# Revised International Staging System (R-ISS) for multiple myeloma

Source: https://onco.cc/key-papers/paper-r-iss-palumbo-jco-2015/  
OnCo record `paper-r-iss-palumbo-jco-2015` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The revised staging system for myeloma combines the older albumin and beta-2 microglobulin stage with high-risk chromosome changes and a raised lactate dehydrogenase, giving three groups with very different survival.

## Summary

Analysis of 3,060 patients from eleven international trials to build a staging system combining ISS stage, chromosomal abnormalities detected by fluorescence in situ hybridisation (del(17p), t(4;14), t(14;16)) and serum lactate dehydrogenase.

Five-year overall survival was 82 percent in R-ISS stage I, 62 percent in stage II and 40 percent in stage III. The R-ISS became the standard prognostic framework and the basis for trial stratification.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: Journal of Clinical Oncology
- Year: 2015
- DOI: 10.1200/JCO.2015.61.2267
- Authors: Palumbo A, Avet-Loiseau H, Oliva S, et al.
- Findings: Five-year overall survival 82, 62 and 40 percent in stages I, II and III.; Five-year progression-free survival 55, 36 and 24 percent.
- What it means: The stage on a myeloma report, and the label of high-risk disease that drives intensified treatment and trial choice, comes from the R-ISS; the 2022 R2-ISS adds 1q gain.
- Caveats: Stage II is a large heterogeneous group.; Derived from trial patients treated with older regimens.

## Sources

- J Clin Oncol 2015: https://doi.org/10.1200/JCO.2015.61.2267
- PubMed: https://pubmed.ncbi.nlm.nih.gov/26240224/

## Connected records

- cancers: [Newly diagnosed multiple myeloma, transplant-eligible](https://onco.cc/cancers/myeloma-transplant-eligible/), [Plasma cell leukaemia](https://onco.cc/cancers/plasma-cell-leukaemia/), [Relapsed or refractory multiple myeloma](https://onco.cc/cancers/myeloma-relapsed-refractory/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)

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