International staging system for multiple myeloma.
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.
Greipp
Philip R
PR
Mayo Clinic College of Medicine and Eastern Cooperative Oncology Group, Rochester, MN, USA.
San Miguel
Jesus
J
Durie
Brian G M
BG
Crowley
John J
JJ
Barlogie
Bart
B
Bladé
Joan
J
Boccadoro
Mario
M
Child
J Anthony
JA
Avet-Loiseau
Herve
H
Harousseau
Jean-Luc
JL
Kyle
Robert A
RA
Lahuerta
Juan J
JJ
Ludwig
Heinz
H
Morgan
Gareth
G
Powles
Raymond
R
Shimizu
Kazuyuki
K
Shustik
Chaim
C
Sonneveld
Pieter
P
Tosi
Patrizia
P
Turesson
Ingemar
I
Westin
Jan
J
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*
D012709:Serum Albumin; D001613:beta 2-Microglobulin; D003404:Creatinine