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      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

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    Multiple Myeloma International Staging System (ISS)

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

    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

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    Next Steps
    Evidence
    Creator Insights
    Dr. Philip Greipp

    About the Creator

    Philip Greipp, MD, is a professor laboratory medicine and pathology at the Mayo Clinic in Rochester, Minnesota. He is practices primarily in the Hematology Department, but has a joint appointment in the Laboratory Medicine and Pathology Department. He has been a supporting author on over 100 publications in numerous peer-reviewed journals on topics ranging from cardiac enzymes to hematologic cancers and novel treatment methods.

    To view Dr. Philip Greipp's publications, visit PubMed

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