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Biol Blood Marrow Transplant. 2018 Dec;24(12):2443-2449. doi: 10.1016/j.bbmt.2018.08.013. Epub 2018 Aug 22.

Staging Systems for Newly Diagnosed Myeloma Patients Undergoing Autologous Hematopoietic Cell Transplantation: The Revised International Staging System Shows the Most Differentiation between Groups.

Author information

1
Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.
2
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
3
Hematology/Oncology, Singapore General Hospital, Singapore.
4
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
5
Department of Stem Cell Transplantation, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas.
6
Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom.
7
Department of Hematology/Oncology, Hospital Infantil Universitario Niño Jesus, Madrid, Spain.
8
Division of Hematology/Oncology, Indiana University Simon Cancer Center, Indianapolis, Indiana.
9
Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
10
Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, Kansas.
11
Stem Cell Transplantation and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
12
School of Medicine, Texas Transplant Institute, San Antonio, Texas.
13
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
14
Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
15
Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas.
16
Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia.
17
Department of Hematologic Oncology & Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina.
18
Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia.
19
Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
20
Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
21
Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
22
Division of Hematology/Oncology, UMass Memorial Medical Center, Worcester, Massachusetts.
23
Division of Hematology, Mayo Clinic, Rochester, Minnesota.
24
Department of Haematology, Royal Adelaide Hospital, Adelaide, Australia.
25
Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia.
26
Division of Hematology/Oncology, Columbia University Medical Center, New York, New York.
27
Markey Cancer Center, University of Kentucky Chandler Medical Center, Lexington, Kentucky.
28
Fred Hutchinson Cancer Research Center, Seattle, Washington.
29
Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.
30
Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
31
Department of Hematology & Oncology, National Cancer Research Center East, Chiba, Japan.
32
University of Colorado Hospital, Aurora, Colorado.
33
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: andsouza@mcw.edu.

Abstract

The Revised International Staging System (R-ISS) and the International Myeloma Working Group 2014 (IMWG 2014) are newer staging systems used to prognosticate multiple myeloma (MM) outcomes. We hypothesized that these would provide better prognostic differentiation for newly diagnosed multiple myeloma (MM) compared with ISS. We analyzed the Center for International Blood and Marrow Transplant Research database from 2008 to 2014 to compare the 3 systems (N = 628) among newly diagnosed MM patients undergoing upfront autologous hematopoietic cell transplantation (AHCT). The median follow-up of survivors was 48 (range, 3 to 99) months. The R-ISS provided the greatest differentiation between survival curves for each stage (for overall survival [OS], the differentiation was 1.74 using the R-ISS, 1.58 using ISS, and 1.60 using the IMWG 2014) . Univariate analyses at 3 years for OS showed R-ISS I at 88% (95% confidence interval [CI], 83% to 93%), II at 75% (95% CI, 70% to 80%), and III at 56% (95% CI, 3% to 69%; P < .001). An integrated Brier score function demonstrated the R-ISS had the best prediction for PFS, though all systems had similar prediction for OS. Among available systems, the R-ISS is the most optimal among available prognostic tools for newly diagnosed MM undergoing AHCT. We recommend that serum lactate dehydrogenase and cytogenetic data be performed on every MM patient at diagnosis to allow accurate prognostication.

KEYWORDS:

International staging system; Revised international staging system; Staging system comparison

PMID:
30142419
DOI:
10.1016/j.bbmt.2018.08.013

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