title: International staging system for multiple myeloma.
abstract: OBJECTIVE
  There is a need for a simple, reliable staging system for multiple myeloma that can be applied internationally for patient classification and stratification.
  
  
  METHODS
  Clinical and laboratory data were gathered on 10,750 previously untreated symptomatic myeloma patients from 17 institutions, including sites in North America, Europe, and Asia. Potential prognostic factors were evaluated by univariate and multivariate techniques. Three modeling approaches were then explored to develop a staging system including two nontree and one tree survival assessment methodologies.
  
  
  RESULTS
  Serum beta2-microglobulin (Sbeta2M), serum albumin, platelet count, serum creatinine, and age emerged as powerful predictors of survival and were then used in the tree analysis approach. A combination of Sbeta2M and serum albumin provided the simplest, most powerful and reproducible three-stage classification. This new International Staging System (ISS) was validated in the remaining patients and consists of the following stages: stage I, Sbeta2M less than 3.5 mg/L plus serum albumin > or = 3.5 g/dL (median survival, 62 months); stage II, neither stage I nor III (median survival, 44 months); and stage III, Sbeta2M > or = 5.5 mg/L (median survival, 29 months). The ISS system was further validated by demonstrating effectiveness in patients in North America, Europe, and Asia; in patients less than and > or = 65 years of age; in patients with standard therapy or autotransplantation; and in comparison with the Durie/Salmon staging system. CONCLUSION) The new ISS is simple, based on easy to use variables (Sbeta2M and serum albumin), and recommended for early adoption and widespread use.
authors.affiliation: Mayo Clinic College of Medicine and Eastern Cooperative Oncology Group, Rochester, MN, USA.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Greipp
authors.forename: Jesus
authors.initials: J
authors.lastname: San Miguel
authors.forename: Brian G M
authors.initials: BG
authors.lastname: Durie
authors.forename: John J
authors.initials: JJ
authors.lastname: Crowley
authors.forename: Bart
authors.initials: B
authors.lastname: Barlogie
authors.forename: Joan
authors.initials: J
authors.lastname: Bladé
authors.forename: Mario
authors.initials: M
authors.lastname: Boccadoro
authors.forename: J Anthony
authors.initials: JA
authors.lastname: Child
authors.forename: Herve
authors.initials: H
authors.lastname: Avet-Loiseau
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Harousseau
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kyle
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Lahuerta
authors.forename: Heinz
authors.initials: H
authors.lastname: Ludwig
authors.forename: Gareth
authors.initials: G
authors.lastname: Morgan
authors.forename: Raymond
authors.initials: R
authors.lastname: Powles
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimizu
authors.forename: Chaim
authors.initials: C
authors.lastname: Shustik
authors.forename: Pieter
authors.initials: P
authors.lastname: Sonneveld
authors.forename: Patrizia
authors.initials: P
authors.lastname: Tosi
authors.forename: Ingemar
authors.initials: I
authors.lastname: Turesson
authors.forename: Jan
authors.initials: J
authors.lastname: Westin
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001208:Asia; D002423:Cause of Death; D003404:Creatinine / Q000652:urine; D005060:Europe; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology*; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000592:standards*; D009656:North America; D010976:Platelet Count; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000032:analysis; D012737:Sex Factors; D015996:Survival Rate; D001613:beta 2-Microglobulin / Q000097:blood*
chemical_list: D012709:Serum Albumin; D001613:beta 2-Microglobulin; D003404:Creatinine