III groups; the 5-year PFS rates were 55%, 36%, and 24%, respectively.

CONCLUSION: The R-ISS is a simple and powerful prognostic staging system, and we recommend its use in future clinical studies to stratify patients with NDMM effectively with respect to the relative risk to their survival.

Original languageEnglish (US)
Pages (from-to)2863-2869
Number of pages7
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology
Volume33
Issue number26
DOIs
StatePublished - Sep 10 2015

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Multiple Myeloma
L-Lactate Dehydrogenase
Chromosome Aberrations
Survival
Interphase
Plasma Cells
Serum
Fluorescence In Situ Hybridization

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Revised International Staging System for Multiple Myeloma : A Report From International Myeloma Working Group. / Palumbo, Antonio; Avet-Loiseau, Hervé; Oliva, Stefania; Lokhorst, Henk M.; Goldschmidt, Hartmut; Rosinol, Laura; Richardson, Paul; Caltagirone, Simona; Lahuerta, Juan J osé; Facon, Thierry; Bringhen, Sara; Gay, Francesca; Attal, Michel; Passera, Roberto; Spencer, Andrew; Offidani, Massimo; Kumar, Shaji K; Musto, Pellegrino; Lonial, Sagar; Petrucci, Maria T.; Orlowski, Robert Z.; Zamagni, Elena; Morgan, Gareth; Dimopoulos, Meletios A.; Durie, Brian G M; Anderson, Kenneth C.; Sonneveld, Pieter; San Miguel, Jésus; Cavo, Michele; Rajkumar, S Vincent; Moreau, Philippe.

In: Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Vol. 33, No. 26, 10.09.2015, p. 2863-2869.

Research output: Contribution to journalArticle

Palumbo, A, Avet-Loiseau, H, Oliva, S, Lokhorst, HM, Goldschmidt, H, Rosinol, L, Richardson, P, Caltagirone, S, Lahuerta, JJO, Facon, T, Bringhen, S, Gay, F, Attal, M, Passera, R, Spencer, A, Offidani, M, Kumar, SK, Musto, P, Lonial, S, Petrucci, MT, Orlowski, RZ, Zamagni, E, Morgan, G, Dimopoulos, MA, Durie, BGM, Anderson, KC, Sonneveld, P, San Miguel, J, Cavo, M, Rajkumar, SV & Moreau, P 2015, 'Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group', Journal of clinical oncology : official journal of the American Society of Clinical Oncology, vol. 33, no. 26, pp. 2863-2869. https://doi.org/10.1200/JCO.2015.61.2267
Palumbo, Antonio ; Avet-Loiseau, Hervé ; Oliva, Stefania ; Lokhorst, Henk M. ; Goldschmidt, Hartmut ; Rosinol, Laura ; Richardson, Paul ; Caltagirone, Simona ; Lahuerta, Juan J osé ; Facon, Thierry ; Bringhen, Sara ; Gay, Francesca ; Attal, Michel ; Passera, Roberto ; Spencer, Andrew ; Offidani, Massimo ; Kumar, Shaji K ; Musto, Pellegrino ; Lonial, Sagar ; Petrucci, Maria T. ; Orlowski, Robert Z. ; Zamagni, Elena ; Morgan, Gareth ; Dimopoulos, Meletios A. ; Durie, Brian G M ; Anderson, Kenneth C. ; Sonneveld, Pieter ; San Miguel, Jésus ; Cavo, Michele ; Rajkumar, S Vincent ; Moreau, Philippe. / Revised International Staging System for Multiple Myeloma : A Report From International Myeloma Working Group. In: Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2015 ; Vol. 33, No. 26. pp. 2863-2869.
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abstract = "PURPOSE: The clinical outcome of multiple myeloma (MM) is heterogeneous. A simple and reliable tool is needed to stratify patients with MM. We combined the International Staging System (ISS) with chromosomal abnormalities (CA) detected by interphase fluorescent in situ hybridization after CD138 plasma cell purification and serum lactate dehydrogenase (LDH) to evaluate their prognostic value in newly diagnosed MM (NDMM).PATIENTS AND METHODS: Clinical and laboratory data from 4,445 patients with NDMM enrolled onto 11 international trials were pooled together. The K-adaptive partitioning algorithm was used to define the most appropriate subgroups with homogeneous survival.RESULTS: ISS, CA, and LDH data were simultaneously available in 3,060 of 4,445 patients. We defined the following three groups: revised ISS (R-ISS) I (n = 871), including ISS stage I (serum β2-microglobulin level <3.5 mg/L and serum albumin level ≥ 3.5 g/dL), no high-risk CA [del(17p) and/or t(4;14) and/or t(14;16)], and normal LDH level (less than the upper limit of normal range); R-ISS III (n = 295), including ISS stage III (serum β2-microglobulin level > 5.5 mg/L) and high-risk CA or high LDH level; and R-ISS II (n = 1,894), including all the other possible combinations. At a median follow-up of 46 months, the 5-year OS rate was 82{\%} in the R-ISS I, 62{\%} in the R-ISS II, and 40{\%} in the R-ISS III groups; the 5-year PFS rates were 55{\%}, 36{\%}, and 24{\%}, respectively.CONCLUSION: The R-ISS is a simple and powerful prognostic staging system, and we recommend its use in future clinical studies to stratify patients with NDMM effectively with respect to the relative risk to their survival.",
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T1 - Revised International Staging System for Multiple Myeloma

T2 - A Report From International Myeloma Working Group

AU - Palumbo, Antonio

AU - Avet-Loiseau, Hervé

AU - Oliva, Stefania

AU - Lokhorst, Henk M.

