{"id":28114,"date":"2022-06-01T07:00:00","date_gmt":"2022-06-01T07:00:00","guid":{"rendered":"http:\/\/ad3970e6d6ea7a5371acb62dcbeb1797"},"modified":"2024-11-03T15:13:38","modified_gmt":"2024-11-03T15:13:38","slug":"r2-iss-an-improved-and-simple-prognostic-staging-system-allows-better-stratification-of-patients-with-intermediate-risk-newly-diagnosed-multiple-myeloma","status":"publish","type":"post","link":"https:\/\/ogkologos.com\/en\/r2-iss-an-improved-and-simple-prognostic-staging-system-allows-better-stratification-of-patients-with-intermediate-risk-newly-diagnosed-multiple-myeloma\/","title":{"rendered":"R2-ISS: an Improved and Simple Prognostic Staging System Allows Better Stratification of Patients with Intermediate-Risk Newly Diagnosed Multiple Myeloma"},"content":{"rendered":"

Within the HARMONY project, the European Myeloma Network collected data from 10,843 patients with newly diagnosed multiple myeloma to propose a second revision (R2-ISS) of the Revised International Staging System (R-ISS). The impact on overall survival (OS) of widely available prognostic tools, such as ISS, serum lactate dehydrogenase (LDH) levels, deletion (17p), translocation (4;14), and 1q gain\/amplification (1q+), was used to define R2-ISS. Four risk groups predicting different OS and progression-free survival (PFS) rates were identified. Compared with the R-ISS, the R2-ISS is an improved and simple prognostic staging system that includes the independent poor prognostic factors 1q gain (3 copies of 1q) or amplification (at least 4 copies of 1q) resulting in better stratification of especially the large group of patients with intermediate-risk newly diagnosed multiple myeloma according to Dr. Mattia D\u2019Agostino of the Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Citt\u00e0 della Salute e della Scienza di Torino in Torino, Italy and colleagues who published this new prognostic algorithm on 23 May 2022 in the Journal of Clinical Oncology<\/em>. <\/p>\n

The authors wrote in the background that the R-ISS was introduced in 2015 with aim to develop a robust prognostic system on the basis of widely available biomarkers. It is now considered a standard risk stratification model for patients with newly diagnosed multiple myeloma. The R-ISS takes into account ISS which integrates \u03b22-microglobulin levels and serum albumin to reflect tumour mass and renal function, high-risk chromosomal abnormalities detected by FISH, del(17p), t(4;14)(p16;q32) or t(14;16)(q32;q23)], and serum LDH levels. The R-ISS identifies 3 groups with main limitation that 62% of patients were classified into the intermediate-risk category, possibly including patients with different risk levels of progression\/death.<\/p>\n

Recently, 1q gain (three copies of 1q) or amplification (at least four copies of 1q), which were not included in the R-ISS, proved to be independent poor prognostic factors in newly diagnosed multiple myeloma. Moreover, in the R-ISS, high-risk chromosomal abnormalities were considered as present, if at least one among del(17p), t(4;14), or t(14;16) was detected, whereas emerging data showed that having more than one high-risk chromosomal abnormalities predicted poorer outcomes. <\/p>\n

Within the HARMONY project, the European Myeloma Network collected individual patient data from a large cohort of young and elderly patients with newly diagnosed multiple myeloma who were enrolled in 16 clinical studies to improve risk stratification and propose a revision of the current R-ISS. The prognostic value of each single baseline risk feature was analyzed in an additive fashion, including 1q gain\/amplification in the risk calculation. An additive scoring system based on top features predicting PFS and OS was developed and validated.<\/p>\n

In the training set of 7,072 patients, at a median follow-up of 75 months, ISS, del(17p), LDH, t(4;14), and 1q+ had the highest impact on PFS and OS. These variables were all simultaneously present in 2,226 patients.<\/p>\n

A value was assigned to each risk feature according to their OS impact. Patients were stratified into 4 risk groups according to the total additive score: low in case of 0 points (19.2%, low-intermediate in case of 0.5-1 points (30.8%), intermediate-high in case of 1.5-2.5 points (41.2%), and high in case of 3-5 points (8.8%).<\/p>\n

Median OS was not reached versus 109.2 versus 68.5 versus 37.9 months, and median PFS was 68 versus 45.5 versus 30.2 versus 19.9 months.<\/p>\n

The score was validated in an independent validation set of 3,771 patients of whom 1,214 had complete data to calculate R2-ISS maintaining its prognostic value.<\/p>\n

The authors concluded that comparing with the R-ISS, the R2-ISS adds 1q+ to the score, and its calculation takes into account the prognostic significance of the coexistence of several chromosomal abnormalities. Furthermore, compared with the R-ISS, the R2-ISS showed an improved discriminating capability, especially in the large group of patients with intermediate-risk newly diagnosed multiple myeloma. The R2-ISS score includes simple and widely used prognostic markers, and the additive nature of its calculation easily allows the future inclusion of new prognostic variables.<\/p>\n

Reference<\/h4>\n

D\u2019Agostino M, Cairns DA, Lahuerta JJ, et al.<\/em> Second Revision of the International Staging System (R2-ISS) for Overall Survival in Multiple Myeloma: A European Myeloma Network (EMN) Report Within the HARMONY Project<\/a>. JCO<\/em>; Published online 23 May 2022. DOI: 10.1200\/JCO.21.02614<\/p>\n

Source<\/a><\/p>","protected":false},"excerpt":{"rendered":"

Within the HARMONY project, the European Myeloma Network collected data from 10,843 patients with newly diagnosed multiple myeloma to propose a second revision (R2-ISS) of the Revised International Staging System (R-ISS). The impact on overall survival (OS) of widely available prognostic tools, such as ISS, serum lactate dehydrogenase (LDH) levels, deletion (17p), translocation (4;14), and […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[5137],"tags":[],"class_list":["post-28114","post","type-post","status-publish","format-standard","hentry","category-world-news"],"_links":{"self":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/28114","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/comments?post=28114"}],"version-history":[{"count":1,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/28114\/revisions"}],"predecessor-version":[{"id":45920,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/28114\/revisions\/45920"}],"wp:attachment":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/media?parent=28114"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/categories?post=28114"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/tags?post=28114"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}