Is the international staging system superior to the Durie-Salmon staging system? A comparison in multiple myeloma patients undergoing autologous transplant

• Published in: Leukemia Vol. 23; no. 8; pp. 1528 - 1534
• Main Authors: Hari, P N, Zhang, M-J, Roy, V, Pérez, W S, Bashey, A, To, L B, Elfenbein, G, Freytes, C O, Gale, R P, Gibson, J, Kyle, R A, Lazarus, H M, McCarthy, P L, Milone, G A, Pavlovsky, S, Reece, D E, Schiller, G, Vela-Ojeda, J, Weisdorf, D, Vesole, D
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.08.2009; Nature Publishing Group
• Subjects: Adult; Aged; Autografts; Biological and medical sciences; Cancer Research; Care and treatment; Comparative analysis; Critical Care Medicine; Diagnosis; Disease Progression; Disease-Free Survival; Female; Follow-Up Studies; Hematologic and hematopoietic diseases; Hematology; Hematopoietic Stem Cell Transplantation; Humans; Immunodeficiencies. Immunoglobulinopathies; Immunoglobulinopathies; Immunopathology; Intensive; Internal Medicine; Kaplan-Meier Estimate; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Multiple myeloma; Multiple Myeloma - mortality; Multiple Myeloma - pathology; Multiple Myeloma - surgery; Neoplasm Staging - methods; Oncology; original-article; Patient outcomes; Predictive Value of Tests; Proportional Hazards Models; Retrospective Studies; Risk assessment; Stem cell transplantation; Stem cells; Survival; Transplantation; Transplantation Conditioning; Transplantation, Autologous; Transplants & implants; Treatment Outcome; Tumor staging; autologous hematopoietic stem cell transplantation; staging; myeloma; Human; Immunopathology; Hematology; International system; Staging; Stem cell; Stage classification; Hematopoietic cell; B cell neoplasm; Malignant hemopathy; Lymphoid neoplasm; Myeloma; Autograft; Immunoglobulinopathy; Lymphoproliferative syndrome; Graft; Comparative study; Cancer
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/leu.2009.61

The international staging system (ISS) for multiple myeloma (MM) is a validated alternative to the Durie–Salmon staging system (DSS) for predicting survival at diagnosis. We compared these staging systems for predicting outcomes after upfront autologous stem cell transplantation by analyzing the outcomes of 729 patients between 1995 and 2002. With a median follow-up of 56 months, the univariate probabilities (95% CI) of non-relapse mortality (NRM), relapse, progression-free survival (PFS) and overall survival (OS) at 5 years were 7, 68, 25 and 52%, respectively. The median OS for stages I, II, III by DSS and ISS were 82, 68, 50 and 64, 68, 45 months, respectively. The concordance between the two staging systems was only 36%. Staging systems were formally compared using Cox models fit with DSS and ISS stages. The relative risks of PFS and OS were significantly different for stages I vs II and II vs III for DSS, but only for stages II vs III for ISS. Although both systems were predictive of PFS and OS, the DSS was superior in formal statistical comparison using Brier score. However, neither system was strongly predictive of outcomes, indicating the need for newer schemes incorporating other prognostic markers.