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

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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.

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Funding

Verónica González-Calle was supported by the Fundación Española de Hematología y Hemoterapia and Janssen (Beca Estancias de Investigación en el Extranjero Convocatoria 2015-2016).

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Authors and Affiliations

  1. Division of Hematology and Oncology Mayo Clinic, Scottsdale, AZ, USA

    Verónica González-Calle, Abigail Slack, Niamh Keane, Tania Jain, Sintosebastian Chirackal, Gregory Ahmann, Esteban Braggio, A. Keith Stewart, P. Leif Bergsagel, Scott A. Van Wier & Rafael Fonseca

  2. Hematology Department, University Hospital of Salamanca, Salamanca, Spain

    Verónica González-Calle

  3. Hematology Department/Transplant Center Mayo Clinic, Phoenix, AZ, USA

    Susan Luft, Craig Reeder, Joseph Mikhael, Pierre Noel, Angela Mayo, Roberta H. Adams, A. Keith Stewart, P. Leif Bergsagel & Rafael Fonseca

  4. Laboratory Genetics/Cancer Center Mayo Clinic, Rochester, MN, USA

    Kathryn E. Pearce & Rhett P. Ketterling

  5. Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA

    A. Keith Stewart

  6. MAYO CLINIC, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA

    Rafael Fonseca

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  1. Verónica González-Calle
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  2. Abigail Slack
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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.

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Correspondence to Rafael Fonseca.

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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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González-Calle, V., Slack, A., Keane, N. et al. Evaluation of Revised International Staging System (R-ISS) for transplant-eligible multiple myeloma patients. Ann Hematol 97, 1453–1462 (2018). https://doi.org/10.1007/s00277-018-3316-7

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