What is the Revised International Staging System (R-ISS) and how is it used in the diagnosis of multiple myeloma (MM)?

Updated: May 11, 2021
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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In 2015, the  International Myeloma Working Group published the Revised International Staging System for Multiple Myeloma. [133] The revised system was subsequently recommended by the NCCN. [2]  The Revised International Staging System (R-ISS) was created by combining the International Staging System (ISS) with chromosomal abnormalities (CA) detected by interphase FISH (iFISH) after CD138 plasma cell purification, plus serum LDH assay results . [133]

Like the ISS, the R-ISS is based on three stages. Stage I criteria are as follows:

  • Beta-2 microglobulin ≤3.5 g/dL and albumin ≥3.5 g/dL
  • Standard risk for CA
  • Normal LDH

Stage II comprises patients who do not meet criteria for stage I or stage III

Stage III consists of the following:

  • Beta-2 microglobulin of 5.5 g/dL or more,  and either
  • High risk for CA  or high LDH

Median progression-free survival is as follows:

  • Stage I : 66 months
  • Stage II: 42 months
  • Stage III: 29 months

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