Second Revision of the International Staging System (R2-ISS) for Overall Survival in Multiple Myeloma: A European Myeloma Network (EMN) Report Within the HARMONY Project
Novartis (Switzerland) · Amgen (United States) · +36 more institutions
Abstract
In the training set (N = 7,072), at a median follow-up of 75 months, ISS, del(17p), lactate dehydrogenase, t(4;14), and 1q+ had the highest impact on PFS and OS. These variables were all simultaneously present in 2,226 patients. A value was assigned to each risk feature according to their OS impact (ISS-III 1.5, ISS-II 1, del(17p) 1, high lactate dehydrogenase 1, and 1q+ 0.5 points). Patients were stratified into four risk groups according to the total additive score: low (Second Revision of the International Staging System [R2-ISS]-I, 19.2%, 0 points), low-intermediate (II, 30.8%, 0.5-1 points), intermediate-high (III, 41.2%, 1.5-2.5 points), high (IV, 8.8%, 3-5 points). Median OS was not reached versus 109.2 versus 68.5 versus 37.9 months, and median PFS was 68 versus 45.5 versus 30.2 versus 19.9 months, respectively. The score was validated in an independent validation set (N = 3,771, of whom 1,214 were with complete data to calculate R2-ISS) maintaining its prognostic value.
The R2-ISS is a simple prognostic staging system allowing a better stratification of patients with intermediate-risk NDMM. The additive nature of this score fosters its future implementation with new prognostic variables.
Citation impact
- FWCI
- 57.39
- Percentile
- 100%
- References
- 67
Authors
31- MDMattia D’AgostinoCorresponding
Novartis (Switzerland), Amgen (United States), Janssen (Belgium), Bristol-Myers Squibb (Germany), AbbVie (United States), Sanofi (France), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, GlaxoSmithKline (France), Janssen (Switzerland), Mundipharma (Germany), Karyopharm Therapeutics (United States), Bristol-Myers Squibb (Switzerland)
- DADavid A. Cairns
Novartis (Switzerland), University of Leeds, Amgen (United States), Janssen (Belgium), Bristol-Myers Squibb (Germany), AbbVie (United States), Sanofi (France), GlaxoSmithKline (France), Janssen (Switzerland), Cancer Research UK Clinical Trials Unit, Mundipharma (Germany), Karyopharm Therapeutics (United States), Bristol-Myers Squibb (Switzerland)
- JJJuan José Lahuerta
Novartis (Switzerland), Amgen (United States), Janssen (Belgium), Bristol-Myers Squibb (Germany), AbbVie (United States), Sanofi (France), GlaxoSmithKline (France), Hospital Universitario 12 De Octubre, Janssen (Switzerland), Mundipharma (Germany), Karyopharm Therapeutics (United States), Bristol-Myers Squibb (Switzerland)
- RWRuth Wester
Novartis (Switzerland), Amgen (United States), Janssen (Belgium), Bristol-Myers Squibb (Germany), AbbVie (United States), Sanofi (France), GlaxoSmithKline (France), Janssen (Switzerland), Erasmus MC Cancer Institute, Mundipharma (Germany), Karyopharm Therapeutics (United States), Bristol-Myers Squibb (Switzerland)
- UBUta Bertsch
Novartis (Switzerland), Amgen (United States), Janssen (Belgium), Bristol-Myers Squibb (Germany), Heidelberg University, University Hospital Heidelberg, AbbVie (United States), Sanofi (France), GlaxoSmithKline (France), National Center for Tumor Diseases, Janssen (Switzerland), Mundipharma (Germany), Karyopharm Therapeutics (United States), Bristol-Myers Squibb (Switzerland)
Topics & keywords
- Medicine
- Multiple myeloma
- Internal medicine
- Risk stratification
- Lactate dehydrogenase
- Overall survival
- Confidence interval
- Oncology