Boris will prolly cover it in further detail, but Dr. Palumbo and others have come up with a revised multiple myeloma prognostics model, published in the Journal of Clinical Oncology. Here is the hi-lite.
The researchers defined three groups: revised ISS (R-ISS) I (871 patients), including ISS stage I, no high-risk chromosomal abnormalities, and normal LDH levels; R-ISS III (295 patients), including ISS stage III and high-risk chromosomal abnormalities or high LDH levels; and R-ISS II (1,894 patients), including all other possible combinations.
The five-year overall survival was 82, 62, and 40 percent, respectively, in R-ISS I, R-ISS II, and R-ISS III, at a median follow-up of 46 months. The corresponding five-year progression-free survival rates were 55, 36, and 24 percent, respectively.
"The R-ISS is a simple and powerful prognostic staging system, and we recommend its use in future clinical studies to stratify patients with NDMM effectively with respect to the relative risk to their survival," the authors write.
Several authors disclosed financial ties to the pharmaceutical and biotechnology industries.
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Re: Revised international staging system (R-ISS)
Here is the full journal article citation, link to the article abstract, and abstract:
A Palumbo et al, "Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group," Journal of Clinical Oncology, August 3, 2015 (link to abstract; subscription or payment required for access to full-text of article)
ABSTRACT:
Purpose:
The clinical outcome of multiple myeloma is heterogeneous. A simple and reliable tool is needed to stratify patients with multiple myeloma. We combined the International Staging System (ISS) with chromosomal abnormalities (CA) detected by interphase fluorescent in situ hybridization after CD138 plasma cell purification and serum lactate dehydrogenase (LDH) to evaluate their prognostic value in newly diagnosed multiple myeloma (NDMM).
Patients and Methods:
Clinical and laboratory data from 4,445 patients with NDMM enrolled onto 11 international trials were pooled together. The K-adaptive partitioning algorithm was used to define the most appropriate subgroups with homogeneous survival.
Results:
ISS, CA, and LDH data were simultaneously available in 3,060 of 4,445 patients. We defined the following three groups: revised ISS (R-ISS) I (n = 871), including ISS stage I (serum β2-microglobulin level < 3.5 mg/L and serum albumin level ≥ 3.5 g/dL), no high-risk CA [del(17p) and/or t(4;14) and/or t(14;16)], and normal LDH level (less than the upper limit of normal range); R-ISS III (n = 295), including ISS stage III (serum β2-microglobulin level > 5.5 mg/L) and high-risk CA or high LDH level; and R-ISS II (n = 1,894), including all the other possible combinations. At a median follow-up of 46 months, the 5-year OS rate was 82% in the R-ISS I, 62% in the R-ISS II, and 40% in the R-ISS III groups; the 5-year PFS rates were 55%, 36%, and 24%, respectively.
Conclusion:
The R-ISS is a simple and powerful prognostic staging system, and we recommend its use in future clinical studies to stratify patients with NDMM effectively with respect to the relative risk to their survival.
A Palumbo et al, "Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group," Journal of Clinical Oncology, August 3, 2015 (link to abstract; subscription or payment required for access to full-text of article)
ABSTRACT:
Purpose:
The clinical outcome of multiple myeloma is heterogeneous. A simple and reliable tool is needed to stratify patients with multiple myeloma. We combined the International Staging System (ISS) with chromosomal abnormalities (CA) detected by interphase fluorescent in situ hybridization after CD138 plasma cell purification and serum lactate dehydrogenase (LDH) to evaluate their prognostic value in newly diagnosed multiple myeloma (NDMM).
Patients and Methods:
Clinical and laboratory data from 4,445 patients with NDMM enrolled onto 11 international trials were pooled together. The K-adaptive partitioning algorithm was used to define the most appropriate subgroups with homogeneous survival.
Results:
ISS, CA, and LDH data were simultaneously available in 3,060 of 4,445 patients. We defined the following three groups: revised ISS (R-ISS) I (n = 871), including ISS stage I (serum β2-microglobulin level < 3.5 mg/L and serum albumin level ≥ 3.5 g/dL), no high-risk CA [del(17p) and/or t(4;14) and/or t(14;16)], and normal LDH level (less than the upper limit of normal range); R-ISS III (n = 295), including ISS stage III (serum β2-microglobulin level > 5.5 mg/L) and high-risk CA or high LDH level; and R-ISS II (n = 1,894), including all the other possible combinations. At a median follow-up of 46 months, the 5-year OS rate was 82% in the R-ISS I, 62% in the R-ISS II, and 40% in the R-ISS III groups; the 5-year PFS rates were 55%, 36%, and 24%, respectively.
Conclusion:
The R-ISS is a simple and powerful prognostic staging system, and we recommend its use in future clinical studies to stratify patients with NDMM effectively with respect to the relative risk to their survival.
Re: Revised international staging system (R-ISS)
I've been confused since diagnosis as to what risk I have. I was diagnosed as Stage 1.
My LDH level was normal. T(14:16) and t (4:14) was seen but in only 6% of the cells analyzed. My multiple myeloma specialist says because of the low number of cells that had these abnormalities, the significance is less. I achieved complete stringent response two years ago and have maintained it on maintenance for the past two years.
Reading this study, I don't know what group I would fit into. Any opinions?
My LDH level was normal. T(14:16) and t (4:14) was seen but in only 6% of the cells analyzed. My multiple myeloma specialist says because of the low number of cells that had these abnormalities, the significance is less. I achieved complete stringent response two years ago and have maintained it on maintenance for the past two years.
Reading this study, I don't know what group I would fit into. Any opinions?
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torimooney - Name: tori
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: apr 2012
- Age at diagnosis: 64
Re: Revised international staging system (R-ISS)
Torimooney what was your treatment regimen?
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Maro - Who do you know with myeloma?: My mom
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 63
Re: Revised international staging system (R-ISS)
My induction therapy was 8 months of Doxil, dex and Velcade and my maintenance regimen of over two years has been dex and Velcade every other week. I remain in stringent complete response with little to no problems of any sort.
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torimooney - Name: tori
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: apr 2012
- Age at diagnosis: 64
Re: Revised international staging system (R-ISS)
Tori,
I am on the same maintenance schedule. Curious as to your dex level. I had mine reduced to 8 mg every other week. I take it in conjunction with the Velcade shot.
Ron
I am on the same maintenance schedule. Curious as to your dex level. I had mine reduced to 8 mg every other week. I take it in conjunction with the Velcade shot.
Ron
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Revised international staging system (R-ISS)
This raises again for me the LDH issue. Mine has been elevated at most blood tests since I was diagnosed. I had read that elevated LDH was a negative prognostic indicator at diagnosis, but my doctor does not seem to be too troubled about it, and so far I am in good shape. There is some suggestion in what I have read that elevated LDH can be the result of muscle injury or inflammation. Since I abuse my muscles regularly, I am hanging my hat on that. It also seems to track when my AST and ALT are elevated.
Just another multiple myeloma mystery.
Just another multiple myeloma mystery.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
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