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    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
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    Patent Pending

    Multiple Myeloma International Staging System (ISS)

    Prognosticates the severity of multiple myeloma based on routinely obtained lab values.
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    INSTRUCTIONS

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

    When to Use
    Pearls/Pitfalls
    Why Use

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

    • The International Staging System (ISS) for multiple myeloma defines 3 subgroups with differing overall survival:
      • Stage I- 62 months
      • Stage II- 44 months
      • Stage III- 29 months
    • The ISS was developed as a simpler, more objective tool to provide prognostic information for newly diagnosed, symptomatic MM patients.
    • It does not reflect disease burden.
    • Durie-Salmon, a cumbersome staging system used in the past, was based on estimating the disease burden but ultimately did not prove to be prognostic and fell out of favor.
    • Compared to older staging systems, ISS is a simple prognostic tool and may be used to stratify patients on MM clinical trials.
    • Multiple myeloma (MM) is a heterogeneous disease, with prognosis affected by various patient and disease related factors (ISS stage, genetics, performance status and other comorbidities).
    • The ISS differentiates patients into 3 separate prognostic groups. The staging is prognostic but does not necessarily guide treatment decisions in the upfront setting. It provides survival information to the physician and patient, and helps stratify patients in current clinical trials.
    • Preferred over the Durie-Salmon system for its simplicity and objectivity, primarily in assessment of bony disease.
    <3.5 mg/L
    3.5 - 5.4 mg/L
    >5.4 mg/L
    <3.5 g/dL
    ≥3.5 g/dL

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Many MM patients are treated through clinical trials. Physicians may consider referring patients to academic treatment centers if they are eligible and willing to receive transplantation, not only to discuss standard treatment options, but also to consider clinical trial options.

    Content Contributors
    About the Creator
    Dr. Philip Greipp
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