Palumbo et al modified the International Staging System (ISS) for myeloma by the addition of chromosomal and chemical information. These can help to more accurately predict the clinical course and prognosis. The authors are from multiple institutions from around the world and members of the International Myeloma Working Group (IMWG).
Patient selection: multiple myeloma
Parameters:
(1) ISS stage based on serum beta-2-microglobulin and albumin
(2) chromosomal abnormalities by FISH
(3) serum LDH in IU/L
beta-2 microglobulin
albumin
ISS Stage
< 3.5 mg/L
>= 3.5 g/dL
Stage I
>= 5.5 mg/L
NA
Stage III
else
else
Stage II
Parameter
Finding
Result
chromosomal FISH
del 17p
high
translocation t(4;14)
high
translocation t(14;16)
high
none of these
standard
serum LDH
<= upper limit of normal
normal
> upper limit of normal
high
ISS Stage
FISH
LDH
R-ISS Stage
Stage I
standard risk
normal
Stage I
Stage III
high risk
NA
Stage III
Stage III
NA
high
Stage III
else
else
else
Stage II
R-ISS Stage
Median Progression-free Survival
Stage I
66 months
Stage II
42 months
Stage III
29 months
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