Table 1.

Revised International Staging System

Prognostic factorCriteria
ISS stage  
  I Serum β2-microglobulin <3.5 mg/L, serum albumin ≥3.5 g/dL 
  II Not ISS stage I or III 
  III Serum β2-microglobulin ≥5.5 mg/L 
CA by iFISH  
  High risk Presence of del(17p) and/or translocation t(4;14) and/or translocation t(14;16) 
  Standard risk No high-risk CA 
LDH  
  Normal Serum LDH below the upper limit of normal 
  High Serum LDH above the upper limit of normal 
A new model for risk stratification for MM  
  R-ISS stage  
      I ISS stage I and standard-risk CA by iFISH and normal LDH 
      II Not R-ISS stage I or III 
      III ISS stage III and either high-risk CA by iFISH or high LDH 
Prognostic factorCriteria
ISS stage  
  I Serum β2-microglobulin <3.5 mg/L, serum albumin ≥3.5 g/dL 
  II Not ISS stage I or III 
  III Serum β2-microglobulin ≥5.5 mg/L 
CA by iFISH  
  High risk Presence of del(17p) and/or translocation t(4;14) and/or translocation t(14;16) 
  Standard risk No high-risk CA 
LDH  
  Normal Serum LDH below the upper limit of normal 
  High Serum LDH above the upper limit of normal 
A new model for risk stratification for MM  
  R-ISS stage  
      I ISS stage I and standard-risk CA by iFISH and normal LDH 
      II Not R-ISS stage I or III 
      III ISS stage III and either high-risk CA by iFISH or high LDH 

Reprinted from Palumbo et al with permission.

CA, chromosomal abnormalities; iFISH, interphase fluorescence in situ hybridization; MM, multiple myeloma.

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