I think most myeloma experts would agree: its time for a myeloma staging system that incorporates genetic risk assessment. Italian specialist, Dr. Palumbo, and his team are proposing docs worldwide use their new system.
Health Day gave Dr. Palumbo a shout out yesterday:
Revised staging system prognostic for multiple myeloma
August 4th, 2015
(HealthDay)—The International Staging System (ISS) combined with chromosomal abnormalities (CA) detected by interphase fluorescent in situ hybridization after CD138 plasma cell purification and serum lactate dehydrogenase (LDH) has prognostic value in newly-diagnosed multiple myeloma (NDMM), according to a study published online Aug. 3 in the Journal of Clinical Oncology.
Antonio Palumbo, M.D., from the University of Torino in Italy, and colleagues assessed the prognostic value of the combined ISS in NDMM. The authors pooled clinical and laboratory data for 4,445 patients with NDMM enrolled onto 11 international trials. ISS, CA, and LDH data were available for 3,060 of the patients.
The researchers defined three groups: revised ISS (R-ISS) I (871 patients), including ISS stage I, no high-risk CA, and normal LDH levels; R-ISS III (295 patients), including ISS stage III and high-risk CA 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.
More information: Abstract
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Journal reference: Journal of Clinical Oncology
Grouping myeloma patients into three groups genetically has revolutionized myeloma research and therapy. When I was diagnosed in 2007, everyone was lumped together. Staging was (and still is) based on kidney or bone involvement, along with anemia and a few other key prognosticators.
While there is statistical evidence to support the view that, based on this system, Stage 3 patients don’t live as long as Stage 1 or 2 patients. But that stat is often busted; even Stage 3 patients tend to respond well to therapy, they may not live as long because they were diagnosed late.
Defined genetically, low and standard risk myeloma patients tend to live significantly longer than high risk patients. More importantly, high risk patients often benefit from a modified treatment regimen. And hopefully things will get even better with time.
I’m guessing Dr. Palumbo’s staging system won’t be the one that sticks in the U.S. But something similar will, most likely one that incorporates even more cytogenetics in the mix.
Either way, a staging system that incorporates risk stratification is long overdue.
Feel good and keep smiling! Pat