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    Chief Complaint


    Organ System


    Patent Pending

    Revised Multiple Myeloma International Staging System (R-ISS)

    Prognostication tool for myeloma patients based on the genetics and other routinely used lab values in conjunction with the original ISS Staging System.


    Use only in patients recently diagnosed with multiple myeloma. Do not use in patients with relapsed myeloma, smoldering myeloma or MGUS.

    When to Use
    Why Use

    Newly diagnosed MM patients. Its utility has NOT been validated in relapsed myeloma, smoldering myeloma or MGUS patients.

    • The revised International Staging System (R-ISS) for multiple myeloma was developed to better prognosticate long term outcomes of myeloma patients using easily obtained and routinely used prognostic variables.
    • It includes the parameters from the International Staging System (ISS), as well as cytogenetic abnormalities (CA) serum lactate dehydrogenase (LDH).
    • The R-ISS creates 3 subgroups with significantly different overall survival:
      • Stage I: 82%
      • Stage II: 62%
      • Stage III: 40%
    • It risk-stratifies multiple myeloma patients better than the original ISS.
    • 40% of patients in the data set were not transplant eligible, which reflects a more real-world population than does previous studies
    • Provides better discrimination of prognosis for MM by using simple, readily available variables.
    • Reliable, validated tool that may have a role in upfront risk stratification in future clinical trials, and also may help patients understand their prognosis better.
    <3.5 mg/L
    3.5-5.4 mg/L
    >5.4 mg/L
    <3.5 g/dL
    ≥3.5 g/dL
    Standard risk
    High risk
    Normal (< upper limit of normal)
    High (> upper limit of normal)


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    Next Steps
    Creator Insights
    Dr. Antonio Palumbo

    About the Creator

    Antonio Palumbo is chief of the Myeloma Unit of the Department of Oncology, Section of Hematology at the University of Torino. He is currently a member of the Board of Directors of the International Myeloma Society. Dr. Palumbo's research focuses on plasma cell dyscrasia, and the pathogenesis and treatment of multiple myeloma.

    To view Dr. Antonio Palumbo's publications, visit PubMed

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