AU - Goldschmidt, Hartmut

AU - Rosinol, Laura

AU - Richardson, Paul

AU - Caltagirone, Simona

AU - Lahuerta, Juan J osé

AU - Facon, Thierry

AU - Bringhen, Sara

AU - Gay, Francesca

AU - Attal, Michel

AU - Passera, Roberto

AU - Spencer, Andrew

AU - Offidani, Massimo

AU - Kumar, Shaji K

AU - Musto, Pellegrino

AU - Lonial, Sagar

AU - Petrucci, Maria T.

AU - Orlowski, Robert Z.

AU - Zamagni, Elena

AU - Morgan, Gareth

AU - Dimopoulos, Meletios A.

AU - Durie, Brian G M

AU - Anderson, Kenneth C.

AU - Sonneveld, Pieter

AU - San Miguel, Jésus

AU - Cavo, Michele

AU - Rajkumar, S Vincent

AU - Moreau, Philippe

PY - 2015/9/10

Y1 - 2015/9/10

N2 - PURPOSE: The clinical outcome of multiple myeloma (MM) is heterogeneous. A simple and reliable tool is needed to stratify patients with MM. We combined the International Staging System (ISS) with chromosomal abnormalities (CA) detected by interphase fluorescent in situ hybridization after CD138 plasma cell purification and serum lactate dehydrogenase (LDH) to evaluate their prognostic value in newly diagnosed MM (NDMM).PATIENTS AND METHODS: Clinical and laboratory data from 4,445 patients with NDMM enrolled onto 11 international trials were pooled together. The K-adaptive partitioning algorithm was used to define the most appropriate subgroups with homogeneous survival.RESULTS: ISS, CA, and LDH data were simultaneously available in 3,060 of 4,445 patients. We defined the following three groups: revised ISS (R-ISS) I (n = 871), including ISS stage I (serum β2-microglobulin level <3.5 mg/L and serum albumin level ≥ 3.5 g/dL), no high-risk CA [del(17p) and/or t(4;14) and/or t(14;16)], and normal LDH level (less than the upper limit of normal range); R-ISS III (n = 295), including ISS stage III (serum β2-microglobulin level > 5.5 mg/L) and high-risk CA or high LDH level; and R-ISS II (n = 1,894), including all the other possible combinations. At a median follow-up of 46 months, the 5-year OS rate was 82% in the R-ISS I, 62% in the R-ISS II, and 40% in the R-ISS III groups; the 5-year PFS rates were 55%, 36%, and 24%, respectively.CONCLUSION: The R-ISS is a simple and powerful prognostic staging system, and we recommend its use in future clinical studies to stratify patients with NDMM effectively with respect to the relative risk to their survival.

AB - PURPOSE: The clinical outcome of multiple myeloma (MM) is heterogeneous. A simple and reliable tool is needed to stratify patients with MM. We combined the International Staging System (ISS) with chromosomal abnormalities (CA) detected by interphase fluorescent in situ hybridization after CD138 plasma cell purification and serum lactate dehydrogenase (LDH) to evaluate their prognostic value in newly diagnosed MM (NDMM).PATIENTS AND METHODS: Clinical and laboratory data from 4,445 patients with NDMM enrolled onto 11 international trials were pooled together. The K-adaptive partitioning algorithm was used to define the most appropriate subgroups with homogeneous survival.RESULTS: ISS, CA, and LDH data were simultaneously available in 3,060 of 4,445 patients. We defined the following three groups: revised ISS (R-ISS) I (n = 871), including ISS stage I (serum β2-microglobulin level <3.5 mg/L and serum albumin level ≥ 3.5 g/dL), no high-risk CA [del(17p) and/or t(4;14) and/or t(14;16)], and normal LDH level (less than the upper limit of normal range); R-ISS III (n = 295), including ISS stage III (serum β2-microglobulin level > 5.5 mg/L) and high-risk CA or high LDH level; and R-ISS II (n = 1,894), including all the other possible combinations. At a median follow-up of 46 months, the 5-year OS rate was 82% in the R-ISS I, 62% in the R-ISS II, and 40% in the R-ISS III groups; the 5-year PFS rates were 55%, 36%, and 24%, respectively.CONCLUSION: The R-ISS is a simple and powerful prognostic staging system, and we recommend its use in future clinical studies to stratify patients with NDMM effectively with respect to the relative risk to their survival.

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