{"entity":{"id":"paper-r-iss-palumbo-jco-2015","kind":"paper","name":"Revised International Staging System (R-ISS) for multiple myeloma","aka":[],"tldr":"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.\n\nFive-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.","asOf":"2026-09-17","links":[{"label":"J Clin Oncol 2015","url":"https://doi.org/10.1200/JCO.2015.61.2267"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/26240224/"}],"tags":[],"related":[],"cancers":["myeloma-transplant-eligible","plasma-cell-leukaemia","myeloma-relapsed-refractory"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2015,"doi":"10.1200/JCO.2015.61.2267","pmid":"26240224","authors":"Palumbo A, Avet-Loiseau H, Oliva S, et al.","paperType":"methods","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."],"whatItMeans":"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."],"changedPractice":true,"participants":3060},"route":"/key-papers/paper-r-iss-palumbo-jco-2015/","neighbours":{"cancer":[{"id":"myeloma-transplant-eligible","kind":"cancer","name":"Newly diagnosed multiple myeloma, transplant-eligible","route":"/cancers/myeloma-transplant-eligible/"},{"id":"plasma-cell-leukaemia","kind":"cancer","name":"Plasma cell leukaemia","route":"/cancers/plasma-cell-leukaemia/"},{"id":"myeloma-relapsed-refractory","kind":"cancer","name":"Relapsed or refractory multiple myeloma","route":"/cancers/myeloma-relapsed-refractory/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}]}}