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Revised International Staging System for Multiple myeloma: A report from the International Myeloma Working Group

Reporter: Aviva Lev-Ari, PhD, RN

Journal of Clinical Oncology

Source Reference: Palumbo A, et al “Revised international staging system for multiple myeloma: A report from the International Myeloma Working Group” J Clin Oncol 2015; DOI: 10.1200/JCO.2015.61.2267.

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.

SOURCE

http://jco.ascopubs.org/content/early/2015/08/03/JCO.2015.61.2267.abstract

• Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

The 3,443 patients with normal serum LDH had a 5-year survival of 68% compared with 47% for 530 patients with high LDH levels (P<0.001). The 5-year PFS was 42% and 31%, respectively, for patients with normal and high serum LDH (P=0.004).

For the 3,060 patients with complete data, K-adaptive partitioning identified three risk categories for the revised-ISS staging criteria:

• Stage I-ISS stage I, no chromosomal abnormalities, normal LDH (n=871, 28%)
• Stage III-ISS stage III plus high-risk chromosomal abnormalities or elevated LDH (n=295, 10%)
• Stage II-All other combinations of ISS, chromosomal abnormalities, and LDH (n=1,894, 62%)

SOURCE

http://www.medpagetoday.com/HematologyOncology/Myeloma/52937