Evaluation of Revised International Staging System (R-ISS) for transplant-eligible multiple myeloma patients

  • Verónica González-Calle
  • Abigail Slack
  • Niamh Keane
  • Susan Luft
  • Kathryn E. Pearce
  • Rhett P. Ketterling
  • Tania Jain
  • Sintosebastian Chirackal
  • Craig Reeder
  • Joseph Mikhael
  • Pierre Noel
  • Angela Mayo
  • Roberta H. Adams
  • Gregory Ahmann
  • Esteban Braggio
  • A. Keith Stewart
  • P. Leif Bergsagel
  • Scott A. Van Wier
  • Rafael Fonseca
Original Article

Abstract

The International Myeloma Working Group has proposed the Revised International Staging System (R-ISS) for risk stratification of multiple myeloma (MM) patients. There are a limited number of studies that have validated this risk model in the autologous stem cell transplant (ASCT) setting. In this retrospective study, we evaluated the applicability and value for predicting survival of the R-ISS model in 134 MM patients treated with new agents and ASCT at the Mayo Clinic in Arizona and the University Hospital of Salamanca in Spain. The patients were reclassified at diagnosis according to the R-ISS: 44 patients (33%) had stage I, 75 (56%) had stage II, and 15 (11%) had stage III. After a median follow-up of 60 months, R-ISS assessed at diagnosis was an independent predictor for overall survival (OS) after ASCT, with median OS not reached, 111 and 37 months for R-ISS I, II and III, respectively (P < 0.001). We also found that patients belonging to R-ISS II and having high-risk chromosomal abnormalities (CA) had a significant shorter median OS than those with R-ISS II without CA: 70 vs. 111 months, respectively. Therefore, this study lends further support for the R-ISS as a reliable prognostic tool for estimating survival in transplant myeloma patients and suggests the importance of high-risk CA in the R-ISS II group.

Keywords

R-ISS Autologous transplantation Myeloma Prognostic factor 

Notes

Author contributions

RF, VGC, and AS conceived and designed the work that led to the submission. VGC, AS, SL, KEP, and RPK acquired data. VGC analyzed, interpreted the data and drafted the manuscript and RF and NK revised the manuscript. All the authors approved the final version.

Compliance with ethical standards

Disclosures

Dr. Rafael Fonseca: Consulting with AMGEN, BMS, Celgene, Takeda, Bayer, Jansen, Novartis, Pharmacyclics, Sanofi and Merck. Member of the Scientific Advisory Board of Adaptive Biotechnologies. Mayo Clinic and Dr. Fonseca hold a patent for the prognostication of myeloma via FISH with annual income of about $2K dollars. There are no conflicts of interest declared by the rest of the authors.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Verónica González-Calle
    • 1
    • 2
  • Abigail Slack
    • 1
  • Niamh Keane
    • 1
  • Susan Luft
    • 3
  • Kathryn E. Pearce
    • 4
  • Rhett P. Ketterling
    • 4
  • Tania Jain
    • 1
  • Sintosebastian Chirackal
    • 1
  • Craig Reeder
    • 3
  • Joseph Mikhael
    • 3
  • Pierre Noel
    • 3
  • Angela Mayo
    • 3
  • Roberta H. Adams
    • 3
  • Gregory Ahmann
    • 1
  • Esteban Braggio
    • 1
  • A. Keith Stewart
    • 1
    • 3
    • 5
  • P. Leif Bergsagel
    • 1
    • 3
  • Scott A. Van Wier
    • 1
  • Rafael Fonseca
    • 1
    • 3
    • 6
  1. 1.Division of Hematology and Oncology Mayo ClinicScottsdaleUSA
  2. 2.Hematology DepartmentUniversity Hospital of SalamancaSalamancaSpain
  3. 3.Hematology Department/Transplant Center Mayo ClinicPhoenixUSA
  4. 4.Laboratory Genetics/Cancer Center Mayo ClinicRochesterUSA
  5. 5.Center for Individualized MedicineMayo ClinicRochesterUSA
  6. 6.MAYO CLINICPhoenixUSA

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